Dr. Jennifer B. Pearlman MD CCFP FAARM ABAARM CFA

Estrogen and Skin Aging

Of all the hormones affecting the skin, estrogens are perhaps the most influential. Estrogens have widespread affects on the skin health, appearance and aging. Estradiol is the predominate form of estrogen throughout a woman’s reproductive lifespan and is integral to supporting healthy skin. Estradiol promotes collagen and elastin production, accelerates wound healing, reduces skin inflammation and protects against skin photoaging and cancer risk. Throughout the menstrual cycle, skin thickness varies in relation to changes in estradiol levels and is thickest mid cycle during ovulation.

Menopause and the Skin

At menopause, with the precipitous decline in estrogen, women experience an acceleration of aging. The loss of ovarian estradiol production results in deleterious effects in many tissues including the brain, heart, vasculature, bone, gastrointestinal system and the skin. Rapid skin aging occurs during menopause marked by increased skin wrinkling, laxity, dryness, and vascularity. The menopausal loss of estrogen disproportionately affects the delicate tissues around the mouth and lips. The downward descent of the corner of the mouth and sagging of lower facial soft tissue beneath the jawline forming the jowl can be considered the “sag sign” of menopause. The collagen content of skin decreases by 30% in the first five years after menopause. Estrogen therapy after menopause has been shown to increase skin hydration and thickness, collagen and elastin content and reduce photoaging. Women who take estrogen after menopause with or without progesterone demonstrate significantly fewer wrinkles.

BioRegenerative Aesthetics

The emerging field of regenerative medicine is unlocking the secrets to reversing aging. Cellular therapies and genomic medicine aim to harness the retained potential of adult somatic cells to be reprogrammed to a younger healthier state. Treatments such as stem cells, exosomes and biostimulators activate the regenerative potential of dermal fibroblasts to produce more collagen and elastin fibres as well as supporting the extracellular matrix. Biostimulators like poly-L-lactic acid (PLLA), Sculptra® and calcium hydroxyapatite (CaHa), Radiesse® are used to treat skin wrinkles and aging by increasing the skin’s collagen content, increasing dermal fibroblasts and in turn increasing the skin’s production of estrogen by the enzyme aromatase.

Estrogen Therapy and Bioregenerative Combinations

Hormonal optimization and estrogen repletion play an important role in addressing skin health, appearance and aging in the post-menopausal or estrogen depleted patient. Systemic estrogen therapy used in combination with progesterone for women with an intact uterus is a cornerstone to addressing symptoms, disease risk and accelerated aging at Menopause. The use of systemic estrogen therapy in conjunction with bioregenerative aesthetictreatments like biostimulators and exosomes can synergistically mitigate the accelerated aging of post-menopausal skin.

Estrogen and Skinspan

Aging is not inevitable. The health, appearance and aging of our skin can be proactively managed with a targeted and multi-modal approach. In addition to the arsenal of aesthetic medical interventions, menopausal hormone optimization therapy (HOT) can play an important role in enhancing healthy lifespan and the skinspan.