Estrogen May Save Your Skin

The expanding list of reasons why post-menopausal women might take estrogen therapy now includes a cosmetic benefit: Your skin might hold up better as you age.

In a study published today, UCLA researchers found that women who used estrogen were 25% less likely to have dry skin than women who didn’t use estrogen.

The impact on wrinkles was even greater, with the study showing that estrogen-users were 30% less likely to have wrinkles than nonusers. The effects were found among both white and African American women.

Estrogen therapy has already been shown to bestow numerous benefits on post-menopausal women, including greatly reducing the risk of heart disease and osteoporosis. Moreover, recent studies have indicated that estrogen therapy, which is often taken in combination with progestin, may stave off dementia and Alzheimer’s disease and might have a protective effect against depression.

On the downside, estrogen therapy has been linked with an increased risk of breast cancer and can boost the risk of uterine cancer if taken without progestin. Estrogen therapy can cause other side effects, such as vaginal bleeding and headaches. In addition, some women simply don’t like how hormones affect their emotions.

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Given the consumer dollars splurged on cosmetic products and surgery, skin appearance will likely emerge as an important factor for many women weighing the pros and cons of hormone replacement therapy.

“I wouldn’t recommend to my patients that they use estrogen for cosmetic reasons only. But I think we need to respect how women feel about their appearance. I don’t think we can underestimate the effect that can have on women,” says one of the study’s authors, Dr. Gail A. Greendale, an associate professor of medicine and director of the Iris Cantor-UCLA Women’s Center.

The analysis, published in today’s Archives of Dermatology, included 3,875 post-menopausal women 40 and older who participated in the first National Health and Nutrition Examination Survey, 1971-’86. The women, whose average age was 61, represented a broad spectrum of ethnic groups, economic and education levels.

Dermatological exams were performed, in which the women’s skin was examined and measured in detail by doctors. Body mass index was also recorded. The women were interviewed about their histories of sun exposure, smoking habits and whether they had ever used estrogen. (The data did not include how long the women used estrogen.)

The information obtained on sunlight exposure and smoking was crucial in determining the ultimate impact of estrogen because these factors are known to contribute excessively to skin dryness and wrinkling. Body mass is a factor in skin appearance because heavier women have more skin padding and are less likely to exhibit wrinkling as they age.

While previous studies have suggested a link between estrogen use and healthy skin, the UCLA study is the first to feature a very large number of diverse participants and to control for the factors of smoking, sunlight exposure and body mass index, Greendale says.

Previous studies on estrogen and skin were based on the analysis of skin biopsies from estrogen users, which tended to show more collagen in the skin.

“But just because you have more collagen doesn’t prove you will have less wrinkling or that skin will be moister. It’s a step before saying that,” Greendale says.

Preserving skin properties is not a purely cosmetic consideration. Dry and sagging skin can facilitate the development of other skin conditions that plague people as they age, such as eczema. In the very elderly, dry and thinning skin can increase the risk of developing bed sores.

“In younger people, the benefits [to skin] are largely cosmetic,” Greendale says. “But some women, over the age of 70 or 80, develop pressure sores. This is a very serious aging skin problem. One of the ways to prevent pressure ulcers is to keep the skin thicker and more elastic.”

Not all estrogen users may be satisfied with their appearance, however. In some women, hormones can wreak havoc with the skin, says Dr. Patrick Abergel, a cosmetic surgeon in Santa Monica.

“Estrogen therapy can be responsible for acne breakout,” he says. “Another negative aspect of hormone therapy is that it sometimes makes the skin prone to blotchiness. This is common in people with darker skin or olive skin.”

Abergel says the decision on whether to use hormone therapy is best left to a woman and her primary care doctor, based on such considerations as heart disease and osteoporosis prevention and cancer risk factors.

“It’s nice to get good results with the skin from estrogen therapy, but you don’t want to see other skin problems develop. I would hate to recommend something that may give only a minor benefit to the skin in comparison to the potential for problems,” he says.

The decision to take estrogen should entail a review of all the pros and cons, Greendale says.

“Every woman brings to this discussion her own views on each of these conditions,” she says. “This new finding with skin is simply another piece of the puzzle that we should present to patients.”