'Clinicians often lack an evidence-based approach to their evaluation and management of menopause-associated skin changes’, said Dr. Shoshana Marmon.
Dr. Shoshana Marmon is an assistant professor and the director of clinical research in the Department of Dermatology at New York Medical College. She presented 'Skin, hormones, and menopause: from research to clinical practice' at The Menopause Society 2026 Annual Meeting, held October 20 to 24, 2026, in San Diego, California. Her talk was part of the plenary symposium, ‘Midlife dermatology: evidence-based care for skin and hair changes in menopause.' She organized current research into four parts: menopause-associated skin changes, sexual and genitourinary health, common dermatoses, and prescribing across the transition.
What the evidence may show about estrogen and skin aging
'Both topical and systemic estrogen have received significant attention for their potential to stabilize or improve these changes, and this makes real biologic sense,' Dr. Marmon said, since estrogen receptors are expressed throughout the skin. Her team's systematic review covered 21 studies of topical estradiol and estriol, 'a weaker estrogen increasingly marketed in compounds and facial products.' Neither is approved by the US Food and Drug Administration for skin aging. 'Across studies, the most consistent improvements were in skin thickness and collagen, but sample sizes were small,' she said. 'Many trials lacked vehicle controls, and some better-designed studies found no benefit, particularly in sun-exposed skin.'
Systemic menopausal hormone therapy (MHT) showed a similar pattern, with collagen and thickness gains most consistent at photoprotected, nonfacial sites and no clear facial improvement in randomized trials. Estrogen signaling was active in both skin types. 'But the collagen response was very different,' she said. Photoaging may blunt that response, so findings in protected skin may not translate to the face. Photoprotection and topical retinoids remain first-line therapies.
How hormonal therapies may intersect with sexual health, dermatoses, and clotting risk
'What's typically overlooked is that decreased libido is a listed adverse reaction for these medications,' Dr. Marmon said of antiandrogens, although the labeling is largely based on data in men. 'When evaluating low sexual desire, it's reasonable to ask about antiandrogen use, and when prescribing antiandrogens, it's a good idea to assess sexual desire at baseline and during therapy, and counsel that libido might be affected.' Before prescribing testosterone, she advised clinicians to 'assess for acne, hirsutism, hair loss, and anti-androgen use, and monitor for new or worsening androgenic skin and hair changes during treatment.' Genitourinary syndrome of menopause and lichen sclerosus can coexist.
Oral estrogen has been associated with increased venous thromboembolism (VTE) risk, while transdermal estradiol has not. When dermatologic therapies with thrombotic warnings are prescribed, Dr. Marmon recommended assessing MHT route, formulation, dose, and baseline VTE risk, and coordinating care across specialties.
Abbreviations: MHT, menopausal hormone therapy; VTE, venous thromboembolism.