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Estrogen deficient skin: what's the deal?

Updated: Aug 23

I recently learned that, on average, women experience a 30% collagen loss in the first five years after they hit menopause. A thirty percent degradation in collagen in five years!!


At first that seemed like a crazy figure. But then I mentioned the number to a good friend of mine who’s an aesthetic doctor, and we both started nodding our heads. Suddenly countless clients and patients came to mind... women who’ve presented in the clinic/treatment room after six months absence complaining that their skin was seemingly ageing overnight. And now it seems obvious; a sharp drop in estrogen can have a profound and rapid effect on our skin quality.


* DF Archer, Gynecol Endocrinol 2012 Oct


So the question is this; how do we set ourselves up to look and feel our best through not only our first half of life but also our second?


The average age of menopause is 51 …average female life expectancy varies by country but is roughly 80 years old in the US and Europe, with many women living much longer that that! Those years COUNT. We COUNT! We want the best possible skin for our age just like we wanted when we younger. We just have to treat it differently. 


While estrogen loss is most pronounced in menopause, in fact estrogen production begins to decline in most women before they even turn 40. When we are in perimenopause (the ten or so years before the cessation of our periods), we start noticing changes in our skin that may interpret as ‘chronicle ageing’, but in fact the gradual decline of estrogen amplifies the aging process. It is gradual at first and then…not so gradual. 


This is because we have estrogen receptors in our skin (the largest organ of our body!!) that, when bound with estrogen, stimulate collagen, elastin and hyaluronic acid.  As the estrogen declines so goes the collagen, elastin and hyaluronic acid. This leads to something called estrogen deficient skin (EDS).


I can say that I was blissfully ignorant to EDS up until probably 6 months ago. But not anymore!! So, what are the signs of estrogen deficient skin? 


˚ thinning skin

˚ dehydrated/dry skin

˚ decrease in collagen and elastin (sagging and laxity)

˚ decrease in barrier function 

˚ dullness 

˚ texture abnormalities 

˚ in skin of color EDS may also include patchy depigmentation and texture abnormalities 


Consider this: collagen loss at menopause is more closely related to the declining estrogen levels than to chronological age. That’s pretty profound - our years on earth, and even our lifestyle choices, don’t necessarily dictate our skin condition in middle age.  


So what what can we do about estrogen deficient skin? This is such a personal thing. I want to share with you the tools that I’ve identified as being in the ‘estrogen deficient skin arsenal’. Whether you employ tool set 1, 2, or 3 (or a combination of all three) is entirely a personal choice. Although if you’ve followed me for any length of time, you'll know I think ALL women should be employing items from toolbox 1:



1. ‘Collagen banking’

We know that as we age collagen, elastin and hyaluronic acid (among other things) decline, and we can combat that by using retinoids, vitamin C, copper peptides, micro needling, radio frequency, among other tools. All of these things build collagen. So it’s vital that we employ a mix of these tools if we want to set ourselves up as best we can to enter menopause. The term ‘collagen banking’ is a relatively new one, but I think it gives us a sense of employing a set of habits, products and techniques to build up healthy collagen prior to and during the menopause - because why wouldn’t we?!?! (if you haven’t started a ‘collagen/elastin support program’ and you are already in menopause, don’t worry! It is NEVER too late to encourage collagen synthesis!!) If you haven't already, do have a look at my microneedling playlist on YouTube as well as this video on how to address sagging skin (one of the hallmarks of estrogen difficiency.)


2. Hormone replacement therapy

Another option is to talk to your doctor about HRT (hormone replacement therapy).  This is definitely a doctor/patient conversation, as not all women are candidates for HRT. It isn’t something you’ll see me discussing on my channel as it is a complex choice that goes way beyond skincare and is unique for every woman.  Absolutely do your research on the internet, but please take that information to your own doctor to make sure you have the very latest accurate knowledge. Of course HRT impacts way more than skin, so the benefits/risk should be looked at mindful of the impact on the entire body.


3. Methyl Estradiolpropanoate - a non-hormonal estrogen receptor antagonist

There is a new active ingredient on the marketplace called Methyl Estradiolpropanoate (MEP). It was released at the end of 2019 and is starting to get traction in the skincare industry. MEP is a non-hormonal way to activate skin estrogen receptors. MEP is what’s known as an ‘estrogen analog’ that activates the cutaneous estrogen receptors. Its effect is entirely within the skin. Once MEP is absorbed into the bloodstream, studies show it’s quickly deactivated into an inactive metabolite.


I’m super excited about MEP as it’s an ingredient that nearly all women can consider. For women who are open to taking HRT, MEP offers an added benefit that targets the skin exclusively - so they needn’t take higher doses of hormone replacement to ensure that they’re getting the maximal benefit for the skin. And for the woman who can't or don’t want to take HRT, MEP offers a solution that acts locally on the skin, without impacting the rest of the body as would be the case with HRT. I’m also excited about MEP because this ingredient has some impressive clinical data to back it up.


MEP is a cosmeceutical option found in a serum and night cream called Emepelle.

Emepelle contains not only MEP but also retinol (night cream only), niacinamide, antioxidants and peptides among other impressive ingredients.  


My affiliate links for Emepelle US and UK:


Emepelle US:

https://emepelle.com/

Use code PENN20 for 20% OFF


Emepelle UK

https://emepelle.co.uk/products/partner-exclusive-package

The code to enter is: EMEP054

This code gives you 2 free Heliocare products when you purchase the Emepelle duo (saving of £65.99)


I'm particularly impressed with some of the before/after shots on the Emepelle website. This closeup shows a 63 year old woman at baseline and after 20 weeks of Emepelle Serum in morning and Emepelle cream in the evening.The area under the eyes can be a particularly tricky one to treat, at any age. For me to see this sort of a transformaiton after using a topical ingredient for five months is pretty impressive.



For those of you wondering whether these effects could be attributed not to MEP but to some of the other fantastic ingredients in Emepelle, the below informaition was produced in their study.



"In a 60-patient safety study evaluating topical MEP for facial features of EDS, Zoe Draelos, MD, showed that once MEP enters the bloodstream, it is broken down by esterases to an inactive carboxyl molecule, avoiding systemic estrogen side effects. In addition, Dr. Draelos clinically evaluated 80 patients for efficacy as well. Importantly, this study looked at MEP alone, and the formulation had no other effective ingredients. In addition, the vehicle itself was specifically designed to confer extremely minimal moisturizing qualities—so there wouldn't be any moisturizer effect from the vehicle. This is important, as historically in some types of formulations, the vehicle and not the hero ingredient could be responsible for the observed benefit seen in those studies. That wasn't the case in this study. Furthermore, the clinical study also showed a statistically significant improvement from baseline at week 14 in parameters including dryness, laxity, atrophy, and dullness as compared to vehicle."


If you haven't already, do have a look at the video I made on the topic of Estrogen Deficient Skin. I also review some the ingredients in Emepelle and talk a bit about my experience using the products.



Emepelle Q&A


I reached out to the makers of Emepelle to ask some questions that I knew you'd be asking. They very nicely came right back with the following answers:


1. I understand that Emepelle cream contains retinoids but I’m committed to my Tretinoin… can Tretinoin be used with Emepelle? If yes, how would I layer the two?

While there is no clinical data related to layering tretinoin and Emepelle with MEP Technology, Emepelle Night Cream combines MEP Technology and retinoid with beneficial results. We recommend applying Emepelle first followed by tretinoin. To begin, try on a small area as a ‘test spot’ along the jawline or in front of the ear for a few evenings to assess any potential inflammation or redness.



2. Can I still use my AHA product when using Emepelle? 


Yes, depending on your skin’s tolerability.  If irritation occurs, discontinue use of those products together, at least temporarily. 




3. I understand that Emepelle serum contains Vitamin C.  Can I continue to use my vitamin C with Emepelle? If yes, how do I layer them? 

Yes, depending on your skin’s tolerability.  If irritation occurs, discontinue use of those products together, at least temporarily. It is customary to apply an antioxidant serum first in any regimen. Allow it to absorb (5-10 minutes) prior to applying additional products.


4. Can men use Emepelle? 



Yes, though men experience Estrogen Deficient Skin differently from women (their natural estrogen levels tend to decline less rapidly).  While men may not necessarily benefit from the MEP Technology, they would benefit from the other anti-aging ingredients such as peptides, niacinamide, antioxidants, and emollients and humectants (and the retinol in Emepelle Night Cream).   


5. Can I use this if I have Rosacea? 


Many ingredients in the serum and cream are beneficial for rosacea-affected skin. However, the retinol in the night cream may cause irritation and redness; therefore, care should be taken when starting to use Emepelle Night Cream. As with starting any retinol regimen, we recommend applying 1-3 nights per week to begin and then increasing usage as your skin tolerates.




6. Who shouldn’t use Emepelle? 


Emepelle is intended for women leading up to and during menopause. While women who aren’t experiencing Estrogen Deficient Skin may not necessarily benefit from the MEP Technology, they will benefit from the other anti-aging ingredients such as peptides, niacinamide, antioxidants, and emollients and humectants (and the retinol in Emepelle Night Cream).  Emepelle is completely non-hormonal and has benefits exclusively for the skin. For women who are unsure if Emepelle is right for them or have specific medical conditions, we suggest they consult with their doctor.


Emepelle Night Cream should be avoided by those who have a strong sensitivity to retinol. 



7. Is there any benefit to using Emepelle preemptively? Say early 30’s? 

Women of all ages may benefit from Emepelle.  While women who aren’t experiencing Estrogen Deficient Skin may not necessarily benefit from the MEP Technology, they would benefit from the other anti-aging ingredients such as peptides, niacinamide, antioxidants, and emollients and humectants (and the retinol in Emepelle Night Cream).   


8. Is there any benefit to using Emepelle during perimenopause?

In the lead up to menopause (perimenopause), estrogen levels begin to decline. Emepelle, with revolutionary MEP Technology, is ideal for use during perimenopause, menopause, as well as post-menopause. Both Emepelle Serum and Emepelle Night Cream also contain a blend of powerful ingredients such as niacinamide, peptides, and retinols that perimenopausal women will benefit from.



9. Are the ingredients ok in jar packaging? Are there any risks that MEP will degrade when exposed to light/air?



Yes, the ingredients are ok in the jar packaging. Emepelle should be stored under 86 degrees F (30 degrees C) and out of sunlight.



10. Could this help women with low estrogen levels (due to ovary removal for example) but not in menopause? 

Yes, Emepelle is suitable for women who have estrogen deficient skin from a variety of causes.  While Emepelle is completely non-hormonal and has benefits exclusively to the skin, if you do have a history of ovarian cancer or other medical conditions we recommend consulting with your doctor before using Emepelle..



11. Is Emepelle ok for women who have had estrogen positive breast cancer? 


Emepelle has not been tested on specific medical conditions. We currently do not have clinical data to support the use of Emepelle products in users with a history of breast cancer.

MEP is completely non-hormonal and only impacts the skin.. If you do have a history of breast cancer or other medical conditions, we recommend consulting with your doctor before using Emepelle.


Once absorbed into the skin, MEP is converted into an inactive metabolite in the bloodstream.


12. I am on hormone replacement therapy (HRT); can I use Emepelle?



We currently do not have clinical data of users using HRT and Emepelle products. However, because MEP is completely non-hormonal and converted to an inactive metabolite in the bloodstream, it should not have an effect on an HRT regimen.


13. How is MEP inactivated in the bloodstream?



When MEP enters the blood, enzymes found in the blood (esterases), break MEP down into an inactive metabolite. Inactive metabolites do not have an effect on the body.


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