If not for texts with friends, would your mind be blank? Would your opinions be flimsy? Your cultural I.Q. anemic? I don’t mean the texts that start “Verizon here” or “Frederick, I’m begging … ” when your name is clearly not Frederick. But the ones that offer some insight. Like “Did you hear my vag cream story?”
I had not, but, in the space of three dots, I’m pretty sure I will. And here it is: “A makeup artist told me to put menopause vagina estrogen cream on my eyes and neck. So I texted my doctor … and he said that’s a great idea.”
All sorts of women have been moving their vaginal cream northward, in the facial direction. Sometimes they’re inspired by a podcast or TikTok, perhaps starring Dr. Mary Claire Haver, a board-certified ob-gyn, esteemed member of the “meno-posse”—a group of medical professionals dedicated to menopausal care—and author of The New Menopause, who spoke about it on a two-plus-hour episode of Huberman Lab. Another, Dr. Jennifer Ashton, floated it on The View, where Joy Behar asked about the viability of Vagisil for the skin. (No viability. “Unless,” said Dr. Ashton, “your face is itchy.”)
Sure, vaginal cream sounds revolting. And applying that vaginal cream to your face sounds perhaps even more unsavory. But the estrogen in that cream might well be one of the most effective skin-care ingredients for women over 35. For anyone who’d rather not shrivel up as they reach their prime, it’s time to get cracking.
“I probably started using it 25 years ago,” says Dr. Ellen Gendler, a board-certified dermatologist in New York, of her longtime affection for Premarin, a vaginal cream containing estradiol. When patients ask her to recommend an eye cream, “I’ve always said use vaginal estrogen cream, or I’ll give you a prescription.”
As Dr. Haver explains, “We lose 30 percent of our collagen when we go through menopause. It’s a big pain point.” No kidding. Dr. Ashton announced on her Instagram feed, “In the first five years after menopause about 50 percent of the dermal collagen is lost. Disappeared. Bye-bye.”
The consequence of that drop is, among other things, the thinning and drying of the skin everywhere, not just on the vaginal walls. Arms, knees, neck, hands, the under-eye area—behold the crêpiness.
Dr. Gendler discovered the wonders of topical estrogen around 1999, when an 80-year-old patient with exceptional skin—“just beyond”—revealed that her secret was estrogen cream. She followed her patient’s example, dabbing it under her eyes and on the backs of her hands. “To me, it kind of made sense,” says Dr. Gendler. “The first thing women complain about is their under-eye skin. That’s the thinnest skin on the face. And it’s worked amazingly for me.”
Dr. Haver turns to a particular blend of estriol with skin-care ingredients called M4, by Alloy, a start-up brand focused on menopause relief. And she looked exceptional on our Zoom call.
“If you’re in your 40s, you want to be thinking about this,” says Dr. Gendler. “Every patient that I prescribe [vaginal estrogen] to continues to use it, and everyone seems to love it.” Those are rare words out of a dermatologist’s mouth, especially one named Ellen Gendler.
When many people hear the word “estrogen,” they immediately think “breast-cancer risk.” But studies of topical estrogen—on the vagina and the face—have proved that the cream is not absorbed systemically and doesn’t increase the risk of breast cancer.
Anne Fulenwider and Monica Molenaar, the founders of Alloy, commissioned a new clinical-safety-and-efficacy study on their M4 prescription estriol cream. It was double-blind, randomized, and rigorous. Dr. Gendler analyzed the study and says it showed “no significant systemic absorption of either estriol or estradiol, and that was very important because the naysayers about this are constantly talking about systemic absorption.” In this case, says Dr. Haver, “we can take breast cancer off the table.”
Fulenwider and Molenaar created M4 when Molenaar discovered she had the BRCA gene, had her ovaries removed, and swiftly descended into early menopause. “After two weeks of using vaginal estrogen [for urinary incontinence], I was like, Well, that was effective. Let me see what happens if I put it on my face,” she tells me.
Estrogen was a popular skin-care ingredient for decades among the Helena Rubinstein and Elizabeth Arden set starting in the 1940s, before it was classified as a prescription drug. Alloy’s M4 aims to marry the aesthetic appeal of an elegant face cream with the power of estriol.
“What we saw in the study was that the estrogen basically upholds the architecture of your skin,” says Molenaar. It showed statistically significant improvements after 12 weeks in overall skin health, including elasticity, hydration, texture, radiance, firmness, and pore size. Fulenwider and Molenaar promptly filed for a patent.
After filling out a medical questionnaire at myalloy.com and waiting a few hours for a doctor to review my answers, I was issued a prescription for M4. I’ve been using it morning and night for two weeks, and so far, so good. But it’s too soon to see any difference in my skin. Of her own experience, Dr. Gendler says, “These are not short-term goals. I didn’t start thinking I’m going to change my eyes in three months. I did this to protect myself going forward, much as you do with weight-bearing exercise or not smoking.” After counseling Alloy informally, Dr. Gendler is now one of their medical advisers.
A friend in L.A. tells me that the rich-lady flex—because there’s always a rich-lady flex—is to enlist a practitioner to create a custom-made estrogen cream from a compounding pharmacy, but Dr. Gender dismisses that as both ridiculous and potentially risky. She also warns women who’ve had melasma to protect their skin religiously with a broad-spectrum S.P.F. or tinted sunscreen, even though the latest study showed no incidence of pigment changes in those who used estrogen creams. Dr. Gendler urges breast-cancer patients to check with their gynecologist and oncologist before trying any estrogen cream, despite all the safety studies.
The second I finished reading the Alloy study, I alerted the group chat. Next time we see each other in person, maybe we’ll be a little less crêpey, a little more moist (gross), a little more hopeful, if only about our skin. We know better than to expect miracles.
Linda Wells is the Editor at Air Mail Look
