From moisture retention to preserving skin’s firmness, estrogen plays a major role in the appearance of a woman’s skin. However, for many patients, the importance of estrogen production might fly under the radar until the visible effects of menopause set in. Fortunately, while menopause is inevitable, living with estrogen-deficient skin no longer has to be.
Now, physicians can introduce patients to preventative and corrective non-hormonal solutions to combat the decline in estrogen production that occurs with menopause. Depending on the stage at which patients address estrogen loss, preventative measures can be taken to slow initial estrogen loss, and seemingly dormant estrogen receptors can even be reactivated with topical treatments from Emepelle. While products and procedures designed to slow estrogen loss are more accessible than ever before, it still falls to the physicians to get these solutions in front of their patients—ideally when they are still premenopausal.
To further explore these concepts, CSF caught up with board-certified, aesthetic fellowship-trained dermatologist and CSF Faculty, Dr. Joel L. Cohen of Greenwood Village, Colorado to provide updates and professional insights to his 2019 presentation for treating estrogen-deficient skin.
Preventative Measures for Premenopausal and Perimenopausal Patients
Initially, premenopausal and perimenopausal patients may be skeptical about preemptively addressing concerns they can’t see much of just yet. Defending against significant estrogen loss could really seemingly be approached similarly to the use of sun protection and the prevention of sun damage: it’s better to prevent than repair. While estrogen loss isn’t completely preventable, the steep 30% decline in cutaneous collagen levels that occurs during the first five years of menopause may be able to be significantly reduced.
That’s why it’s important to introduce products like Emepelle—a non-hormonal approach to estrogen-deficient skin— for menopausal and really peri-menopausal patients. According to Dr. Cohen, “Emepelle is a 2-product regiment that can really be considered for perimenopausal women before they experience a sharp decline in their collagen levels during menopause. The day serum has antioxidants, is non-comedogenic and layers nicely under sunscreen. The night cream contains a mild topical retinoid – where retinoids can help to decrease matrix metalloproteinase enzymes like collagenase that degrade structural support of the skin””
By combining Emepelle with other beneficial procedures, the visible effects of menopause seem subtler to many patients. “Procedures can certainly complement these Emepelle topicals in a very big way, including chemical peels, microneedling, radiofrequency, microfocused ultrasound, non-ablative lasers and ablative lasers,” says Dr. Cohen.
Due to benefits of addressing these potential concerns before they manifest, Dr. Cohen also stresses the importance of a physician’s role in helping a patient realize the connection between signs of aging and estrogen loss:
“These conversations stem from a thorough consultation with our patients about cosmetic concerns and appearance management goals. Patients often do not make the connection between estrogen loss and their accelerated skin aging. . . They typically associate their aging skin with ‘getting older’ and/or sun exposure. As a physician, I like to educate my patients on what they might expect so that they are informed and can evaluate preventative options, including embracing diligent sunscreen use. . . If a female patient has expressed cosmetic concerns, I think it’s very helpful to talk to her about EDS before she progresses too far into menopause so that we are better able to address her goals.”
Addressing Estrogen-Deficient Skin in Menopausal Patients
Patients who choose to wait until after they’ve entered menopause present a somewhat different challenge, as it’s likely some of their estrogen receptors have already become dormant, resulting in significant collagen loss. Even when considering menopausal patients alone, the length of time they have been in menopause may actually impact their results. Again, with 30% of the skin’s collagen lost during the first five years of menopause, it is important to note that an additional 2.1% is lost with each subsequent year. So, each patient’s treatment path is likely to look different, and it’s important to tailor their expectations to their specific situation—dryness, laxity, etc.
It appears patients who have been in menopause longer may need more time to see optimal results. Dr. Cohen indicated, “From my clinical study results, some of the women that have been amenorrheic for longer periods of time took several weeks longer than the younger participants to start manifesting improvement—which may be related to more of her estrogen receptors having been either dormant or at least down-regulated during menopause.”
Fortunately, while it may take a bit longer for long-dormant estrogen receptors to respond to treatment, many patients seem to exhibit positive results regardless of time spent in menopause. “There has not yet been a clinical study correlating study participants’ length of time in menopause with the efficacy of treatment. With that said, I have seen some very nice results both in patients who have only been in menopause for a few years and also with those that have been in menopause for much longer,” says Dr. Cohen.
Treating Estrogen-Deficient Skin with Emepelle
What allows Emepelle to provide such positive results whether a patient is perimenopausal or has been in menopause for many years is its MEP Technology. MEP reawakens and upregulates estrogen receptors that disappear or become dormant throughout menopause. This addresses the main concerns of estrogen-deficient skin such as collagen loss, dryness, dullness, laxity, atrophy and the appearance of fine lines. Topical MEP Technology in Emepelle has not been found to have active metabolites in the circulation after cutaneous application, from a study that Dr. Zoe Draelos published. Dr. Cohen says:
“MEP is a new category, a NERA (Non-hormonal Estrogen Receptor Activator). MEP is not a hormone, but rather, it is an estrogen analog that activates cutaneous estrogen receptors with effects that seem to be completely limited to the skin. It is shown to stimulate specifically cutaneous collagen without off-site activity. When MEP enters the bloodstream, the esterases, or enzymes found in the blood, rapidly break MEP down into an inactive metabolite—where it is then excreted from the body.”
With 2 different Emepelle products, adding MEP technology to a patient’s daily routine seems to be an easy step for women to begin a long-term plan to help with sun damage, aging skin and estrogen-deficient skin. And, with the ease of adding Emepelle to any regimen, physicians have a solution to estrogen-deficient skin that is more accessible and approachable than ever before.
How do you address estrogen-deficient skin in your practice? Share your thoughts on treating perimenopausal and menopausal patients in the comments below.