Derm-it Trotter! Don't Swear About Skincare.
Feeling frustrated or overwhelmed with everything skin? Does the skinformation overload make you want to swear about skincare? Join Dr. Shannon C. Trotter, board certified dermatologist, as she talks with fellow dermatologists and colleagues in skincare to help separate fact from fiction and simplify the world of skin. After listening, you won’t swear about skincare anymore!
Derm-it Trotter! Don't Swear About Skincare.
Menopause & Your Skin: What Really Happens When Estrogen Drops
Menopause shifts more than moods—it transforms skin. We break down what really happens when estrogen drops, why hydration and barrier function decline, and how that leads to dryness, fine lines, acne, and new sensitivity. With Dr. Brenda Dintiman, a board-certified dermatologist, we dig into the truth behind topical estrogen, what’s promising, and what still needs research.
We explore modern hormone therapy options, why HRT is never one-size-fits-all, and where topical or vaginal estrogen can meaningfully help. If crepey skin or GLP-1–related changes are your new frustration, we outline realistic fixes—from sunscreen, retinoids, vitamin C, and peptides to targeted lasers like 1927 nm and 1550 nm. Clear priorities, fewer false promises, and a roadmap you can start today. If this episode helped, subscribe, leave a review, and share it with a friend navigating midlife skin.
To make the barrier of the skin healthy in the vaginal area once you was treating other more serious like lichen sclerosis, we called it, uh, diseases, breast cancer, are clear to use vaginal estrogen, which of course absorbs more in that mucosa than it does on the face. I am curious about how it will help creepy skin because we're seeing so much creepy skin on the arms, especially with our GLP1 weight loss patients.
SPEAKER_00:Welcome to Dermitrotter, Don't Swear About Skin Care, where host Dr. Shannon C. Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.
SPEAKER_01:Welcome to the Dermitrotter Don't Swear About Skin Care podcast. Today I've got a great topic to tackle because it's really been in the news lately and caught trend. But first I want to introduce my guest, Dr. Brenda Dentaman. She's a board-certified dermatologist, has more than 30 years' experience in both medical and cosmetic dermatology with a special interest in skin and estrogen, which actually is why I brought her on the podcast. So welcome. It's great to have you here, Brenda.
SPEAKER_02:So great to be here. So much to talk about today.
SPEAKER_01:Definitely, because it's definitely caught on trend. You know, we've talked about this a little bit before recording. And I will tell you, being in, you know, the specialty of Durham for a while, it's interesting to see sort of the translation of menopause health finally enter in, I think, skin where it's more in the spotlight. And I it's kind of like, why is this trend evolving? Why do you think all of a sudden people are finally talking about it?
SPEAKER_02:Well, I think because we have some amazing champions out there. My uh interests started with Dr. Rachel Rubin, Kelly Carkinson, and Dr. Laura Stryker, so many of them. And I literally use that phrase that I'm binge watching as menopause. I don't binge watch TV too much, but I became obsessed with the topic, especially because I'm the generation that I was calling the lost menopause generation, because the hormones were taken away about the time we all needed them. So it's really, you know, it's really incredible to see new research coming out that's going to help everyone from now on.
SPEAKER_01:And it's exciting too. It's finally getting the attention it deserves. I teased my husband, I said, This affected men, we probably would have given it great attention, you know, 25 years ago, right? It's just taken some time as we've learned more about it and how it affects our bodies and then particularly our skin, because a lot of people do you know notice these changes, both perimenopause, during menopause, and postmenopausal. Do you mind talking a little bit about some of the skin changes that women might experience during this time?
SPEAKER_02:Absolutely. I don't think we really realized what was happening. We didn't attribute it to the hormones going down. We would say to a patient, your skin may start to look kind of ruddy and dry. It just hasn't had that glow or luminescence that it used to. And now I think we know it's because the estrogen was going down in our skin, the barrier function, it did not retain moisture as well. And the skin just looked rough and not, and little fine wrinkles started, even as early as your 40s when you were perimenopausal.
SPEAKER_01:Yeah, and I think that's what a lot of people come in, and it's sort of like, you know, I think age almost slapping them in the face is the way one of my patients described it, which I thought was pretty accurate. And she said, I just don't know what's happening. And she said, I know this is supposed to be quote unquote natural, like I'm supposed to go through it. But, you know, her thoughts were, do I really have to go through it in a way that, you know, traditionally we've thought of? And I think that's where our mindset is shifting a little bit, that yeah, although it is a natural sort of process of our bodies to kind of experience menopause, we don't necessarily have to live with all the things that come along with it. Have you noticed that with some of your patients as well?
SPEAKER_02:Absolutely. And the other thing I remember is many of us would start to get very heavy periods, and really we never paid attention to having our period, at least not being a working physician. And all of a sudden it was debilitating. And some women also got acne acne and hair loss at the same time. And the biggest difficulty was to find a physician that would able was able to listen to you because now every caveat was this could cause breast cancer or this could cause heart disease. So, therefore, are you really that problematic? Are you really having night sweats? Are you really that debilitated? Can't you just hang in there? And so the way that it was presented to you was really don't do hormones. And I remember not being very motivated to stay on them because I didn't know why I should stay on them. There was no why about your bones, there was no why about frozen shoulders, no why about you're not gonna have brain fog. I don't even know if I knew I had brain fog. I had teenagers. You know.
SPEAKER_01:Yeah, and and that's what, you know, when patients come in, I tell them, you know, there's a whole list of things that you know you could be experienced. Like you mentioned, it's like you're feeling like you're a teenager again. You get acne potentially again, you know, those hairs start to thin, you know, that collagen starts to break down in the skin, and we're appreciating that with you know decreased elasticity, or feeling like we're noticing more of those fine lines and wrinkling. And then you're right, then it's the other physical aspects of it. People feel like they gain weight and they feel fatigued, or like you mentioned, just not being able to focus mentally. And yeah, I told me, yeah, that might be something our bodies are supposed to kind of go through. But the good news is I think we're shifting, you know, the way we approach this, that there are ways to sort of help us through that process. So you don't necessarily have to suffer, because I feel like that's what people think, they just have to suffer through. And you're right, hormone replacement therapy, you know, especially when I started training and that still was sort of it's very taboo, right? We were really worried about what harm would we potentially do for somebody, kind of going forward, potentially with that. And and now I think we're seeing people look a little bit more into that, try to do some more research and figure out, you know, is there a safer way we could approach this to take care of some of those symptoms? Have you had some conversation or thoughts personally on kind of where you think we might go with HRT?
SPEAKER_02:Well, I think that uh so many patients are bringing up the conversation that I think all specialties owe it to themselves to learn what the new standards are. And pretty much we know that the topical estradiol patches are so much safer than the forms we were given. We were often kept on birth control pills or higher dose estrogen with the progesterone. The progesterone is different. So all these things contribute to a safer, better way to go through hormone replacement. I've heard it even called now pet therapy by Dr. Kelly, progesterone, estrogen, testosterone therapy. You know, why does it have to be called what we're calling it? And uh and I think we're gonna be dealing with a lot of different issues. We have a lot of women who have gone through IVF, we have a lot of women that have had early loss of estrogen. I know personally patients who maybe didn't have a period for 10 years before they were 40 and then had to go on replacement. So there's a lot of issues to deal with sorting out, you know, who will tolerate the medications and how to tweak it and find someone that's willing to work with you. And there's been some great work done. I have heard that only about 2.8% of women are being treated right now. So there's a big space and a lot of education that needs to be spread.
SPEAKER_01:Interesting. Yeah, I and I agree with you. I think that tide is shifting. There seems to be a bit more openness about the discussion, although, as you mentioned too, some unanswered questions about maybe what is the exact or the right approach. And that can be individual to the patient based on history and what else they have going on. But fascinating that we're kind of sort of just shifting the tide or changing that mindset on how we may approach, you know, hormone replacement therapy for women going forward, especially to help with menopause and all the things that come with it. But that gets us into kind of the heart of the matter here, talking more about estrogen and topical forms of estrogen, because if you've been on TikTok or you've been on Instagram, I mean you see people saying, I've got my vaginal estrogen cream, and I'm just going to slap it on my face and see what happens. And so I wanted to talk more about, you know, do you use topical estrogen creams in your practice? And when do you typically recommend them for somebody if you do use them?
SPEAKER_02:Well, mainly I've been recommending vaginal estrogen for the last two years. I you may wonder why a dermatologist does that, but dermatologists are one of the experts involver disease. One of the famous experts, Dr. Lynn Margison, who I just had the opportunity to talk with, was giving me historical perspective on how important it was to make the barrier of the skin healthy in the vaginal area when she was treating other more serious, like lichen sclerosis, we called it, uh, diseases. But that being said, we now know that we can use estrogen on the face. The studies that have been done are very small still. We're not really sure where that's going to go. Um, one of the many people can use the same vaginal estrogen cream on the face that they're using on the vaginal vulvar labia twice a week. Um, you can use it on your face a little bit once a day. It's a thicker cream, so it may not be something that people want to use, but now we can get it compounded in estriol, which is a weaker form of estrogen, weaker form. It's not the estradiol. And that's a little bit more palatable to use. It's creamier, it's lighter, because we are trying to add moisture to the skin. So I think the jury's still out on where this is gonna go. I'm sure, like you, my number one anti-aging cream is sunscreen. Sunscreen, and still the number one thing that we know works are tretinoin, retinols to repair and replace new collagen. So that's always got to be part of the picture.
SPEAKER_01:So if you had somebody come in, obviously you'd recommend sunscreen, retinoids for them, topical vitamin A forms, and you might talk about vitamin C. If they wanted to know, you know, well, should I use topable estrogen? Who do you really recommend it for? And what benefits do you feel like it's bringing to the skin?
SPEAKER_02:I think the benefits are going to be a little bit extra moisture and a maybe increased collagen, although I think that's going to be difficult. I think the retinoids are going to still be better with that. But again, there aren't any studies yet. Um, and I would probably have them use it at night if it's the heavier version, if they're using the um over-the-counter, the generic estrogen, which is very cost-effective, like$15 to$20. And if not, to try to get it in these other forms, estriol, because it'll be more pleasant to use in the morning under your makeup.
SPEAKER_01:Do you feel like there's any drawbacks to potentially using the topical estrogens or when you feel like it wouldn't be beneficial for somebody?
SPEAKER_02:I think some people may have problems with getting some acne breakout. So maybe very oral derm. They talk about it maybe causing uh melasma or pigmentation, but that's not been shown yet. I would think that would be dependent on if you're very prone to it already. But uh at this point we're not seeing it.
SPEAKER_01:Okay. So pretty safe overall for most people to use. And and with the compounding, is there certain, you know, concentration or is it kind of all the same the way you approach it if somebody has it handmade at a pharmacy?
SPEAKER_02:I've only used certain companies. I've I've used skin medicinals, and I know like they have an estriol that at first was a little bit more liquidy, and we gave them feedback and said, you know, it's kind of running off your face. In fact, I was treating one hand and one arm to see if I could see moisture. You know, I thought that I might be able to see it more on my hands than actually using it on half your face, which is a little difficult. And so then they reformulated it to make it a little more creamy. As we know in Durham, so much of things is about the base because you could get an irritation or allergic reaction to what the estrogen is in, and you may not be actually allergic to the estrogen.
SPEAKER_01:And base, you know, I guess what we know now, and I know things obviously change in medicine. We get more information, more data. If somebody came in and said, you know, can I use an estrogen cream? You know, I do have a history of breast cancer, or I have a family history, you know, of ovarian cancer. Like, is there any hesitation do you feel like of bringing these on board to use for this game? Because a lot of people might listen to this and say, I want to go out and buy me some estrogen. And I kind of want to give them some guidance on what your thoughts are on based on what we just know right now.
SPEAKER_02:I guess I still honor the oncologists in this process. I feel like even until they give them the blessing that it's okay to use it, although very little is being absorbed. I know that some of our patients that have had breast cancer are clear to use vaginal estrogen, which of course absorbs more in that mucosa than it does on the face. But I think, you know, we still have to have them work with their oncologists. If it's, especially if it's been recent, I think in the last five years of having breast cancer, I think it's only fair to do that.
SPEAKER_01:That that's good, you know, I think food for thought for our patients because I would say they can have access to vaginal estrogen very easily, just walk into the drugstore and pick it up. And sometimes I think we assume always because things are over the counter, right, that it's going to be perfectly safe. But you're right, maybe they're oncologists and certain history or context may not be so comfortable with that. So I like to kind of give people that that little nugget there so they kind of think twice about it too, and make sure they have that conversation. And when you talk about the benefits, kind of going back to that, sounds like really the hydration piece, is where you've seen the maximum benefit for patients. And I assume then, too, you're recommending this. Then you also will treat vaginal skin as well.
SPEAKER_02:I'm sorry, you could just say that again. Vaginal skin. I don't know why it's dinging.
SPEAKER_01:You're fine. I don't know why it's um it's probably an alert on an email, I think.
unknown:I don't know.
SPEAKER_01:Um and so um the qu the question I was asking is you know, do you feel like, you know, as dermatologists, you mentioned before, we're experts to technically in the vaginal area as well. Do you tend to manage patients and treat vaginal skin as well with topical estrogens?
SPEAKER_02:I've done that much more than having them use it on the face, honestly. From age 60 to 85-year-old just came in recently. And you know, the as we know now, it helps the microbiome, it helps the skin be healthier, it helps around the urethra, it helps us get less uh urinary tract infections. And as Rachel Rubin says, it could save lives because many women end up in the hospital when they're older with a bladder infection. So it that's been very interesting, and not to mention not having itching, burning, painful intercourse. And we can't judge people by their age. Conversation shouldn't stop. The there's sort of this 10 years after menopause is when you can be on, I think that's gonna change when you can be on replacement. But I think you can have this conversation about vaginal estrogen with an 85-year-old. This is not something that we should judge if they are having symptoms or if they want to take that risk benefit of using the vaginal estrogen.
SPEAKER_01:So are you using it to, you know, obviously vaginal area mentioned, also recommend potentially for face, especially if somebody, I assume if somebody has dry skin or their particular instances or skin issues, if somebody came with particular skin concerns, like how do you like, I guess, figure out that this is like the perfect patient? I feel like we need to start talking about topical estrogen for your face.
SPEAKER_02:I don't know if I'm there yet.
SPEAKER_01:Fair enough.
SPEAKER_02:I really, I really think we're gonna need more studies because we have so many other great products. We know that peptides are wonderful for the skin. We know that the retinol are, we know that, you know, so I don't know where it's gonna play. About two years ago, when I was asked that question, I rolled my eyes because I thought, come on, let's unless I'll wear uh tinted sunscreen first and not try to go for that one-hit wonder. I really think that it's some multiple things that are gonna help. Your diet affects you, you know, the your your other habits affect you. It's not gonna be just one cream like estrogen on the face, it's gonna make the difference. But maybe it'll be helpful for moisture and having the skin look more uh lubricated for sure.
SPEAKER_01:Okay. So it sounds like then if somebody comes into the office, you're trying to pinpoint who would benefit, you're you're really integrating in usually to a routine that obviously includes something we talked about before, topical vitamin A, sunscreen, maybe a vitamin C, that type of thing. And then if you're like, well, there's still complaining of dryness or something else. Do you do you think it replaces true moisturizer? Again, is it sort of like an add-in to the whole regimen?
SPEAKER_02:I think it's an add-in, especially on the face. I think I I don't think we can see yet that it's gonna help other parts, or maybe it's gonna be too much would be used. Um I am curious about how it will help creepy skin because we're seeing so much creepy skin on the arms, and especially with our GLP1 weight loss patients. So I think that's gonna be super interesting to see what the next phase is. Or will we have it compounded with other ingredients, you know, that help help moisture and help the creepiness of the skin? Do you have any tips for that creepy skin?
SPEAKER_01:Yeah, I feel like often that's one of the things we struggle with the most. And you're right, I think estrogen actually could play a role. We actually have some patients that were sort of playing around with that a little bit now on the crepiness factor, because we do struggle, you know, with different types of moisturizers. We've tried to try to rebuild some of those lipids in the skin and build the integrity. And I agree with you with the GLP1s, we've seen a lot of people come in. And, you know, I have to say a lot of the things we recommend are helpful, but they're not as dramatic, I think, as what patients are expecting. You know, you can see some level of improvement, but a lot of people, it's just beyond what you know, I think a topical can maybe accomplish. And that's where I feel like people are trying to look for other procedures to help with that skin. But I feel like it's an area that we struggle with to really give great improvement. Uh, so I'm hopeful with some of the new products that are out, um, with Cetophiles, and these other new things that have come to light, I think are actually going to change, you know, sort of the landscape a little bit. But at the same time, often I think there's multiple things we're doing to try to get patients where they want. But satisfaction, I feel like, is overly low sometimes. Isn't that that?
SPEAKER_02:You're getting a little fuzzy and crackly. Uh do you know that?
SPEAKER_01:No, on my audio, it sounds crisp. So you have a little bit of echo on yours, a little background echo.
SPEAKER_02:Oh, okay. Um, like you're all fuzzy right now.
SPEAKER_01:Okay, yeah. No, you um it's clear on my end. Yeah, your yours was a little fuzzy. It's going fuzzy again, like early when we started. Um, so I don't know. I'm looking here at the preview. It's showing my crisp on the preview upload. So it might be the internet on your end a little bit where I'm coming through. Oh, okay.
SPEAKER_02:Okay, I'm sorry, I didn't want to go too long.
SPEAKER_01:You're fine. I appreciate you now. What other thing? You're good. I was gonna talk about like an office procedure. Are there other things that you wanted to talk about too, with kind of that you like to emphasize with the estrogens based on what I kind of sent through?
SPEAKER_02:Uh let's see. I don't know if I want to get into the MPEL since I've never used it.
SPEAKER_01:I voided out since you mentioned that, so I didn't go into that.
SPEAKER_02:Um Yeah, I guess we can just summarize with uh what other things build collagen. Can you hear me okay?
SPEAKER_01:Yeah, you're coming here, no problem. My video and your voice, the echo's gone.
SPEAKER_02:So I think like what we've said, we've have so many great tools in our toolbox as dermatologists, that we we know we often have to do multiple things, that one treatment pattern is not good for all people. And so there's the prevention component with the sunscreen, there's the rejuvenation component with what you can do at home, and then oftentimes, you know, doing a laser, such as I think Fraxel and LASEMD Ultra, which are kind of similar wavelengths, the 1927 for pigmentation, and then Fraxel has the 1550, that's good also for building collagen, that these are great ways to build collagen that it's been lost with, you know, going through menopause with sun damage. Because we know, again, that we're not just losing collagen because our hormones went down. We're also losing it because of sun damage and dietary changes. So I think that's a great thing to emphasize that you can do kind of low downtime procedures. You may only have to be red for 24 hours. You then might have some roughness of your skin for a week, but there seems to be a lot of brightening and improvement of the skin with these procedures. Um, I think it's fun to remember that back in the 50s, all the way until the FDA was approved, there was actually estrogen in over-the-counter creams, Helena Rubinstein's creams, and you know, no wonder our moms were buying these anti-creams. I just thought it was a made-up story until I found it. And um it wasn't until the FDA came out that they needed to have regulations that they stopped it. So this is not new information. The other fun thing is to find a book in your house called The Silent Passage from the 90s. And if you read the quotes there, the same issues were being addressed with physicians and they they paint a pretty nice picture about how doctors were talking about it. But I think we want to do even better. We want to really like, you know, treat the whole patient. We want to guide them to people who can help them with their hormone replacement path so that they don't suffer through a lot of these things. And we know using the GLP1s, the weight loss drugs are also really decreasing inflammation on our body. So we have a lot of tools that I think are going to help us in the next 10 years.
SPEAKER_01:Well, and as we look forward to that, and if there's listeners out there that are kind of in that perimenopausal menopausal state, any kind of final, like maybe top like three skin tips that you have for them as they're kind of battling some of these changes?
SPEAKER_02:Well, go to a dermatologist to help you, especially if you're starting to get acne or excess hair or hair loss. We've we're we're the experts, we've been doing this forever. And also to continue to wear your sunscreen, try to be careful with trendy things that that can be irritating or uh, you know, dangerous with your skin. You may not realize it. So many things that are natural often have tons of fragrance, tree extract, things you might already know you're allergic to. So natural is not always better, but natural can be just using simple cleansers, moisturizers, sunscreen, and then your kind of medical grade, more you know, intense products.
SPEAKER_01:And I think too, the lesson we've learned in our short conversation or today is really you don't have to really grin and bear it anymore. I think there's people out there to help you through. Yes, it is a natural process in life, but again, I think always with that comes some challenges that people just don't, again, have to just put up with. We can help people, women in particular, just make menopause, you know, and the next journey in life, but hopefully a much better one than what we've done historically for people.
SPEAKER_02:Absolutely. And I hope in a year when we talk about this, we have so many more studies, so much more experience that we've shared amongst ourselves because that's how we're gonna learn by talking to patients, listening to them, and seeing how they do over the next year.
SPEAKER_01:So it's thanks for coming on, Brenda. We'll have to invite you back on once we get more information, see where we're headed to next on this topic. Um, but you know, I think we definitely have some good you know insight on potentially hydration with that estrogen cream, but other important components of skincare as we've talked about, and so many other things we can talk about with the menopause and the skin. So we'll have to bring you back on to go over some of those. But thank you so much for coming on. Thank you. It's wonderful. And stay tuned for the next episode of Dermotrotter Don't Swear About Skin Care.
SPEAKER_00:Thanks for listening to Dermot Trotter. For more about skincare, visit dermittrotter.com. Don't forget to subscribe, leave a review, and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.
