Estriol face cream is a compounded estrogen cream applied to the face to treat the thinning, dryness and fine wrinkles that can follow falling estrogen around menopause. Two small 1990s trials without a placebo group enrolled 18 and 59 women before or around menopause.1,2 On both a 0.3% estriol cream and a 0.01% estradiol cream, skin elasticity, firmness, moisture and wrinkle depth improved over 6 months.1,2 Prolactin rose in the larger trial, and no hormonal side effects were noted.1,2 Estriol is not FDA-approved in the United States.3 Your physician weighs that evidence against your hormone history and your goals before prescribing it.
How Estrogen Shapes Your Facial Skin
Estrogen helps your skin hold its structure. A review in the American Journal of Clinical Dermatology describes estrogen as preventing a decrease in skin collagen in postmenopausal women. Topical and systemic estrogen therapy can increase collagen content and so maintain skin thickness.4
The same review links estrogen to skin moisture. It raises hyaluronic acid and related water-holding compounds in the skin and may help maintain the outer barrier layer.4 Wrinkling may also respond, through estrogen's effects on collagen and elastic fibers.4
The 1996 trial's authors noted that skin aging tends to begin alongside other perimenopausal symptoms, and suggested falling estrogen as a common factor.1 The stages of menopause explain where you may be in that transition. Once you know where you are on that timeline, your physician can match treatment to it.
What the Estriol Face Cream Trials Found
Two trials from the same lead author, both from the 1990s, tested estriol on the face. Neither trial enrolled postmenopausal women.1,2 Each compared estriol with estradiol, and both measured results at 6 months.
The 1994 pilot. Eighteen perimenopausal women applied either a 0.3% estriol cream (8 women) or a 0.01% estradiol cream (10 women) for 6 months, with monthly dermatology visits.2 Both groups improved. The authors reported that the estriol group's results were "slightly superior with regard to their extent and onset." No hormonal side effects were noted, either clinically or on hormone monitoring.2
The 1996 trial. Fifty-nine women nearing menopause used the same two creams. After 6 months, elasticity and firmness had "markedly improved," and wrinkle depth and pore size fell by 61 to 100% in both groups.1 Skin moisture rose. Biopsies in 10 women showed more type III collagen and more collagen fibers by the end of treatment.1
These trials are small, and their results are encouraging. Neither abstract reports a placebo group, and neither followed women past 6 months.1,2 If you start estriol cream, those trials give you a realistic frame: a months-long trial with your physician, judged at follow-up visits.
Other Topical Estrogens Tested on Facial Skin
Other estrogen creams have their own trials, and the results vary by the estrogen used and the skin being treated.
| Trial | Estrogen tested | Women | Length | Main finding |
|---|---|---|---|---|
| Creidi 19945 | Conjugated estrogen (Premarin) cream vs placebo | 54, aged 52 to 70 | 24 weeks | Thicker skin and fewer fine wrinkles than placebo |
| Silva 20176 | Estradiol vs genistein (a soy compound) | 30, aged 45 to 55 | 24 weeks | Both raised facial collagen, estradiol more so |
| Yoon 20147 | 1% oestrone vs vehicle | 80 postmenopausal | 24 weeks | No gain in wrinkles or elasticity on sun-exposed skin |
The Premarin trial was randomized and double-blind. Roughness, laxity and mottled pigment improved in both groups, with no difference between them, and no woman stopped for a safety reason.5 Each participant also used a daily sunblock.5
The oestrone trial found a risk signal. Treated skin showed a 10.3-fold rise in MMP-1, an enzyme that breaks down collagen. The authors concluded topical oestrogen "may be deleterious in ultraviolet-induced skin ageing."7
Taken together, the positive trials measured thinning and wrinkles, and the one trial on sun-damaged skin found no gain.5,6,7 Daily sun protection stays part of your plan.
FDA Status and Compounded Estriol
Estriol is not FDA-approved in the United States.3 A 2011 evidence review notes that estriol is widely used in Europe, and that randomized trial data support prescribing only estropipate, estradiol and progesterone for menopausal symptoms.3 Any estriol face cream sold in the US is therefore a product the FDA has not approved.
The 2020 National Academies of Sciences, Engineering, and Medicine (NASEM) review looked closely at compounded hormones. A summary of its recommendations notes that bioidentical hormones are available in FDA-approved formulations. It adds that non-approved compounded preparations are marketed as bioidentical but have uncertain content.8 The same summary calls their wide use, despite a lack of safety and efficacy evidence, "concerning."8
Before you start, ask your physician which pharmacy would compound the cream, what it contains, and why estriol fits your goal better than an FDA-approved estrogen product.
Systemic Absorption and the Safety Questions a Physician Weighs
A face cream is meant to act on the skin, and the small trials looked for effects elsewhere in the body. In a 1993 study, 17 women with a mean age of 57 used estradiol or estriol ointment on the face for 3 months. Their serum hormone levels and vaginal cell smears showed no change that reached statistical significance.9
In the 1996 trial, prolactin was the only hormone that rose, and no systemic hormonal side effects were noted.1 The pilot's authors still advised limiting the concentration and the size of the area treated to keep systemic risk down.2
The North American Menopause Society's 2022 position statement explains that hormone therapy risks differ by type, dose, duration, route, timing of initiation, and whether a progestogen is used. It calls for individualized treatment with periodic reevaluation.10 That statement covers hormone therapy broadly, and your physician brings the same individualized approach to a face cream.
Your physician weighs your personal and family history, any hormone-sensitive condition, and whether you already use systemic hormone therapy. The HRT for menopause guide covers the systemic options. Bring your full hormone history to the visit, so the decision rests on your record.
Estriol Cream Within a Menopause Skin Plan
Estriol cream works on one part of skin aging. The rest of your plan covers sun exposure, sleep, nutrition and the other habits in lifestyle changes for menopause. If your main concern is dark patches, melasma treatment has its own evidence. Vaginal dryness is treated with vaginal estrogen products, covered in vaginal estrogen cream.
The Opt Take on Estriol Face Cream
Skin changes during perimenopause are one sign among several. Your physician reads them as part of a pattern, alongside sleep, energy and cycle changes. The Opt Health women's track supports women through perimenopause, menopause and post-menopause.
Care starts with an in-home blood test or a visit to a local lab partner, covering 55+ biomarkers. A 60-minute physician consultation on Foundation reviews your results. On the Optimization tier, your plan can include specialized prescriptions for hormone imbalances, based on your profile, with up to 4 supplements and 2 prescriptions shipped 4 times a year.
Follow-up labs with a physician consultation repeat 4 times a year on Optimization and twice a year on Foundation. Details are on the women's track page.
Get started: Begin with Opt Health, where a physician reads your labs, builds your plan, and adjusts it over the loop.
Frequently Asked Questions
Estriol face cream is a compounded cream containing the estrogen estriol, made for facial skin. It is used to treat skin changes linked to the drop in estrogen around menopause.1,2 Estriol is not FDA-approved in the United States, so your prescriber is choosing an unapproved product and should explain why it fits you.3
In two small trials without a placebo group, elasticity, firmness, moisture and wrinkle depth improved over 6 months on estriol and on estradiol cream.1,2 Biopsies in 10 women showed more type III collagen.1 Those effects match estrogen's known role in keeping your skin's collagen and moisture.4
The evidence is positive and limited. Two small trials, of 18 and 59 women, reported improvement after 6 months, and neither abstract reports a placebo group.1,2 Trials of other estrogen creams found benefit on thinning and fine wrinkles, and one found no gain on sun-damaged skin.5,7 Your physician can tell you whether your skin changes fit the profile those trials studied.
The estriol trials assessed results at 6 months, with monthly follow-up visits.1,2 The pilot reported estriol's effects as slightly faster in onset than estradiol's.2 The trials reported results at the end of treatment, so a review with your physician after several months of use is the realistic checkpoint.
Some can be. In the 1996 trial, the rise in serum prolactin reached statistical significance, though no systemic hormonal side effects were noted.1 In 17 women using facial estrogen for 3 months, serum hormone levels and vaginal smears showed no change that reached statistical significance.9 The 1994 pilot's authors advised limiting concentration and treated area, which your prescriber factors into your plan.2
The trials reported no hormonal side effects over 6 months, and a 3-month study found no hormone change that reached statistical significance.1,2,9 Long-term safety has not been studied, and compounded preparations have uncertain content.8 Hormone therapy risks vary by type, dose and route, which is why the decision belongs with a physician who knows your history.10
Skin changes in menopause are one part of a hormonal pattern. An Opt Health membership on the women's track starts with 55+ biomarkers and a physician consultation, with follow-up labs and a physician consultation up to 4 times a year on Optimization.
References
- Schmidt JB et al. Treatment of skin aging with topical estrogens. Int J Dermatol. 1996;35(9):669-674. https://pubmed.ncbi.nlm.nih.gov/8876303/
- Schmidt JB et al. Treatment of skin ageing symptoms in perimenopausal females with estrogen compounds: a pilot study. Maturitas. 1994;20(1):25-30. https://pubmed.ncbi.nlm.nih.gov/7877517/
- Conaway E. Bioidentical hormones: an evidence-based review for primary care providers. J Am Osteopath Assoc. 2011;111(3):153-164. https://pubmed.ncbi.nlm.nih.gov/21464264/
- Shah MG et al. Estrogen and skin: an overview. Am J Clin Dermatol. 2001;2(3):143-150. https://pubmed.ncbi.nlm.nih.gov/11705091/
- Creidi P et al. Effect of a conjugated oestrogen (Premarin) cream on ageing facial skin: a comparative study with a placebo cream. Maturitas. 1994;19(3):211-223. https://pubmed.ncbi.nlm.nih.gov/7799828/
- Silva LA et al. Collagen concentration on the facial skin of postmenopausal women after topical treatment with estradiol and genistein: a randomized double-blind controlled trial. Gynecol Endocrinol. 2017;33(11):845-848. https://pubmed.ncbi.nlm.nih.gov/28508697/
- Yoon HS et al. Long-term topical oestrogen treatment of sun-exposed facial skin in post-menopausal women does not improve facial wrinkles or skin elasticity, but induces matrix metalloproteinase-1 expression. Acta Derm Venereol. 2014;94(1):4-8. https://pubmed.ncbi.nlm.nih.gov/23722352/
- Stuenkel CA. Compounded bioidentical hormone therapy: new recommendations from the 2020 National Academies of Sciences, Engineering, and Medicine. Menopause. 2021;28(5):576-578. https://pubmed.ncbi.nlm.nih.gov/33739316/
- Kainz C et al. When applied to facial skin, does estrogen ointment have systemic effects? Arch Gynecol Obstet. 1993;253(2):71-74. https://pubmed.ncbi.nlm.nih.gov/8215610/
- North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. https://pubmed.ncbi.nlm.nih.gov/35797481/
This content is for informational purposes and does not replace evaluation, diagnosis, or treatment by a qualified medical professional.
This article is part of our guide to hormone health. See how hormone replacement therapy works at Opt Health.
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