Honest Conversations

Conversation About Menopause

I got my lab work back today and immediately texted two people with what I considered very exciting news:

I am officially postmenopausal. I made it.

Apparently this isn't how every woman reacts to menopause.

I was genuinely excited.

I texted my best friend and told her I thought some congratulations were in order. After all, I had managed to make it through menopause without killing anyone, divorcing anyone, or cheating on anyone during what I somewhat dramatically described as the dissolution of my sexual prowess.

She responded:

“I am so proud of you!!!”

As she should be.

I was proud of me too.

Then I texted a coworker, who completely understood my excitement. She told me she had recently added estrogen patches and joked that they had “dialed down” her anger.

I told her I think mine may be the only reason I made it.

This is how women actually talk to each other about menopause.

At least the women I know.

And somewhere underneath the jokes is a subject I've become increasingly interested in—not only because I've now experienced it myself, but because I've spent more than a decade looking at aging faces.

“I Swear I Aged Overnight”

I hear some version of this from women all the time.

They'll tell me they were doing fine and then suddenly something changed.

Their skin looks different. It feels drier. Their jawline isn't quite where they remember it being. Their neck seems to have changed. Fine lines aren't quite so fine anymore.

And they'll look at me and say:

“I swear this happened overnight.”

Of course, aging didn't actually happen overnight.

But I understand why it can feel that way.

There are a lot of things happening to the face as we age. We lose collagen. Fat compartments change. The facial skeleton continues to remodel. Skin changes. Years of sun exposure begin making themselves known.

And then, for women, hormones enter the picture.

The decline in estrogen around menopause has real effects on the skin. Skin can become thinner and drier and lose some of its firmness and elasticity. The American Academy of Dermatology notes that collagen loss can be particularly significant during the first several years of menopause.

So when a woman in her late forties, fifties or even early sixties sits across from me and says, “What happened to my face?” there usually isn't one answer.

It's aging.

It's hormones.

It's genetics.

It's sun exposure.

It's changes underneath the skin as well as changes to the skin itself.

Everything is changing—just at different rates.

The HRT Question

Because I work with women every day, hormones come up in conversation more than you might expect.

I routinely ask patients whether they're using hormone replacement therapy as part of their medical history.

And over the years, I've noticed something interesting.

Some of the women I see in their sixties who have been on HRT for years seem to have beautiful skin quality and elasticity. Many also tell me they feel better and have more energy.

But here's where I have to be careful.

Those same women often exercise. Many lift weights. They take care of themselves. They tend to be proactive about their health.

So is it the hormones?

Is it their lifestyle?

Is it genetics?

Probably some combination of things.

I'm observing patients, not conducting a clinical trial.

But it has made me pay attention.

There is research suggesting menopausal hormone therapy may have beneficial effects on skin thickness, collagen and elasticity, although the evidence isn't perfect and more high-quality research is needed.

That does not mean I think women should take hormones to look younger.

I don't manage hormone replacement therapy in my current practice, and this isn't a blog about menopause treatment. HRT is an individual medical decision that should be made with a provider who knows your history, symptoms and risks.

I'm simply fascinated by the relationship between hormones and what I see every day.

And Then There Is Estrogen Face Cream

Yes. Patients ask me about this too.

I've had women ask whether they should put estrogen cream on their faces because they've seen it discussed online.

My answer isn't going to be: Absolutely. TikTok said so.

Research into topical estrogen and skin aging exists, and the subject continues to be studied, but this is not an area where I'd suggest women start experimenting with prescription hormones on their faces based on something they saw on social media. A recent systematic review specifically examined the safety and efficacy of topical estrogen for skin aging, which tells you this is an active area of research—not a settled beauty hack.

There is a difference between interesting science and something every woman should be doing.

Those two things get confused on the internet all the time.

Maybe “Overnight” Isn't So Crazy After All

I used to think it was interesting how many women independently used almost exactly the same language:

I aged overnight.

Now I understand it a little differently.

No, your face didn't suddenly age ten years while you were sleeping on Tuesday.

But women can go through a period when several changes seem to become visible at once. And when the face in the mirror suddenly doesn't reflect the way you still feel, those changes can feel much bigger than a few wrinkles.

I understand that better now.

I'm living it too.

And perhaps that's another benefit of getting older while practicing aesthetic medicine. I'm no longer only explaining aging from the other side of the treatment chair.

I'm experiencing it right along with the women sitting in mine.

For the record, I'm still pretty happy about making it.

Nobody died. Nobody got divorced. And apparently we're all still speaking to each other.

I'd call that a successful transition. 😂