Managing Menopausal Skin Changes: A Narrative Review of Skin Quality Changes, Their Aesthetic Impact, and the Actual Role of Hormone Replacement Therapy in Improvement

Abstract

Background: The decline in estrogen during menopause contributes to structural and functional skin changes, including decreased collagen production, reduced elasticity, and moisture loss, resulting in dryness and wrinkling. Today, hormone replacement therapy (HRT) enhances skin quality by promoting collagen synthesis, elasticity, and hydration. Minimal invasive aesthetic treatment could add value to this patient group. Methods: To assess the relationship between menopause, hormones, and HRT on skin health, we conducted a comprehensive literature search using the terms (menopause OR menopausal) AND (aging OR aging) AND (skin) AND (estrogen OR estrogen OR hormones) AND (hormone replacement therapy OR HRT). To explore aesthetic treatments specific to menopausal women, searches included (“menopause” OR “menopausal”) AND (“aesthetics” OR “aesthetics” OR “cosmetic” OR “filler”). Additional studies were identified from references in the uncovered articles. Results: We reviewed the impact of hypoestrogenism and HRT on menopausal skin and identified unmet needs in its aesthetic management. Most studies reported positive associations between HRT and improvements in menopausal skin aging, but findings were sometimes inconsistent. Despite decades of research, clinical guidelines do not support HRT use solely for estrogen-deficient skin due to a lack of robust clinical trials on skin-specific therapy. Many women remain unaware of the skin-related impacts of menopause, which can affect quality of life, and few aesthetics studies analyze data based on menopausal status or HRT use. Given the growing demand for aesthetic treatments in this population, future studies should intentionally incorporate demographic data and analyses on menopausal status and HRT use.