Publisher Summary The maintenance of skin function and appearance is important and plays an influential role in the quality of life for women who can spend up to one-third of their lives in a hypoestrogenic state. Ideally, a safe and effective topical hormone replacement preparation without systemic adverse effects would be a highly desirable treatment for hypoestrogenic skin. Menopausal skin effects occur within the overall background of progressive inexorable intrinsic alterations that are superimposed changes over extrinsic changes, principally due to cumulative ultraviolet exposure. The principal way to discern skin alterations related to hypoestrogenemia occurring in menopausal women is through study of the amelioration that occurs after estrogen-based hormonal replacement. Dry skin complaints are common and generally can easily be treated with small alterations in personal lifestyle habits. Significant menopausal-associated sweating can be managed with estrogen-based hormone replacement therapy (HRT) or other systemic therapies. HRT helps to maintain or restore collagen and skin thickness, possibly dampening of the pace of development of fine wrinkles, increasing skin strength, improving acute wound healing rates, and perhaps preventing skin breakdown in elderly postmenopausal women.