Melasma and menopause: what you need to know

Discover the role of hormones in melasma, a common skin condition, and how to manage it

• Melasma is a skin condition that causes patches of pigmentation, usually on your face
• Hormone changes in pregnancy and menopause can aggravate the condition
• Management approaches include sunblock, topical creams and laser therapy

Melasma is a common skin condition when patches of skin develop a brown or greyish pigmentation. Melasma mainly develops on your cheeks, forehead, upper lip, nose and chin. But it can affect any area of your face and other areas of your body exposed to the sun, such as your forearms and neck. Areas of melasma are flat, not raised.

Who is at highest risk?

It is much more common in women, who account for between 90% and 95% of cases [1]. Up to 50% of women are affected during pregnancy, hence the name ‘pregnancy mask’, according to the British Association of Dermatologists (BAD).

Sometimes men are affected, but much less frequently. Melasma is more common in people of colour and those who tan very easily.

RELATED: Skin, hair and nail changes in menopause: a dermatologist’s guide

What causes melasma?

The exact cause is not known, but it is thought to be because of pigment-producing cells in your skin called melanocytes producing too much pigment (melanin). The three main factors that seem to contribute to the condition are genetics, those with a family history have a higher risk, sun exposure and hormones.

Melasma is not just a skin discolouration problem. It’s a complex, chronic, inflammatory, serious skin condition. It can seriously affect the quality of life of people who develop the condition and it can impair social comfort because of the appearance of it. It is not like a tan, and the sun is just one factor.

What about the sun?

Sunlight is an important factor in stimulating your melasma. Patients mostly notice worsening melasma between April and July. This is because the ultraviolet (UV) light and the visible light in the sun triggers or worsens the condition, by stimulating pigment production.

RELATED: 7 common sun protection mistakes – and how to avoid them

What role do hormones play?

Your hormones can play a role in causing melasma, although it is not yet understood exactly how. Some women’s skin patches are triggered by times when hormones change: pregnancy, starting the contraceptive pill or using HRT can all start or trigger the condition [2, 3]. The hormone oestradiol can stimulate melanocytes, which are the cells that make melanin, the skin pigment [4].

RELATED: Skin changes during the menopause

How can melasma be managed?

Firstly, invest in a good broad-based sunblock that is tinted, which means it contains iron oxide. This will protect you against both UV light and visible light.

You should be absolute scrupulous about its use, as even a short exposure to sunlight can undo your hard work. Sunblock is crucial and for some people, sunblock may be enough treatment.

What else can I use to treat my melasma?

There are a number of different products that can help reduce the impact of melasma:

Hydroquinone is the most commonly prescribed product. It works by reducing the production of dark pigmentation in your skin. It comes mixed with two other products, tretonin and a steroid, to become what is called the triple formula or Kligman’s formula. This can only be used for three or four months but is effective in about 60 to 70% of people.

Azelaic acid is a good maintenance product after you have used hydroquinone to help prevent melasma returning. It is a cream that can be bought over the counter.

Cysteamine is a product that works well for maintenance. It helps block the production of melanin and works as an antioxidant, which may also have an impact on your malfunctioning pigment-producing cells. This product, which you put on your face for five to 15 minutes a day and then wash off, is also available over the counter.

In addition, there are botanical products derived from plants including soy and liquorice, that may have some anti-pigmentary effects.

RELATED: Do you really need a menopause moisturiser?

What about in-clinic treatments?

There are several in-clinic treatments, such as laser therapy, which are sometimes used alongside topical creams. Laser can be very effective for melasma [5].

These treatments are not usually available on the NHS, so if you are considering this kind of approach for melasma it is advisable to seek a proper medical assessment from a doctor, rather than seeking care for this complex condition at a high street beauty therapist.

RELATED: Melasma: keeping hyperpigmentation at bay in the summer

References

1. Wang J.Y., Zafar K., Bitterman D., Patel P., Kabakova M., Cohen M., Jagdeo J. (2025), ‘Gender, Racial, and Fitzpatrick Skin Type Representation in Melasma Clinical Trials’, J Drugs Dermatol, 24(1):19-22. doi: 10.36849/JDD.8379
2. Jang Y.H., Lee J.Y., Kang H.Y., Lee E.S., Kim Y.C. (2010), ‘Oestrogen and progesterone receptor expression in melasma: an immunohistochemical analysis’, J Eur Acad Dermatol Venereol, 24(11) pp1312-6. doi: 10.1111/j.1468-3083.2010.03638.x
3. Filoni A., Mariano M., Cameli N. (2019), ‘Melasma: How hormones can modulate skin pigmentation’, J Cosmet Dermatol, 18(2) pp458-463. doi: 10.1111/jocd.12877.
4. Cario M. (2019), ‘How hormones may modulate human skin pigmentation in melasma: An in vitro perspective’, Exp Dermatol. 28(6) pp709-718. doi: 10.1111/exd.13915.
5. Lai D., Zhou S., Cheng S., Liu H., Cui Y. (2022), ‘Laser therapy in the treatment of melasma: a systematic review and meta-analysis’, Lasers Med Sci, 37(4) pp2099-2110. doi: 10.1007/s10103-022-03514-2.