Can Perimenopause Cause Hyperpigmentation? We Answer This Question Along with Several Others About Melasma

Skin hyperpigmentation often coincides with the aging process, but that doesn’t necessarily mean that one thing leads to another. Uneven patches of darkened facial skin on the forehead, nose, cheeks, upper lip, and chin could be the result of previous sun exposure, genetics, hormone replacement therapy (HRT), a fluctuation or surge in sex hormones, or a reaction to certain skin care products or medications. If you have brown or grayish-brown patches in these areas, they may also be caused by a medical condition known as melasma.

What Is Melasma and Who’s At Risk?

Melasma can affect anyone, including men, but 90% of cases occur in women, and medical professionals estimate that up to “33% of the population may get melasma…between [the ages of] 20 and 40.” According to the American Academy of Dermatology Association, people of color have a higher risk of developing melasma because their skin naturally contains more pigment-producing melanocytes than lighter skinned people. And individuals that live in areas with high sun exposure are particularly at risk.

How Is Melasma Diagnosed?

Although discoloration of the face can be distressing and may impact your self-esteem if it lingers for a prolonged period of time, the condition, itself, is not serious or harmful, and there are no symptoms that cause discomfort. Dermatologists often diagnose the condition simply by visually inspecting your skin. On occasion, they may use a Wood’s lamp to measure the depth of the discoloration, and on even rarer occasions, a skin biopsy may be taken in order to rule out a more serious skin condition.

Do Hormones Play a Role in Skin Discoloration?

Hormones play so many important roles in helping the body remain healthy, but sometimes they cause unwanted skin discoloration. Researchers believe that estrogen and progesterone may trigger excess pigmentation production during different stages of a woman’s life, including pregnancy and perimenopause. The condition is so common among obstetric patients during the last three months before giving birth that it has earned the moniker “the mask of pregnancy.”

Since many perimenopausal women experience erratic or heavy menstrual periods in the time leading up to menopause, their doctors often prescribe contraceptive birth control pills to normalize cycles and minimize heavy flow. Unfortunately, the estrogen and progesterone in oral contraceptives can trigger excess pigmentation and cause melasma.

Can Sun Exposure Trigger Melasma or Make it Worse?

Just like the dark spots that surface decades after sun exposure, melasma has been linked to the sun. Not only can the sun cause melasma, but it can also make it worse. Between the UV rays, the visible light, and the heat the sun puts off, your skin can react by producing more pigment to protect itself. Unfortunately, when melanin production is triggered, it may result in an uneven skin tone that can linger for months at a time. 

Unfortunately, there’s no surefire way to know exactly what triggers melasma, especially where perimenopausal hormone fluctuations are concerned. According to Dr. Shadi Kourosh, the director of the Pigmentary Disorder and Multi-Ethnic Skin Clinic at Harvard-affiliated Massachusetts General Hospital, “Underlying factors such as hormonal changes may not manifest until a person goes on vacation to a southern location like Florida, or during the summertime when she spends more time in the sun.”

What At-Home Procedures Should Be Avoided If You Have Melasma?

Taking matters into your own hands may be tempting, but keep in mind that melasma generally gets worse when the skin is aggravated. Harsh physical scrubs may make arms and legs feel baby soft, but avoid using them on your face to minimize irritation. If you occasionally wax your brows, upper lip, or chin to remove excess facial hair, look for alternative hair removal methods to avoid irritating areas that have melasma.

Ingredients That May Help With Melasma

  • Azelaic acid and tretinoin, also known as Retin-A, speed up skin cell turnover, which can eliminate darkened patches quicker than normal. Dermatologists often recommend using these ingredients in tandem with hydroquinone to lighten discoloration on the face.
  • Niacinamide, also known as vitamin B3, “has anti-inflammatory properties and is able to decrease the transfer of melanosomes.” When treating discoloration of the face, choose serums that have niacinamide near the top of the list to ensure you’re getting the highest concentration possible.
  • Vitamin C’s antioxidant properties prevent skin from absorbing damaging UV rays while fighting off free radicals. If you opt to use vitamin C, be sure to use sunscreen as well because some forms of vitamin C can make your skin more sensitive to the effects of the sun.
  • Kojic acid, a popular staple in Korean skincare and a natural compound found in mushrooms, reduces the amount of pigment in melanocytes. Before adding kojic acid to your routine, discuss your options with your dermatologist since it can be irritating to the skin.
  • Hydroquinone lightens discoloration and comes in both over-the-counter and prescription strengths. As with many promising treatments, it does have potential downsides and may actually cause further skin darkening (ochronosis) over time, so use should be kept to a minimum and overseen by a physician.

Some Aesthetic Procedures May Help As Well

Beyond at-home ingredient-based solutions, you may want to consult with a dermatologist regarding in-office treatments or medications to improve your melasma. Chemical peels, light-based therapy, laser procedures, microneedling, and microdermabrasion may improve your skin, but not everyone is a good candidate for every procedure. In some cases, intense pulsed light (IPL), microdermabrasion, and chemical peels worsen the condition, so seek a reputable board-certified dermatologist before undergoing any form of treatment for discoloration on the face.

One Must-Have Skin Care Product

Since the biggest known trigger of melasma at any age is the sun, it’s important to include sunscreen in your daily routine. Many people prefer chemical sunscreen products because they don’t leave a white cast behind, but doctors caution that using them only converts the UV rays on contact instead of reflecting them away from the skin.

Doctor Kourosh says, “You want to choose the non-chemical, blocking sunscreen, because that will stop all the light and different wavelengths from coming through.” Look for the words zinc oxide or titanium oxide on the label to ensure your sunblock doesn’t further aggravate your melasma.