This article reviews the link between melasma and hormonal birth control. It also covers birth control methods that don’t cause melasma, when to see the healthcare provider and treatment.
The Link Between Melasma and Birth Control
Hyperpigmentation causes dark skin patches, as you see with freckles and liver spots. Melasma is hyperpigmentation caused by female hormones (estrogen and progesterone) and sun exposure.
Oral contraceptives (hormonal birth control pills or OCPs), hormone replacement therapy, and pregnancy cause estrogen levels to rise, increasing pigment production.
Hyperpigmentation caused by age and sun exposure usually appears on the side of the face, cheeks, and jawline. Melasma is often called the “mask” during pregnancy. That is because it usually develops in the following areas of the face:
Forehead Nose Upper lip CheeksChin
While melasma can affect anyone, it is more common in young women. For women over 50, dark spots are usually due to age and sun exposure rather than hormones.
What Types of Birth Control Don’t Cause Melasma?
Birth control methods that don’t involve hormones like estrogen and progesterone do not cause melasma.
Approximately 40% to 50% of melasma is triggered by oral contraceptives or pregnancyAbout 25% of women taking hormonal birth control pills develop melasmaForty-one percent of women have melasma during pregnancyThose who develop melasma in pregnancy are more likely to have it when taking hormonal birth control Fifty-five percent to 64% of people with melasma have a family history
Common non-hormonal birth control methods include:
Birth control sponge Cervical caps Diaphragm External condoms Internal condoms Non-hormonal intrauterine device (IUD) Phexxi (hormone-free gel inserted into the vagina before sex) Spermicides
While barrier methods such as condoms offer the added benefit of preventing sexually transmitted infections (STIs), some people prefer oral contraceptive pills. This could be because it gives them more control over pregnancy prevention, or they take them for treatment of period problems.
There is little documented about melasma and IUDs, but a small study showed improvements after switching to a levonorgestrel-releasing IUD. Talk to your healthcare provider to learn if an IUD is right for you.
Treating Melasma From Birth Control
Treating melasma starts with decreasing sun exposure and talking with your healthcare provider about changing birth control methods. It usually fades once you stop taking hormonal birth control.
Your healthcare provider may also recommend a combination of treatments, including topical (on the skin) prescription medications and brightening creams. Melasma is not harmful, so treatment is strictly cosmetic and optional.
Topical skin lightening creams include:
Hats Stay in the shade or use an umbrella Sunglasses Sun shirts Sunscreen
Alphaquin, Eldoquin, Lustra, Melanex, Melquin (hydroquinone): Hydroquinone cream is the most studied and used treatment for melasma. Avita, Refissa, Renova, Retin-A (tretinoin) mixed with Dermacort, Dioderm, Lanocort (corticosteroid): Tretinoin is a retinoid derived from vitamin A and helps reduce dark spots. Corticosteroids decrease inflammation. TRI-LUMA (hydroquinone, tretinoin, corticosteroid): This triple combination cream is one of the most effective treatments for melasma. Lysteda (tranexamic acid): A promising oral treatment; more research is needed to study its long-term effectiveness and safety.
Some small studies show that over-the-counter (OTC) skincare products with the following ingredients have some success in decreasing hyperpigmentation:
Ascorbic acid (Vitamin C) Alpha hydroxy acid Aloesin Azelaic acid Glycolic acid Licorice extract Lignin peroxidase Niacinamide Soybean extract
When to See a Healthcare Provider
While melasma is harmless, it’s best to see a healthcare provider specializing in dermatology before starting treatment so they can rule out other conditions that could cause melasma.
Contact your healthcare provider for the following as well:
You need to change your birth control methodYou have dark spots that do not fade after stopping birth control You have dark spots that do not fade after the delivery of your baby
Summary
Melasma is a type of hyperpigmentation that causes dark patches on the skin. Female hormone shifts from pregnancy or hormonal birth control can cause melasma. Treatment usually involves stopping hormonal birth control, minimizing sun exposure, topical medications, or specialty treatments. Talk with your healthcare provider before stopping birth control. They may suggest other forms of birth control, such as an IUD or barrier device.
A Word From Verywell
While melasma is not harmful, it can affect your appearance and negatively impact self-esteem. It typically fades after stopping birth control or delivering your baby, but it can take a few months. If your melasma doesn’t fade, discuss topical creams or specialty skin treatments such as laser therapy with your healthcare provider.
