Can You Get Melasma During Menopause?

When I was pregnant, I got brown freckle-like patches on my face, and they faded shortly after I gave birth. My doctor told me they were called melasma. I’ll be 50 in a few months and am noticing the same thing happening. Is it possible to get melasma during menopause?

—Anonymous

Melasma is a darkening of the skin caused by increased activity of the pigment-producing cells of the skin called melanocytes. Two common triggers of melasma are sun exposure and hormones, in particular estrogen and to some degree progesterone.

As a result, when hormone levels are higher, such as during pregnancy, melasma is more likely. Pregnancy is a common culprit — one of my medical school professors called it “the mask of pregnancy.” But pregnancy isn’t the only time when melasma can appear; some women experience melasma when taking birth control pills as well.

During the late-reproductive stage and perimenopause, estrogen levels rise higher and fall lower than during the peak reproductive years. As a result, perimenopause is also a time when melasma can crop up. Some women will also get melasma from taking hormone therapy. But after menopause, estrogen levels are typically low and melasma should disappear.

Some women are more prone to melasma than others. Lighter skin appears to be a risk factor. Certainly if you have had melasma in the past, you are more likely to develop it again.

The best thing you can do to decrease melasma is to use sun protection, including sunscreen and protective clothing, consistently. If you are taking hormone therapy, you might consider seeing if a smaller dose could manage your perimenopausal symptoms just as well as a larger dose. A dermatologist can prescribe topical treatments that can reduce the appearance of melasma too. And know that after menopause, your estrogen levels will come down and this will likely reduce the appearance of your melasma, just as it improved after pregnancy.

The upshot: Melasma can be triggered by high estrogen levels, and estrogen levels can be high during the late-reproductive stage and in perimenopause. Reducing sun exposure and some topical treatments can improve the appearance of melasma.