*Content reviewed by HotPause Health Medical Advisor, Dermatologist, Dr. Marisa Chapman

Melasma In Menopause

Melasma is a common skin condition that causes dark, flat patches of brown or grayish pigmentation. It is much more common in women, who account for between 80 and 85% of cases and up to 50-70% of women are affected during pregnancy. While it presents mostly on your face, it’s not shy about appearing on other sun-kissed spots like your forearms and neck. Though commonly linked with pregnancy, melasma can also sneak up as a symptom of perimenopause and menopause. Given the body’s ever-changing hormone levels, melasma becomes prevalent during these times of hormonal transitions. Beyond the skin, melasma can deeply affect a woman's confidence and social life due to its visible and often prominent placement. Don’t worry, we have some tips to help.

Why Does Melasma Happen in Menopause?

The exact cause of melasma is complex and not fully understood, but the main culprit is an overzealous production of melanin by those tiny pigment factories in your skin called melanocytes. Your genetic makeup, the amount of sun you soak up, and, yes, the hormonal roller coaster of menopause, also all play a part.

What Can You Do About Melasma in Menopause?

Talk to your doctor to see if any of these treatment options might be a good fit to help treat Melasma.

• Sun Protection: Using a broad-spectrum physical sunblock that contains zinc and iron oxide is crucial as it protects against both UV and visible light, key triggers for melasma.
• Topical Treatments: Options include:
  • Hydroquinone: A skin-lightening agent, often used in a combination formula with a retinoid and a steroid, it reduces the development of dark pigmentation
  • Natural Lightening Agents: There are several other ingredients that can help minimize pigmentation, including licorice root, kojic acid, Vitamin C, niacinamide, glycolic acid and arbutin.
  • Azelaic Acid: Helpful for maintaining skin tone after initial treatment with stronger products.
  • Cysteamine Cream: This newer treatment reduces melanin production and offers antioxidant benefits, useful for ongoing management.
• Chemical Peels: Various types of peels can be used to remove layers of skin, including unwanted pigment, to reveal healthy underlying skin cells.
• Tranexamic Acid: Typically reserved for more stubborn cases of melasma, there are two forms of tranexamic acid, topical and oral. The pill form was originally approved to treat bleeding disorders, but can also be used to treat decrease melanin production. Use is limited to a 3-6 month duration, given its increased risk of blood clot events; this medication should only be taken under the supervision of your physician.
• Laser Therapy: While not a first-line treatment, laser therapy can be considered for persistent cases that do not respond to topical treatments. Lasers treatments should be performed by experienced professionals, as they can actually make melasma worse if used incorrectly.