Will menopause help my really resistent case of melasma?

Hello Doctor Irwin, I have struggled with melasma for years, and I have tried all kinds of treatments for it. Some didn't work at all, and others made it worse (like IPL). I have had some success with Obagi but it only reduced the melasma to a certain point and then seemed to hit a plateau. Within the past year, I've reached menopause (early, since I am 42), and so far I had not needed any HRT. So my question is this: does melasma fade naturally when estrogen levels decline? Is it possible that as my hormones change, my problem will go away?

Since melasma is caused, as far as we know, by a combination of female hormones (mostly estrogen) and UV light/sunlight, melasma tends to get better or disappear after menopause. I’ve honestly never seen a case of melasma in a post menopausal woman unless she was on HRT. It should get better especially if you are doing all the things to reduce it. The only thing in the article Melasma in Depth that has changed is that the initial data on Fraxel which was positive in the beginning is not as positive now – since some patients clear initially and then recur and a small percentage get worse with Fraxel laser.


It’s still key to double or triple sunscreen with mineral based sunscreens every day. For example, use mineral based sunscreens like the SkinCeuticals Physical block with the Colorscience powder over it.


Sometimes, if the melasma is really resistent it is worth a small biopsy to make sure it really is melasma. There are other skin diseases that can cause pigment problems on the face – please discuss this with your dermatologist. I saw a patient recently who had been diagnosed with and treated for melasma for some years, who actually has a low grade irritant or allergic problem. Another patient had a melasma diagnosis who in fact (on biopsy) has Nevus of Ota which is a fairly common problem in some asian ethnic groups. But I think you see my point!


Hope this helps,  Dr. I


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Read Dr. Irwin’s article Menopause and Your Skin.

Dr. Brandith Irwin, MD

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