The Connection Between Your Birth Control And Melasma

We’ve talked about what causes melasma, but now we are going to take a deep dive into how melasma and birth control (aka ‘oral contraceptive pills’) are related.

How Does Birth Control Contribute To Melasma?

Hormones are among the primary cause of melasma – especially estrogen. Elevated levels of estrogen in the body increase pigment production, and hormonal birth control works by increasing the levels of estrogen in the body. That’s why melasma is commonly seen with oral contraceptive use. One study found that 25% of women reported their melasma began after beginning hormonal birth control (Ortonne).

Several studies have been done to figure out the exact role estrogen plays in the development of this condition (Handel).

Hormonal birth control contributes to melasma in the following ways:

• Estrogen acts directly on melanocytes (the cells that make your pigment), which in turn causes more pigment production.
• Estrogen increases the number of melanocortin receptors in melanocytes. This makes the melanocyte cells more sensitive to sun or inflammation.
• Estrogen also increases the expression of PDZK1, a gene that increases the levels of the pigment-forming enzyme tyrosinase. Tyrosinase is a pigment-making mini-factory that increases your skin’s capacity to create pigment.

Estrogen isn’t the only ingredient in many hormonal birth control methods. Progesterone is another common ingredient in oral contraceptives. A study looking at both affected and unaffected skin in melasma found that the affected skin had significantly increased numbers of progesterone receptors (Tamega). This means that the affected skin could also be especially sensitive to progesterone levels.

If I Stop Taking Birth Control, Will My Melasma Go Away?

Your melasma may lighten significantly if you stop taking birth control. However, if you have a family history of melasma, it’s less likely that your melasma was triggered by oral contraceptives (Ortonne).

How long does it take for melasma to go away after stopping birth control?

This varies from person to person, as some people see improvement within months and others do not. In either case, UV protective measures such as daily sunscreen, sun avoidance during peak hours (10 am – 2 pm), and wearing broad-brimmed hats are an essential part of helping melasma fade faster.

Should I Keep Taking My Birth Control If I Have Melasma?

It depends on your preferences when it comes to contraception. There are many options available, including both non-hormonal and hormonal methods. Some women find a progesterone-only hormonal birth control is better for managing melasma compared with those containing estrogen.

Learn more about your birth control options:

• Types of Birth Control (FDA)
• Contraception Methods (CDC)

Can I Treat My Melasma If I Am Taking Birth Control?

Definitely! In fact, you should start treatment as soon as possible. The earlier you start a prescription-based daily regimen that includes the three most effective ingredients for treating melasma, the sooner your skin will be clear. That means you don’t have to change your entire contraceptive plan while treating melasma.

Useful Links

• Melasma Symptoms, Causes & Treatment Explained
• Tips for Managing Melasma
• Sun Safety Tips

References

• Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771–782. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155956/
• Ortonne JP, Arellano I, Berneburg M, Cestari T, Chan H, et al. (2009) A global survey of the role of ultraviolet radiation and hormonal in uences in the development of melasma. J Eur Acad Dermatol Venereol 23: 1254-1262. https://www.ncbi.nlm.nih.gov/pubmed/19486232
• Tamega Ade A, Miot HA, Moco NP, Silva MG, Marques ME, Miot LD. Gene and protein expression of oestrogen-beta and progesterone receptors in facial melasma and adjacent healthy skin in women. Int J Cosmet Sci. 2015;37(2):222–8. https://bmcdermatol.biomedcentral.com/articles/10.1186/s12895-017-0066-5

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Brandon Kirsch, MD

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital.