Some people first notice more visible melasma during pregnancy. Others feel that their melasma changes after childbirth or after starting contraceptive pills, leading them to wonder whether it is “hormonal melasma”.
Hormones are associated with melasma, but this does not mean that everyone with melasma has abnormal hormone levels. Melasma involves several factors, including sun exposure, skin susceptibility, genetics and hormonal changes at certain stages of life. [1][2]
This article explores the relationship between melasma and hormones during pregnancy, after childbirth, with contraceptive use and at menopause. It distinguishes relatively well-supported evidence from areas where conclusions should not be drawn too quickly.
What is “hormonal melasma”, and how are hormones involved?
“Hormonal melasma” is an everyday term for melasma suspected to be associated with hormonal changes. It is not a diagnosis that establishes the cause simply by looking at darker marks.
Melasma causes darker patches or brown spots on the skin, often on the face, including the cheeks, forehead and upper lip. In skin affected by melasma, pigment-producing cells called melanocytes are involved in increased melanin production. However, the overall mechanisms are complex and cannot be explained by a single cause. [1][2]
Medical research suggests that oestrogen and progesterone may be involved in melasma in some people, particularly during pregnancy or with certain types of hormone use. However, hormonal changes do not cause melasma in everyone, and visible melasma cannot establish whether blood hormone levels are abnormally high or low. [1][2]
Why do some people develop melasma during pregnancy?
Pregnancy involves changes in several hormones, including oestrogen and progesterone. These are among the factors believed to contribute to melasma in some pregnant people. [1][3]
People with existing melasma may notice darker marks becoming more prominent, while others first see melasma during this period. Many pregnant people do not develop melasma at all, so pregnancy should not be used as the sole explanation.
Everyday sun exposure often occurs alongside these changes. Ultraviolet (UV) radiation and certain wavelengths of visible light can stimulate pigment production. Basic care during pregnancy should therefore focus on appropriate light protection and products suitable for pregnancy. Consult a doctor before using a product or treatment if you are unsure about its safety. [2][3][4]
Will melasma fade on its own after childbirth?
Melasma that begins during pregnancy may fade after childbirth, but not in everyone. Some people continue to see melasma, while others may notice it darkening again with sun exposure or other triggers. [3][5]
The terms “melasma during pregnancy” and “postpartum melasma” should therefore not be treated as completely interchangeable. The time when melasma first appears may differ from the time when it changes.
If melasma continues to concern you after childbirth, consult a doctor to assess whether the pigmentation is melasma or another condition and plan care suited to your health. Tell the doctor if you are breastfeeding before choosing medicines or products for melasma. [3][5]
Are contraceptive pills associated with melasma?
Melasma has been associated with hormonal contraceptive pills, particularly in people already susceptible to it. This does not mean that everyone who uses these pills will develop melasma, or that the pill is the sole cause of darker marks. [1][2]
If melasma appears or changes after starting contraceptive pills, noting when you started the medicine and how your skin changed can help your discussion with a doctor. However, do not stop or change your medicine or contraceptive method on your own because of melasma. Choosing contraception requires consideration of your medical history, the suitability of the medicine and your individual needs.
Assessing melasma and choosing contraception may involve doctors with different areas of expertise. Inform the doctor managing your contraception rather than making decisions based solely on information found online.
Does the menopausal transition or menopause worsen melasma?
Sex hormone levels change at menopause, but we cannot conclude that declining hormone levels worsen melasma in everyone. Melasma changes differ between individuals and are also influenced by sunlight, previous melasma and other factors. [2][6]
Another factor to distinguish is hormone replacement therapy (HRT) — the use of hormones to manage certain symptoms or health conditions. This is different from the natural transition to menopause.
A review published in 2026 found limited evidence on HRT and melasma, mostly consisting of case reports. It was insufficient to conclude that every type or route of HRT causes melasma in the same way. [6]
If you use HRT and notice changes in darker marks, tell your treating doctor. Do not adjust or stop hormones on your own.
Why can melasma darken without an obvious hormonal change?
Hormones are only part of the overall picture. In some people, melasma clearly relates to a stage of life. Others see darker marks during periods of increased sun exposure or less consistent skin care, without a clear hormonal event. [1][2]
Consistent sun protection has relatively clear supporting evidence. For people with melasma, the AAD recommends combining measures such as avoiding intense sun, seeking shade, wearing a wide-brimmed hat and using broad-spectrum UVA/UVB sunscreen with SPF 30 or higher. Reapply as directed when outdoors or sweating. [4]
For protection against certain wavelengths of visible light, tinted sunscreens containing iron oxides may be another option. Choose a formulation that suits your skin and daily life. [4]
To understand factors beyond hormones, continue with Factors associated with melasma which explains other factors that may be involved in melasma.
What should you note if you suspect hormones are related to your melasma?
You do not need to determine which hormone might be involved yourself. Recording the following information can help make your discussion with a doctor more detailed.
- When the darker marks first appeared — when they started and whether there were periods when they looked darker or lighter
- Pregnancy and postpartum history — whether the marks began during pregnancy or were noticed afterwards
- Current medicines and hormones — such as contraceptive pills or HRT, including the names and when you started using them
- Everyday sun exposure — such as travelling outdoors, working near a window or going out in the sun during the day
- Previous products and skin care — particularly irritation or changes in pigmentation after using a product
These details are only part of an assessment. They cannot establish that all darker marks are melasma or confirm hormones as the direct cause.
How do doctors assess melasma suspected to be associated with hormones?
Doctors generally consider the appearance of pigmentation together with medical history and the timing of skin changes. Melasma can resemble post-inflammatory hyperpigmentation, freckles or other pigmentation conditions. In some cases, examination tools may be used at the doctor’s discretion. [2][5]
Melasma alone does not establish a hormonal disorder or mean that everyone needs hormone testing. Its cause cannot be determined solely from the darkness or location of patches in a photograph.
For an overview of how melasma differs from other darker marks, read What Is Melasma, and Why Does It Differ Between People? and information about melasma assessment and care at SITA Clinic
Frequently asked questions about melasma and hormones
Does having melasma mean my hormones are abnormal?
Not necessarily. Hormones may be associated with melasma in some people, but a hormonal abnormality cannot be diagnosed from melasma alone.
Does pregnancy-related melasma disappear after childbirth in everyone?
No. Melasma fades after childbirth in some people, while in others it persists or darkens again, particularly with triggers such as sun exposure.
Should I stop contraceptive pills if melasma appears after starting them?
Do not stop or change the medicine on your own. First consult the doctor managing your contraception to consider options suited to your medical history and individual needs.
Will melasma disappear or darken at menopause?
There is no single answer for everyone. Melasma changes at menopause can vary, and evidence is insufficient to conclude that declining hormones alone make melasma better or worse.
Can the colour or location of facial marks identify “hormonal melasma”?
No. The appearance of pigmentation alone cannot confirm a hormonal cause. A doctor should assess it alongside your history and a skin examination.
Summary: Understand life stages without rushing to conclusions about melasma
Melasma may be associated with hormones during pregnancy, with contraceptive pills or with certain types of hormone use. This does not mean that everyone with melasma has a hormonal abnormality. Skin changes involve several factors, and care should consider both skin condition and medical history.
If facial pigmentation concerns you, or you are unsure whether it is melasma or another pigmentation condition, consult a doctor for assessment before choosing care. You do not need to identify the type of melasma yourself.
This article provides general educational information, not a diagnosis or individual advice about medicines. People who are pregnant, breastfeeding or using hormones should consult a doctor before choosing medicines or changing treatment.
References
[1] American Academy of Dermatology Association (AAD). Melasma: Causes. Updated 15 February 2022. https://www.aad.org/public/diseases/a-z/melasma-causes
[2] DermNet. Melasma. Updated October 2020; minor update December 2025. https://dermnetnz.org/topics/melasma
[3] American Academy of Dermatology Association (AAD). Melasma: Overview. The date of the most recent update is not confirmed. https://www.aad.org/public/diseases/a-z/melasma-overview
[4] American Academy of Dermatology Association (AAD). Melasma: Self-care. The date of the most recent update is not confirmed. https://www.aad.org/public/diseases/a-z/melasma-self-care
[5] American Academy of Dermatology Association (AAD). Melasma: Diagnosis and treatment. The date of the most recent update is not confirmed. https://www.aad.org/public/diseases/a-z/melasma-treatment
[6] Abdeen S, Shao E, Lim D. Does Hormone Replacement Therapy Influence Melasma Development? A Review of the Evidence and Management Guidelines. Dermatologic Surgery. Published online 28 January 2026; print August 2026; 52(8):765–769. https://pubmed.ncbi.nlm.nih.gov/41603615/; DOI: 10.1097/DSS.0000000000005032
