Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 2/25/2021
Tired of dealing with blotchy, darkened patches from melasma? You’re not alone. Around five to six million women in the US suffer from melasma, a common skin condition that can cause blotchy, heavily pigmented patches of skin to develop on the face and body.
Healthcare providers aren’t completely sure what causes melasma, but several different factors are known to trigger an outbreak if you have melasma-sensitive skin.
While most people are familiar with common triggers like sun exposure and pregnancy, there’s another common melasma trigger that’s far less well known: hormonal birth control.
That’s right—the same pills that stop you from getting acne and keep your skin smoother and softer can also contribute to melasma.
Below, we’ve explained how birth control pills can aggravate melasma and cause your skin to become hyperpigmented.
We’ve also shared a few proven, science-backed ways that you can control melasma and improve your skin, all while keeping yourself protected from pregnancy.
If you have melasma, a variety of different things can trigger an outbreak. The most well-known is sun exposure, which causes your body’s melanocytes to overproduce melanin and produce dark, blotchy patches of skin.
Birth control triggers melasma for the same reasons as pregnancy: changes in the amount and type of hormones your body produces.
When you’re pregnant, your body ramps up its production of estrogen. During the first trimester, an average woman’s estradiol levels can range from 188 to 2497 pg /mL. Three months later, in the second trimester, they range from 1278 to 7192 pg/mL.
Because melasma skin is estrogen-sensitive, this steady increase in your body’s production of estrogen means melasma is a common occurrence during pregnancy.
The hormones used in birth control pills can have a similar effect on your body’s estrogen and progestin levels.
Most birth control pills contain a mix of ethinyl estradiol (a type of estrogen) and a progestin.
In the small quantities used in birth control pills, these hormones are powerful enough to prevent your ovaries from releasing eggs and reduce your risk of becoming pregnant.
They’re also more than powerful enough to trigger a response in melasma-prone skin, causing the same blotchy, hyperpigmented look that can occur when you’re pregnant.
Unlike pregnancy, which lasts for about nine months, most women continue taking birth control pills for years at a time.
This means that while melasma usually fades after you give birth, there isn’t a hormonal “off” switch that stops melasma when you use birth control.
Luckily, there are options available for controlling melasma while you use birth control.
If you’ve noticed an increase in the severity of your melasma after starting birth control, the best thing to do is to talk to the healthcare provider that prescribed your birth control pills.
They’ll usually suggest one of two things:
Switch to another contraceptive method. Because melasma is triggered by estrogen, non-hormonal contraceptives usually won’t aggravate it.
Switch to a different birth control pill. Not all birth control pills use estrogen, meaning you might be able to lighten your melasma symptoms by switching from a combined birth control pill to a progestin-only mini pill.
Both of these approaches work well to reduce hormonal melasma. However, while these options can reduce the severity of your melasma symptoms, they won’t actively treat skin that’s already affected by melasma.
If you want to treat your melasma-prone skin and lighten discolored areas, the best options are topical medications like tretinoin and hydroquinone.
Tretinoin is a topical retinoid. It works by speeding up your skin cell turnover process, causing you to replace old skin cells with new ones at a faster pace. This means that hyperpigmented skin cells are gradually replaced by newer ones.
A small study showed that tretinoin works well as a melasma treatment, usually producing results over the course of five to six months. Our guide to tretinoin for melasma goes into more detail about how you can use tretinoin to get rid of hormonal melasma.
Hydroquinone is a topical medication that can lower the amount of pigmentation in your skin.
It works by stripping away the excess pigmentation caused by melasma, helping areas of blotchy skin blend in with the rest of your face.
Studies show that hydroquinone is very effective as a melasma treatment, especially when it’s combined with topical retinoids like tretinoin.
Our guide to hydroquinone and melasma explains how you can use hydroquinone with other medications or on its own as a melasma treatment.
Dealing with melasma can be frustrating, but it’s far from impossible. By learning how melasma and other skin discoloration happens and what can aggravate it, treating your hyperpigmented skin becomes much easier.
Our guide to the most common causes of skin discoloration and their treatments covers this topic in more detail, with real, scientific treatment options for skin conditions like melasma. You can also learn more about melasma in our guide to melasma causes, symptoms and treatments.