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Publication:
NIH - National Library of Medicine
Author:
Hajira Basit, Kiran V. Godse, Ahmad M. Al Aboud
Date:
August 8th 2023
Article Summary
Melasma and Menopause: When Your Skin Gets Patchy
Hot Flush Fix Summary
Right, let's talk about something that's been catching many of us off guard during menopause - melasma (something I’ve been suffering with). Those brown or greyish patches that seem to appear on your face, particularly around your cheeks, forehead, and upper lip.
Melasma is more common in women of colour and those experiencing hormonal changes during menopause. However, recent research from the NIH reveals a fascinating finding: it's actually progesterone, not estrogen, that's the main culprit. Postmenopausal women given progesterone develop melasma, whilst those given estrogen alone don't. This completely changes our understanding of HRT and melasma risk.
There's also a surprisingly strong genetic component - about 50% of people with melasma have a family history of it (that’s me!), and identical twins often both develop it.
Plus, there's a four-fold increase in thyroid disease among melasma patients, so it might be worth checking your thyroid function if you develop these patches.
Women of colour face particular challenges because their melanin-rich skin is more reactive to sun exposure, and treatments must be gentle to avoid further hyperpigmentation or scarring. During menopause, skin often becomes thinner, drier, and less resilient, requiring a tailored approach.
Here's some genuinely good news: Melasma patients actually have a lower risk of melanoma than the general population. And if you avoid the sun religiously and don't use triggering treatments, melasma often disappears on its own within a few months. It's not cancerous, won't develop into skin cancer, and isn't contagious.
The HotFlush Fix - Your Melasma Management Action Plan
SUN PROTECTION (ABSOLUTELY ESSENTIAL)
• Use broad-spectrum sunscreen SPF 30+ with zinc oxide or titanium dioxide daily
• Choose tinted sunscreen containing iron oxide - protects against both UV and visible light
• Wear wide-brimmed hats and UV protective sunglasses
• Seek shade between 11 am-3 pm when it's sunny
GENTLE SKINCARE ROUTINE
• Use mild, fragrance-free cleansers to avoid irritation
• Moisturise regularly to combat menopausal skin dryness
• Consider brightening serums with vitamin C or niacinamide
• Avoid harsh scrubs or irritating products
TREATMENT OPTIONS TO DISCUSS WITH GP/DERMATOLOGIST
• First-line: Triple combination cream (hydroquinone 4%, tretinoin, fluocinolone)
• Azelaic acid for maintenance after hydroquinone treatment Tranexamic acid to reduce pigmentation
• Avoid chemicalpeels and lasers initially - they are second-line and may worsen melasma
PATIENT OPTION: WATCHFUL WAITING
• Many cases resolve naturally with strict sun avoidance within a few months
• No treatment is often the safest approach if you can be patient
HRT CONSIDERATIONS
• Be aware that progesterone is themain trigger - estrogen-only HRT seems safer for melasma
• Discuss melasma risk with your doctor if considering combined HRT
• Monitor skin changes if already on progesterone-based HRT
• Do not stop HRT without medical advice - weigh benefits against risks
Check your thyroid: Ask your GP to test thyroid function, as there is a fourfold increase in thyroid disease among melasma patients. This is particularly important if melasma appears during pregnancy or after starting contraceptives.
FAMILY HISTORY MATTERS
• Tell your doctor if family members have had melasma - 50% have a genetic predisposition
• Be extra vigilant with sun protection if you have a family history
IMMEDIATE STEPS
• Begin sun protection today using appropriate methods
• Consider skin camouflage makeup to boost confidence during treatment
• Book an appointment with a dermatologist experienced in treating Melasma
• Take photos to track changes
Just a friendly reminder: I'm sharing what I've learned, not prescribing what you should do. Always chat with your GP about what's right for your unique situation!
