Can you get hyperpigmentation from birth control? Understanding Melasma and How to Treat It

October 11, 2025 •

4 min read

According to one study, up to 29% of women using oral contraceptives developed melasma. This condition, which manifests as dark, splotchy patches on the skin, is a known side effect of hormonal birth control, triggered by fluctuations in estrogen and progesterone.

Quick Summary

Hormonal birth control can cause melasma by altering hormone levels and increasing melanin production. Sun exposure is a key trigger that worsens this type of hyperpigmentation. Treatment options and preventative measures are available.

Key Points

Hormonal Birth Control Connection: Hormonal birth control, particularly methods containing estrogen, can trigger hyperpigmentation known as melasma.
Hormonal Influence: Elevated levels of estrogen and progesterone stimulate melanocytes, the cells that produce skin pigment, to increase melanin production.
Sun Exposure is Key: Exposure to ultraviolet (UV) radiation from the sun is the major aggravating factor, worsening and triggering melasma.
Risk Factors: Genetic predisposition, darker skin tones, and a history of melasma during pregnancy increase the risk.
Treatment Options: Treatments range from diligent sun protection and topical creams (hydroquinone, retinoids) to chemical peels, laser therapy, and changing birth control methods.
Prevention is Critical: The most effective preventative strategy is year-round, consistent sun protection with broad-spectrum, high-SPF sunscreen.

The Link Between Birth Control and Melasma

Melasma is a common skin condition characterized by brown or gray-brown patches, most often appearing on the face, including the cheeks, forehead, chin, and upper lip. It is frequently referred to as the “mask of pregnancy” (chloasma) because of its link to pregnancy hormones, but it can also be triggered by hormonal contraception. The mechanism is a result of elevated estrogen and progesterone levels, which stimulate the melanocytes—the cells responsible for producing skin pigment—to overproduce melanin. This overproduction leads to the noticeable dark patches on the skin's surface.

How Hormones Influence Skin Pigment

At a cellular level, hormones affect skin pigmentation in several ways:

Estrogen Stimulation: Estrogen, a key component in many hormonal birth control methods, directly acts on melanocytes. It increases the activity of the enzyme tyrosinase, which is essential for melanin production.
Increased Receptor Sensitivity: Hormones can increase the number of melanocortin receptors in melanocytes, making these cells more sensitive to sun exposure or inflammation, leading to a greater risk of pigmentation.
Genetic Factors: A genetic predisposition plays a significant role. Individuals with a family history of melasma or those with darker skin tones (higher Fitzpatrick skin types) are at a higher risk of developing melasma when exposed to hormonal triggers.

Birth Control Types and Melasma Risk

Almost any form of hormonal birth control that introduces estrogen and/or progesterone into the body can potentially cause melasma. The risk, however, can vary based on the method and dosage. Lower-dose or non-estrogen options generally pose a lesser risk.

Combined Oral Contraceptives (COCs): The pill is a well-known trigger for melasma due to its combination of estrogen and progesterone. The risk appears to increase with longer duration of use.
Hormonal IUDs: Methods like Mirena and Skyla contain levonorgestrel, a form of progesterone. Since they deliver hormones locally and have a lower systemic dose compared to COCs, they are associated with a significantly lower risk of melasma.
The Patch and Ring: The contraceptive patch (e.g., Ortho-Evra) and vaginal ring (e.g., NuvaRing) also contain both estrogen and progesterone and therefore carry a similar risk to COCs.
The Shot and Implant: Hormonal injections (e.g., Depo-Provera) and the implant (e.g., Nexplanon) are progestin-only methods. While progesterone is implicated in melasma, these methods may carry a lower risk than estrogen-containing options.
Non-Hormonal Methods: Barrier methods (condoms, diaphragms) and the copper IUD (ParaGard) do not affect hormone levels and are completely free of the risk of causing melasma.

Aggravating Factors and Prevention

While hormones are the internal trigger, external factors significantly influence the development and severity of melasma. Sun exposure is the most crucial factor, as UV radiation further stimulates melanin production. Heat and visible light from sources like screens can also play a role. For this reason, prevention is paramount, especially for those with risk factors.

Strict Sun Protection: Applying a broad-spectrum sunscreen with a high SPF (30 or higher) daily is essential. Tinted sunscreens containing iron oxide can provide additional protection against visible light.
Avoid Peak Sun Hours: Limiting sun exposure between 10 a.m. and 4 p.m. can minimize the effect of UV radiation.
Wear Protective Clothing: Wide-brimmed hats and sunglasses offer additional physical barriers against the sun.
Consider a Change in Contraception: If melasma is severe, discussing non-hormonal or lower-hormone alternatives with a healthcare provider can be an effective long-term strategy.

Melasma Treatment Options

For individuals experiencing birth control-induced melasma, various treatments are available, though results vary and require consistency and patience. The first step should always be a consultation with a dermatologist to confirm the diagnosis and rule out other potential skin conditions.

Comparison of Melasma Treatment Options


Treatment Method	Description	Pros	Cons
Topical Creams	Applied directly to the skin to lighten dark patches. Common ingredients include hydroquinone, retinoids (tretinoin), azelaic acid, and kojic acid.	Non-invasive, widely available, and can be very effective over time.	Requires consistent, long-term use. Can cause skin irritation. Some ingredients, like hydroquinone, require careful, short-term use to prevent side effects.
Chemical Peels	A chemical solution exfoliates the outer layers of the skin to reveal new, less pigmented skin underneath.	Can provide faster and more noticeable results for surface-level pigmentation.	Risk of inflammation, which can paradoxically worsen melasma. Should be performed by an experienced professional.
Laser Therapy	Uses focused light to target and break down melanin deposits in the skin.	Can be effective for persistent cases that do not respond to topical treatments.	Can carry a risk of post-inflammatory hyperpigmentation or scarring if not done correctly. Potential for relapse.
Switching Birth Control	Changing from a hormonal contraceptive to a non-hormonal method or one with lower systemic hormone levels.	Addresses the root hormonal cause, offering a long-term solution.	Requires a discussion with a healthcare provider to find the right alternative. Melasma may take time to fade, or may not fully resolve.

Lifestyle and At-Home Maintenance

In addition to professional treatments, maintaining a diligent at-home skincare routine is critical. This includes using gentle, non-irritating products, especially avoiding harsh scrubs or scented soaps that can cause irritation. Incorporating antioxidants like Vitamin C can help protect the skin from environmental damage.

Conclusion

While hormonal birth control is a safe and effective option for many, it's important to be aware of potential side effects, including hyperpigmentation in the form of melasma. This condition is triggered by hormonal fluctuations, primarily involving estrogen and progesterone, and is significantly worsened by sun exposure. For those affected, several management strategies are available, from topical treatments and sun protection to changing contraceptive methods. Consultation with a healthcare provider and a dermatologist is the best approach to find the most suitable and effective solution.

This information is for educational purposes only. Always consult with a qualified healthcare professional before making any decisions about your health or treatment plan.

Frequently Asked Questions

Only hormonal birth control methods that contain estrogen and/or progesterone can cause hyperpigmentation, specifically a form called melasma. Non-hormonal options, like the copper IUD or condoms, do not have this side effect.

The primary cause is the fluctuation of hormones, particularly estrogen and progesterone, which stimulate the overproduction of melanin in skin cells. This is significantly exacerbated by sun exposure.

For some, melasma will fade significantly or disappear after discontinuing the hormonal birth control. However, this is not a guarantee and depends on factors like genetics and the duration of exposure. For some, it can be a chronic condition.

The most important preventative measure is strict sun protection. This includes daily use of a broad-spectrum sunscreen with a high SPF (at least 30), wearing sun-protective clothing and hats, and avoiding sun exposure during peak hours.

Yes, lower-dose hormonal options and especially non-hormonal methods like the copper IUD are less likely to cause melasma. Methods like hormonal IUDs that release hormones locally also carry a lower risk.

Yes, you can and should treat melasma while on birth control, especially with topical creams and strict sun protection. A dermatologist can help develop a treatment plan. However, for a complete resolution, addressing the hormonal trigger by switching birth control might be necessary.

Certain irritating or scented cosmetics can potentially worsen melasma by causing inflammation. It's best to use gentle, non-comedogenic products. Choosing makeup with SPF can also offer an extra layer of sun protection.