Dark, patchy pigmentation on the face, often across the cheeks, forehead, upper lip, or bridge of the nose, is a common and often frustrating skin change many women notice for the first time, or find suddenly worsening, during perimenopause. Known medically as melasma, it is strongly hormone-linked, and it disproportionately affects women with deeper skin tones, making it a particularly relevant topic for Indian women.
Why Melasma Happens and Worsens in Perimenopause
Hormones directly stimulate pigment-producing cells. Melasma is driven by an overactivity of melanocytes, the cells that produce pigment (melanin) in the skin. Oestrogen and progesterone both influence melanocyte activity, which is why melasma is well known to appear or worsen during hormonally turbulent times, classically during pregnancy (sometimes called the “mask of pregnancy”), with hormonal contraceptive use, and during the hormonal fluctuations of perimenopause.
Sun exposure is the essential trigger. Melasma will not develop or worsen without ultraviolet (UV) light exposure. Hormones create the underlying susceptibility, but sun exposure is what actually activates and darkens the pigment. This is why melasma is so common in India, with its high year-round sun exposure, and why sun protection is absolutely central to managing it.
Deeper skin tones are more prone to melasma. Because Indian skin generally has more active melanocytes than lighter skin tones, melasma is particularly common and can be more stubborn to treat in Indian women, making informed, consistent management especially important.
What It Looks Like
Melasma typically appears as symmetrical, brownish or greyish-brown patches, most commonly on the cheeks, forehead, bridge of the nose, upper lip, and chin. It usually develops gradually rather than overnight, tends to worsen with sun exposure (often more noticeable or darker after time outdoors, or seasonally), and is generally not itchy, painful, or raised, simply a change in pigmentation.
What Genuinely Helps
Rigorous, daily, broad-spectrum sun protection is the single most important step. This cannot be overstated: without consistent sun protection, other treatments have limited effect, and melasma will keep worsening. This means a broad-spectrum sunscreen (protecting against both UVA and UVB) applied generously every single day, rain or shine, reapplied through the day if you are outdoors, along with physical protection like a wide-brimmed hat or umbrella when possible. This is a non-negotiable foundation, not an optional extra.
Gentle, consistent skincare. As covered in our guide to skin ageing in perimenopause, the skin is often already drier and more sensitive during this stage, so avoid harsh, irritating products, since irritation itself can worsen pigmentation. Choose gentle, fragrance-free cleansers and moisturisers.
Targeted treatment ingredients, ideally guided by a dermatologist. Several ingredients have evidence for helping lighten melasma, but many are more effective and safer when introduced and monitored by a dermatologist, particularly for perimenopausal skin, which can be more reactive. It is worth a proper consultation rather than self-treating with strong actives, since some can cause irritation or worsen pigmentation if used incorrectly.
Professional treatments, where appropriate. Dermatologists have access to a range of in-clinic treatments for more stubborn melasma. These are best discussed individually, as suitability depends on your skin type and the specifics of your pigmentation, and not all treatments suit all skin tones equally.
Manage expectations and be patient. Melasma is notoriously slow to improve and can be stubborn to treat fully, particularly in deeper skin tones. Consistent sun protection and treatment over months, rather than expecting a quick fix, is the realistic path, and even with excellent management, some pigmentation may persist or return, particularly with sun exposure.
Consider the hormonal angle. Because melasma is hormone-linked, some women notice it is affected by hormonal treatments, including both hormonal contraceptives and HRT, in either direction. This is worth mentioning to your doctor if you are starting or considering hormonal treatment and have a history of melasma.
When to See a Doctor or Dermatologist
Routine dermatology appointment if you have new or worsening facial pigmentation, both to confirm it is melasma rather than another cause, and to build a proper, personalised sun protection and treatment plan. This is genuinely worth professional guidance rather than trial and error with over-the-counter products, particularly given how common ineffective or even harmful products marketed for “pigmentation” can be.
Also worth mentioning any hormonal treatment you are taking or considering, since this is relevant context for your dermatologist in managing melasma effectively.
Melasma is a frustrating, hormone-linked visitor of perimenopause, particularly common in Indian skin, but it is manageable with the right, consistent approach. Rigorous daily sun protection is the non-negotiable foundation, and a dermatologist can help you build the rest of an effective, personalised plan around it.
The Second Spring is an information resource, not a medical provider. For personal advice, speak with your doctor or gynaecologist. Write to us at thesecondspringofficial@gmail.com
You Don't Have to Go Through This Alone
Perimenopause can feel confusing and isolating, but you don't have to figure it out by yourself. Talk to a gynaecologist or doctor who understands perimenopause about what you're experiencing, or see how other Indian women are navigating the same changes in our community.
In a medical emergency, call 112. For mental health support, iCall can be reached at 9152987821 (Mon–Sat, 8am–10pm).
