Hormonal Triggers
Pregnancy is a time when you can expect the unexpected. In addition to the variety of skin changes a woman can experience during pregnancy, some degree of hyperpigmentation affects nearly all women. However, in some women the level of hyperpigmentation is noticeably increased. Melasma generally occurs in 10 to 15 percent of pregnant women and in 10 to 25 percent of women taking oral contraceptives.6 For decades, melasma was known as the mask of pregnancy, with the assumption that it must be caused by an increase in female hormones due to pregnancy or birth control pills. The reality is that we still do not clearly understand the hormonal link to melasma.
Melasma skin is more estrogen-responsive than non-melasma skin.1,6 Nevertheless, other hormones involved in a woman's menstrual cycle and pregnancy, including progesterone and α-MSH, can also stimulate pigmentation. Just as melasma skin is more estrogen-responsive, it has also been shown to be more progesterone-responsive than normal skin.9 The notion that oral contraceptives can lead to skin changes is not a new one. In 1967, dermatologist Sorrel Resnik, M.D. showed that melasma developed in women as a direct result of taking oral contraceptives.8 Today, several forms of hormonal contraceptives are available including combination oral