Can Birth Control Cause Dark Spots on Your Face?

Yes, birth control can cause dark spots on your face for some people. Hormonal birth control, especially the pill, is a known trigger for melasma, a common condition that shows up as brown or gray-brown patches on the cheeks, forehead and upper lip. It doesn't happen to everyone, and there's a lot you can do to protect your skin while you keep the contraception that works for you.

Can birth control cause dark spots on your face?

Yes. Hormonal birth control can trigger melasma, a type of hyperpigmentation that appears as brown or gray-brown patches, usually on the face. The American Academy of Dermatology (AAD) lists birth control pills among the medications that may trigger it. Most people on the pill never get melasma, but if your skin is already prone to it, hormones can tip the balance.

Melasma is common, and it's especially common in women. Many people first notice it during pregnancy or soon after starting birth control (AAD). If you'd like the full background first, start with what melasma is and who gets it.

Hormones are rarely the only factor. In a case-control study of women with and without facial melasma, the condition was linked with sun exposure, family history, pregnancy and years of oral contraceptive use, all at once (Handel et al., 2014). So birth control may be one piece of the picture, alongside your genes and how much light your skin sees every day.

Why do hormones cause brown spots on the face?

Researchers think estrogen and progesterone make pigment cells (melanocytes) in some areas of the face more active, so they make extra melanin. Sunlight and visible light then keep those cells switched on. That mix of hormones plus light is why birth control brown spots on the face tend to show up in the places the sun hits most.

A few things make hormone-linked dark spots more likely:

• Family history. Melasma often runs in families.
• Skin tone. Melasma happens on every skin tone, but it's more common and often longer-lasting on medium to deep skin tones, including olive, tan and brown skin.
• Sun and light. UV and visible light both play a part, and so does warmth. Here's why heat can make melasma worse.
• Other hormone shifts. Pregnancy is the classic trigger, which is why melasma is sometimes called the mask of pregnancy.

In a global survey of women with melasma, researchers concluded that a combination of these factors, rather than one single cause, usually sets it off (Ortonne et al., 2009).

What does birth control melasma look like?

Melasma from birth control usually looks like flat, brown to gray-brown patches with soft, blurry edges. The patches tend to appear on both sides of the face in a roughly matching pattern. The cheeks, forehead, bridge of the nose, chin and upper lip are the most common places. Melasma isn't raised, itchy or painful.

Common patterns include:

• Across both cheeks and the bridge of the nose
• Along the forehead and temples
• Above the upper lip, sometimes called a melasma mustache
• On the chin or along the jawline

Not every dark spot is melasma. Acne marks, sun spots and patches left by irritation can look similar at first glance. If you're not sure which one you have, a dermatologist can tell you for certain, often just by looking closely at your skin.

Which birth control causes melasma?

Most research on birth control and melasma looks at combined oral contraceptive pills, which contain estrogen and a progestin. Much less is known about progestin-only pills, the implant, the shot, the ring, the patch or hormonal IUDs. No hormonal method comes with a promise that it won't affect your skin, and everyone reacts differently.

Here's what's fair to say:

• The pill is the best-studied link. Reports of melasma after starting oral contraceptives go back to the 1960s (Resnik, 1967).
• Other hormonal methods are less studied. People do report melasma on the ring, patch, implant and hormonal IUDs, but there isn't good research comparing them.
• The copper IUD contains no hormones. That's a fact about the device, not a promise about your skin, because melasma has other triggers too.

If you think your contraception is linked to new dark patches, bring it up with the doctor, nurse practitioner or pharmacist who prescribes it. Please don't stop or switch on your own. Your prescriber can weigh your skin concerns alongside everything else that matters, like how well a method works for you and your health history.

Does melasma go away after stopping birth control?

Sometimes. For some people, melasma slowly becomes less noticeable after they stop hormonal birth control, usually over months rather than weeks. For others it lingers for years, because sun, visible light, heat and genetics keep it going. Stopping birth control isn't a skin plan, so never stop contraception for your skin without talking to your prescriber first.

The AAD notes that melasma goes away for some women after they stop taking birth control, while for others it can last for years (AAD). Even the early reports described pill-linked melasma that didn't fully go away after the pill was stopped (Resnik, 1966).

A few things are worth knowing:

• Daily protection matters more than timing. Whatever you decide about contraception, daily sun protection is what dermatologists stress most.
• Unplanned changes carry real risks. Going off birth control without a plan can mean an unplanned pregnancy, and pregnancy is itself a strong melasma trigger.
• You have options either way. A dermatologist can build a plan for your skin that works alongside the contraception you choose, including prescription options if you want them.

How can you care for your skin if birth control triggers dark spots?

The most useful thing you can do is protect your skin from light every single day. That means a broad-spectrum SPF 30 or higher, ideally a tinted sunscreen with iron oxides, reapplied whenever you're outdoors. Add shade, a wide-brimmed hat and a gentle routine, and see a dermatologist if you'd like more support.

A simple daily routine:

1. Cleanse gently. Skip harsh scrubs. Irritation can leave its own dark marks, and over-exfoliating is one of the everyday habits that make dark marks worse.
2. Moisturize. A comfortable, well-supported skin barrier is less reactive.
3. Wear tinted sunscreen every morning. Iron oxides in tinted formulas help block visible light, which untinted sunscreens don't cover well. Here's what to look for in a sunscreen for melasma.
4. Reapply. Every 2 hours outdoors, and after sweating or swimming.
5. Add a hat and shade. A wide-brimmed hat and sunglasses help, especially around midday.
6. Keep cool. Heat is a common trigger, so take breaks from saunas, hot yoga and hot kitchens when you can.

Curious about brightening ingredients? Cosmetic ingredients like vitamin C, niacinamide, azelaic acid and licorice root show up in many routines for uneven tone. Ask your dermatologist what fits your skin, and about any prescription options they suggest.

For quick answers, browse our melasma FAQs and sun protection FAQs.

When should you see a doctor or dermatologist?

See a dermatologist if you have new dark patches and aren't sure what they are, if they bother you, or if daily sunscreen and a gentle routine don't feel like enough. See a doctor promptly for any spot that changes, bleeds, itches or grows. If you're wondering whether a spot is melasma or melanoma, always ask a dermatologist.

Two appointments can help:

• Your prescriber, to talk through your contraception, including whether a different method makes sense for you.
• A dermatologist, to confirm it's melasma and build a skin plan, which can include prescription options.

Before either visit, jot down your current medications, when the patches first appeared and anything that seems to make them darker, like a beach trip, a heat wave or a new pill pack. That short list makes the conversation much easier.

References

• American Academy of Dermatology. Melasma: Overview
• American Academy of Dermatology. Melasma: Causes
• American Academy of Dermatology. Melasma: Self-care
• Handel AC, et al. Risk factors for facial melasma in women: a case-control study. Br J Dermatol. 2014.
• Ortonne JP, et al. A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol. 2009.
• Resnik S. Melasma induced by oral contraceptive drugs. JAMA. 1967.
• Resnik SS. Combined or sequential oral contraceptives may cause melasma without total regression. JAMA. 1966.

This article is for general information and isn't medical advice. If you have a skin condition or concern, talk to a doctor or dermatologist.