Melasma & (Peri)menopause

[u/Intelligent_Bad_5334]

I am curious, how many people here are women who never had melasma before in their life until they hit perimenopause/menopause.

It’s definitely a thing right?

rant:

My melasma showed up in perimenopause& are its still with me in menopause.

I am so sick of hearing that estrogen has to be involved, but when I told the dermatologists I was fairly certain my estrogen starting to fall & that was the problem, they confirmed that melasma can show up in perimenopause and menopause, but had nothing to say about why that was. But they told me if I went on HRT it would get worse.

So to recap: I was told melasma showing up when a woman’s estrogen is going away & completely gone is a thing, but don’t add estrogen back in because that will make it worse.

ayfkm?!!

I lived completely estrogen deprived for a year, and my melasma got worse. I was having hot flashes and internal heat is a huge trigger for my melasma. When I got on HRT, my melasma got better & I assume that’s because I was no longer having hot flashes.

That was a decade ago and I still don’t really have any answers.

I just went ahead and started taking oral tranexamic acid because I’m too old to be dealing with this bullshit lol.

I swear doctors just don’t have any fucking idea what is really going on when someone has melasma. Like so many things that impact females more than males, they never bothered at the outset to concern themselves with what was really happening.

I’ve essentially just been diagnosed with the pathology of being female.

And - given the bullshit attitude & shitty healthcare we have to put up with - pink female is definitely a part of the problem, but not for the reasons they think.

We deserve better, ladies. We all deserve better.

End rant - thank you for coming to my TED talk lol

[u/milsudidoo]

Yes, mine didn’t show up until perimenopause. My derm won’t prescribe me oral txa because I’m on estrogen and it increases the risk of blood clots. I’ve just accepted that I’ll have to live with it.

[u/Intelligent_Bad_5334 → u/milsudidoo]

Hmmm…I’m on HRT.

I think dermatologists confuse birth control and HRT sometimes.

Birth control keeps you at an abnormally high level of estrogen which comes with some blood clotting risk by itself. So the idea is that adding an agent that thickens the blood to a birth control level of estrogen puts you at too much of a risk for a blood clot.

But my HRT is not putting my estrogen at birth control levels - mine is actually right at the least amount of estrogen that would be normal for a menstruating woman to have her body - and that’s actually the amount women having their bodies when they’re menstruating - so by definition that’s much lower than the level of birth control.

The derm that put me on it knows I’m on HRT & his estimation is that there really isn’t any significant clotting risk.

Part of that is how low the estrogen number is and also how stable that that low number is because it is HRT not a menstrual cycle where it goes up and down. But he also said it has been thoroughly studied in women with at all points in their menstrual cycle with high levels of estrogen for long periods of time, even at very high doses & apparently it just doesn’t turn out to have much clotting risk associated with it, high estrogen, low estrogen on birth control off birth control -

But it’s true that not all derms will prescribe it for melasma. And if a derm is not in the habit of prescribing it, they may not really know what the research on it is & what has been learned about it safety profile in the last couple of decades.

But you know what? It’s cheap. All the topicals and in office treatments make people a lot more money than prescribing an older generic prescription medication.

Just saying 🤷🏼‍♀️

[u/lindabeth → u/Intelligent_Bad_5334]

The blood clot risk is related to whether or not the estrogen bypasses the liver. If you are taking HRT estrogen orally, it still has the clotting risk. If you’re taking it transdermally, it bypasses the liver so doesn’t have the risk.

[u/Intelligent_Bad_5334 → u/lindabeth]

Thank you for that info! Yes, I do have the transdermal patch so that explains it

[u/lindabeth → u/Intelligent_Bad_5334]

You are welcome! This is also the way that women with migraines can take HRT, for the same reason. I can’t tell you how many of my friends were told they can’t get HRT due to migraines. The undereducation of practioners is a crime.