Melasma vs Sun Spots: Why They're Not the Same Thing, and Why Perimenopause Makes Melasma More Common

Skin Quality & Rejuvenationaesthetics
Written By Caroline Warden

Last updated: 21st September 2026

In this article:

  • What is melasma, and how is it different from a sun spot?
  • Melasma vs sun spots: how to tell them apart
  • Why does perimenopause make melasma more common?
  • Can HRT cause or worsen melasma?
  • Why aggressive treatment can make melasma worse, not better
  • What actually helps melasma?
  • What actually helps sun spots?
  • Is pigmentation treatment available near me in Hale, Altrincham or Cheshire?
  • Frequently asked questions

A patient in her late forties came to see me at my Hale clinic recently, convinced the new brown patches across her cheeks were "just age spots." They weren't. They were melasma, and she'd never had it before in her life. This mix-up happens often, the two conditions can look similar at a glance, but they have completely different causes and need completely different treatment.

What Is Melasma, and How Is It Different From a Sun Spot?

Melasma is a patchy, symmetrical hyperpigmentation, usually across the cheeks, forehead, upper lip or jawline. It happens when melanocytes, the pigment-producing cells in your skin, become hyperactive rather than more numerous. The trigger is hormonal, oestrogen and progesterone both stimulate an enzyme called tyrosinase that drives melanin production, and sun exposure then makes existing patches darker.

A sun spot, properly called a solar lentigo, is a completely different process. Years of cumulative UV exposure cause a localised increase in melanocyte activity and number at that one spot, with no hormonal involvement at all. That's the key distinction: melasma is a hormonal condition that sun exposure worsens; a sun spot is a sun damage condition with no hormonal component.

Melasma vs Sun Spots: How to Tell Them Apart

Feature Melasma Sun Spots
Shape and edges Patchy, blurred, ill-defined borders Discrete, sharply defined spots
Pattern Symmetrical, often both cheeks, forehead, upper lip or jawline; typically spares the eyelids Scattered randomly, no symmetry
Colour Light brown, grey-brown, sometimes bluish Uniform light to dark brown, sometimes very dark
What drives it Hormonal fluctuation, worsened by UV and visible light Cumulative UV exposure over years, no hormonal link
Who tends to get it Women of reproductive age, pregnancy, contraception, HRT, perimenopause; more common in darker skin tones Anyone with years of sun exposure, common from midlife regardless of hormones
Typical course Chronic and relapsing; can worsen with the wrong treatment Stable once present; doesn't usually spread on its own

Why Does Perimenopause Make Melasma More Common, Even If You've Never Had It Before?

This is the part that catches people out. Melasma is usually associated with high hormone states, pregnancy, the contraceptive pill, so it seems odd that perimenopause, a time of declining hormones, would trigger it too. The answer is that perimenopause isn't simply a gradual decline, it's a period of erratic, unpredictable hormone fluctuation, and it's that instability, not just the direction of change, that appears to activate melanocytes.

Some women see old melasma resurface if they had it during a previous pregnancy or while on the pill. Others develop it for the first time in their late forties or early fifties, and understandably assume it's simply age-related sun damage rather than a hormonally driven condition with its own treatment approach.

Can HRT Cause or Worsen Melasma?

It can, in some women. A 2017 case report described a postmenopausal woman who developed melasma on her arms purely from a topical oestrogen cream prescribed for skin rejuvenation, not even a systemic dose. Systemic HRT has a longer-established link to melasma in susceptible individuals.

This isn't a reason to avoid HRT, the benefits for many women are substantial and well established elsewhere on this site. It's a reason to mention it if pigmentation appears after starting treatment. There's reasonable, if still limited, evidence that transdermal oestrogen may carry a lower melasma risk than oral preparations, likely because it avoids the liver metabolising the hormone into by-products that are particularly stimulating to melanocytes. If this applies to you, it's worth raising the formulation and delivery route with whoever manages your HRT, rather than assuming you have to stop.

Why Aggressive Treatment Can Make Melasma Worse, Not Better

This is the single most important thing to understand about melasma. Because it's driven by hyperactive melanocytes rather than sun damage sitting still, anything that inflames the skin, strong peels, aggressive lasers, harsh exfoliation, can trigger a rebound of even darker pigmentation once the inflammation settles. Melasma is notorious for coming back worse after overly enthusiastic treatment. This is exactly why a patient, gradual approach beats a dramatic one here.

What Actually Helps Melasma?

Approach Why It Helps
Daily broad-spectrum, tinted mineral sunscreen Melasma responds to visible light as well as UV; iron oxide tints block both
Gentle topical agents (azelaic acid, vitamin C, prescription tretinoin) Calm pigment production without the inflammation that triggers rebound
Oral tranexamic acid, in appropriate candidates An evidence-based prescription option for stubborn cases, requires screening for clotting risk first
Avoiding heat (saunas, hot yoga) where possible Heat increases local blood flow and inflammatory signalling, both of which can flare melasma
Patience Melasma is chronic and relapsing; steady, gentle management beats chasing a quick fix

What Actually Helps Sun Spots?

Because sun spots don't carry the same rebound risk, they're generally more straightforward to treat. Medical-grade peels and targeted prescription skincare can fade them effectively. Laser and IPL treatment can also work well here, genuinely, without the same downside melasma carries, though it isn't something I offer at my clinic. If that's specifically what you're after, I'll say so honestly at consultation and point you toward it rather than offer something else instead.

Is Pigmentation Treatment Available Near Me in Hale, Altrincham or Cheshire?

Yes. Pigmentation, both melasma and sun damage, is one of the most common concerns I see at my clinic in Hale, from patients across Altrincham, Bowdon, Alderley Edge, Wilmslow and Cheshire. Because the two conditions need different approaches, getting an accurate diagnosis first matters more than jumping straight to a treatment.

Book a Consultation

If you've noticed new pigmentation and aren't sure whether it's melasma, sun damage, or something else entirely, I'd be glad to take a proper look and talk through what will actually help at a consultation in Hale.

Frequently Asked Questions About Melasma and Sun Spots

Can melasma go away on its own?

Sometimes, particularly when it's triggered by pregnancy or a specific medication that's since stopped. Perimenopausal melasma tends to be more persistent and usually needs active, gentle management.

Does melasma mean I'm going through menopause?

Not necessarily, melasma can appear at any hormonally active life stage. But new melasma appearing in your forties or fifties is a reasonable prompt to consider what else might be shifting hormonally.

Should I stop my HRT if I develop melasma?

Not without discussing it first. Melasma is a manageable skin condition, and there may be simpler adjustments, such as switching to a transdermal formulation, worth trying before stopping a treatment that may be helping you in other ways.

Can microneedling or peels make melasma worse?

They can, if too aggressive. Anything that inflames the skin risks a pigment rebound in melasma specifically. This is why a gentler, more gradual approach is used rather than the stronger treatments that suit sun spots well.

How long does it take to see improvement in melasma?

Realistically, months rather than weeks, and it's a condition you manage rather than cure outright. Consistent sun protection matters more than any single treatment.

Are sun spots dangerous?

Typical sun spots are benign. Anything changing in shape, colour or size, or that looks uncertain, should always be checked rather than assumed, which is why I refer anything pigmented I'm not completely confident about rather than treating it.

What SPF should I use if I have melasma?

A high-factor, broad-spectrum sunscreen, ideally a tinted mineral formula, since melasma responds to visible light as well as UV, and an untinted sunscreen doesn't block visible light in the same way.

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Dr Caroline Warden is an NHS GP with over 19 years of clinical experience and a special interest in cosmetic dermatology, an independent prescriber, and holds a Level 7 postgraduate diploma in cosmetic injectables. She is the sole practitioner at Dr Caroline Warden Skin & Aesthetic Clinic, a female-led, family-run clinic at 2 Crown Passages, Hale, Altrincham, awarded Best Doctor Led Aesthetic Clinic in Cheshire 2026 by GHP. GMC number 6157708. This article is for information only and does not constitute individual medical advice.

Caroline Warden
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