Melasma and Forms of Contraception

Perhaps you know that melasma can be triggered and/or aggravated by oral contraceptives. What you may not know is that newer forms of contraception, such as intrauterine devices (IUD), may be less melasma-triggering than combined oral contraceptives (OCPs). A report by Dr. Kroumpouzos and colleagues that was published in journal Acta Dermato-Venereologica indicates that IUDs such as MIRENA may be less melasma-stimulating than combined OCPs. The report included 4 cases in which melasma improved spontaneously when the patient was switched from a combined oral contraceptive to intrauterine levonorgestrel-releasing IUD (MIRENA).

Melasma is a common acquired hypermelanosis of the skin that has been mainly associated with ultraviolet light exposure, pregnancy, and OCPs. Melasma was historically noted as striking and widespread with the use of the very first combined OCPs. A study indicated that 41% of women had onset of melasma after pregnancy, and 25% after starting an OCP. Developing melasma during pregnancy is associated with a higher risk for melasma with OCP use.

The observation by Dr. Kroumpouzos and colleagues is greatly supported by the results of an Internet study ( which used data from the US FDA, and showed that the frequency of melasma in women on MIRENA was very low (0.06%), and significantly lower than the frequency of melasma in several populations. The improvement of melasma observed in the 4 patients reported by Dr. Kroumpouzos and colleagues may be associated with the higher systemic hormone (progestin and estrogen) levels produced by combined OCPs when compared to those produced by MIRENA. MIRENA releases levonorgestrel primarily in the uterine, and only a very small amount of this hormone is systemically absorbed.

This interesting report indicates for the first time that levonorgestrel-releasing IUDs, such as MIRENA, can be less melasma-stimulating than the combined OCPs. Along the same lines, copper IUDs that release no hormone to the circulation can be safe too when it comes to melasma. The group of Dr. Kroumpouzos is continuing their research in order to address these issues and further define safe forms of contraception for women with a predisposition for melasma.

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