Why Dark Skin Spots Develop During Perimenopause & Menopause

Many women notice an increase in dark spots and uneven skin tone during perimenopause and menopause. The hormonal changes during this time affect collagen production, hydration levels, and skin thickness which can cause existing pigmentation from sun exposure and skin aging to become more visible. In addition, decreases in estrogen levels can lead to the slowing of skin renewal, allowing discolorations on the skin’s surface to remain visible for longer.

Many dark spots are benign, but some should be evaluated by a professional. Skincare and sun protection can help prevent the worsening of dark spots and hyperpigmentation over time and a consistent skincare routine should always include sun protection to shield from the sun’s harmful effects.

Why Dark Spots Appear or Worsen in Midlife

Research has shown higher rates of visible hyperpigmentation in postmenopausal women. Hormonal changes do not directly account for all pigmentation changes during midlife, but they can make existing discoloration and photodamage more noticeable.

Estrogen helps support elasticity and collagen production, as well as overall skin structure. During perimenopause and menopause, declining estrogen can lead to thinner, drier skin that renews itself more slowly. This slower cell turnover may allow pigment in the skin to linger longer instead of fading as it may have earlier in life.

Years of cumulative UV exposure and previous skin damage may also become more visible during midlife as structural support within the skin changes. Pigmentation changes often occur along with other menopause-related skin concerns.

How Hormones Influence Skin Pigmentation

Melanin is the substance in the body that is responsible for the coloration in skin, hair, and eye pigmentation. It acts as a natural shield from the sun by absorbing its rays, protecting cells from damage. Melanin is produced by cells in the skin called melanocytes which are responsive to environmental and hormonal signals.

The skin contains estrogen receptors, and the decline in hormones during perimenopause and menopause may influence how skin responds to UV exposure and inflammation. This might help to explain why pigmentation patterns change during hormonal transitions and why some women notice uneven skin tone becoming more visible during midlife.

Although this connection is important, pigmentation changes are usually the result of several factors and not caused by a single process.

Common Types of Dark Spots in Perimenopause and Menopause

Not all dark spots are the same and seeing a clinician to identify them is important so they can determine the best way to treat them.

Solar lentigines are flat brown spots associated with long-term UV exposure. These spots often appear on the face, chest, shoulders, and hands and are sometimes called “age spots”.

Melasma is patchy brown or gray-brown discoloration. It commonly appears symmetrically on cheeks, forehead, upper lip and often associated with hormonal fluctuations and sun exposure.

Post-inflammatory hyperpigmentation can occur after acne, irritation, inflammation, or injury and may persist longer in skin that is slower to turn over.  Acne flares that occur during perimenopause often cause discoloration on the skin afterward due to the sensitive and delicate nature of menopausal skin.

Other types of hyperpigmentation can occur more frequently during menopause as well and can be due to underlying conditions or even medications. 

Sun Exposure and Skin Aging: A Major Driver of Dark Spots

UV exposure remains one of the largest contributors to visible pigmentation. Ultraviolet radiation stimulates melanin production as part of the skin’s protective mechanism. Sun exposure and the resulting melanin production accumulate gradually over decades and the skin conditions created by menopause make pre-existing photodamage easier to see.

Hyperpigmentation most commonly appears on sun-exposed areas of the body, especially the face, hands, chest, and shoulders. Preventing its occurrence is the most important part of managing hyperpigmentation. Using sunscreen every day is an important part of preventing hyperpigmentation from worsening. Broad-spectrum SPF, hats, shade, and protective clothing may help reduce additional discoloration from occurring over time.

When Dark Spots Should Be Checked by a Clinician

Most dark spots associated with aging and sun exposure are benign, but some skin changes deserve medical evaluation.

Dermatologists use the “ABCDE rule” to evaluate spots that appear on the skin. Using this guideline they examine the area of pigmentation to look for:

• A: asymmetry

• B: irregular borders

• C: uneven color

• D: increasing diameter

• E: evolution or change over time

They will also evaluate if the area has any symptoms such as itching, bleeding, crusting, or rapid growth.

New or changing areas of pigmentation should not be self-assessed or diagnosed and should always be evaluated by a professional. This should occur when they begin to appear unusual or if new changes take place.

Skincare Ingredients That Can Help Prevent or Fade Dark Spots

Hyperpigmentation fades gradually instead of disappearing quickly and most brightening treatments require consistent use for several weeks or months before improvement is visible. Many women begin noticing skin texture and tone changes over 8-12 weeks or longer. 

These are common skincare ingredients and treatments used to manage hyperpigmentation:

• Tretinoin: increases cell turnover and may gradually improve uneven pigmentation and photodamage by promoting new skin cells to appear more quickly.

• Vitamin C: adds antioxidant support and may help provide a more even-looking skin tone.

• Azelaic acid: an antioxidant and anti-inflammatory that may help calm skin and prevent new spots from forming

• Niacinamide: supports barrier function

• Chemical peels and laser procedures (with a dermatologist or licensed aesthetician)

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Menopausal skin can become more reactive than earlier in life and using too many active ingredients together can increase the likelihood of irritation or dryness. Adding more products at once does not necessarily produce faster results. The best results are obtained by gradually introducing new products to the skin and allowing time to adjust. Many women find that a small number of consistent products often works better than a complicated routine that is difficult to maintain long term.

Can Hormone Therapy or Topical Estrogen Affect Dark Spots?

Many women have questions about how topical hormone therapy affects the skin. Topical estrogen therapy may improve hydration, elasticity, and skin thickness in some women. However, evidence regarding its effect on hyperpigmentation remains inconclusive.  

Because hormonal skin changes during perimenopause and menopause can alter the structure of the skin, many women find that their skin needs a different kind of support than it did earlier in life. Treatment decisions about skincare during this time should be individualized and discussed with a clinician familiar with menopause-related skin concerns.

References 

• Hall G, Phillips TJ. Estrogen and skin: the effects of estrogen, menopause, and hormone replacement therapy on the skin. J Am Acad Dermatol. 2005;53(4):555-568. doi:10.1016/j.jaad.2004.08.039

• Verdier-Sévrain S, Bonté F, Gilchrest B. Biology of estrogens in skin: implications for skin aging. Exp Dermatol. 2006;15(2):83-94. doi:10.1111/j.0906-6705.2005.00377.x

• Lephart ED. A review of the role of estrogen in dermal aging and facial attractiveness in women. J Cosmet Dermatol. 2018;17(3):282-288. doi:10.1111/jocd.12484

• Skoczyńska A, Budzisz E, Trznadel-Grodzka E, Rotsztejn H. Melanin and lipofuscin as hallmarks of skin aging. Postepy Dermatol Alergol. 2017;34(2):97-103. doi:10.5114/ada.2017.67070

• Akiba S, Shinkura R, Miyamoto K, et al. Influence of chronic UV exposure and lifestyle on facial skin photo-aging: results from a pilot study. J Epidemiol. 1999;9(6 Suppl):S136-S142. doi:10.2188/jea.9.sup_6_s136

• Bergfeld WF. A lifetime of healthy skin: implications for women. Int J Fertil Womens Med. 1999;44(2):83-95.

• Roster K, Fleshner L, Karatas TB, et al. Menopause and common dermatoses: a systematic review. Am J Clin Dermatol. 2026;27(1):67-84. doi:10.1007/s40257-025-00966-4

• Hu SW, Chu J, Meehan S, Kamino H, Pomeranz MK. Acquired brachial cutaneous dyschromatosis. Dermatol Online J. 2011;17(10):16.

• Choi SW, Roh KY, Chung KW, Kim MR. Hormone replacement therapy in women with pre-existing hyperpigmented lesions. Maturitas. 2000;35(1):65-69. doi:10.1016/S0378-5122(00)00104-3

Frequently Asked Questions

Why do dark spots and uneven skin tone suddenly appear or become more visible during perimenopause and menopause?

During perimenopause and menopause, declining estrogen levels cause your skin to become thinner, drier, and significantly slower to renew itself. This reduction in cell turnover causes existing pigmentation to linger on the skin's surface for longer periods rather than fading. Furthermore, because estrogen helps support collagen production, hydration, and overall skin structure, its decline weakens the skin's matrix, making decades of accumulated ultraviolet (UV) photodamage and previous skin injuries much more apparent.

What are the most common types of hyperpigmentation that develop in midlife, and how do they differ?

The three most common types of discoloration seen in midlife are solar lentigines, melasma, and post-inflammatory hyperpigmentation. Solar lentigines—often called "age spots"—are flat brown spots caused by long-term UV exposure that typically surface on the face, chest, shoulders, and hands. Melasma presents as patchy, symmetrical brown or gray-brown discoloration, most frequently appearing on the cheeks, forehead, and upper lip, and is heavily influenced by a combination of sun exposure and hormonal fluctuations. Post-inflammatory hyperpigmentation occurs as residual dark spots left behind after an acne flare-up, irritation, or injury, persisting much longer in menopausal skin because cell turnover has slowed down.

When should a new or changing dark spot be checked by a clinician instead of being treated at home?

While most dark spots linked to aging and sun exposure are completely harmless, any new or changing area of pigmentation must be evaluated by a professional. Dermatologists utilize the "ABCDE rule" to check for signs of concern, looking specifically for Asymmetry, irregular Borders, uneven Color, increasing Diameter, and Evolution or change over time. Additionally, you should skip self-assessment and seek a medical evaluation immediately if a pigmented spot begins exhibiting physical symptoms such as itching, bleeding, crusting, or rapid growth.