I have bad melasma with Mirena. What is the best contraceptive for those prone to melasma?

Thank you for your question. Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, microneedling/PRP, aerolase, and sometimes erbium laser (coollaser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

I can only answer based upon POSSIBILITY and not PROBABILITY- oestrogen pills and formulations are notorious in contributing, but not causing melasma. Other contraceptive methods such as the POP and depo formulations have a 10 % chance of worsening patients who are predisposed to melasma. On this basis, I do not advise cessation of contraception during treatment. This is based upon the fact that removal of the precipitating culprit rarely reverses the condition without treatment. 


Melasma is a very common cause of skin pigmentation. It can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. This forms the foundation of all treatments. 



I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’) 



In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher. 

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin. 



All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia. Real Self Advisory Board