Estrogen is often blamed as the cause of melasma, and it’s easy to understand why this happens. Estrogen can directly stimulate melanocytes to produce pigment, and melanocytes within melasma lesions show increased numbers of estrogen receptors. Still, this doesn’t mean estrogen is the “root cause” of melasma.

Melasma also appears during birth control use, pregnancy, hormone replacement therapy (HRT), and perimenopause — times when estrogen levels can be elevated. On the surface, these observations suggest estrogen is behind the hyperpigmentation, but that doesn’t explain why most women don’t develop melasma under those conditions.

The term “root cause” gets thrown around a lot. Many people assume their diagnosis itself is the root cause, when in reality it’s just a label. But even when people understand that the root cause is deeper than their diagnosis, most stop short of discovering why their chronic symptoms occur.

For example, someone with hypothyroidism might view their thyroid dysfunction as the “root cause” of their fatigue or other symptoms. But the deeper question is why the thyroid isn’t functioning properly. Is it because of nutrient deficiencies, chronic stress, exposure to toxins, or impaired conversion of T4 (inactive thyroid hormone) to T3 (active thyroid hormone)? Continuing to ask “why” helps to uncover the true root cause.

Returning to melasma, the real question isn’t whether estrogen is involved — it clearly is to some extent. But why? Why do melanocytes in melasma lesions express more estrogen receptors than those in surrounding skin? Why do some women develop persistent pigmentation while others with similar hormone changes do not? And why does pigment persist even after estrogen levels normalize? Exploring these “why” questions opens the door to looking beyond estrogen and uncovering the deeper factors — oxidative stress, sluggish detox, and gut health issues — that truly drive melasma.

There’s More to Melasma Than Estrogen

Many women experience estrogen imbalances — I see it all the time in my practice. Yet most of these women never develop melasma. If estrogen were a true root cause, we would expect melasma rates to closely mirror the high prevalence of estrogen imbalances — but they don’t.

Studies on estrogen levels in women with melasma show mixed results. Some women with melasma do show higher estrogen levels when tested, while others have normal or even low levels. This reinforces that estrogen does not explain why melasma develops or persists.

Some women notice melasma developing during times when estrogen levels rise, such as with birth control, HRT, pregnancy, or perimenopause. They may see improvement when they discontinue birth control or HRT, or as they move past pregnancy or perimenopause. However, many continue to struggle with persistent melasma — further evidence that estrogen does not explain the condition.

Melasma Is a Protective Mechanism

To understand why estrogen isn’t a root cause, it helps to understand what melasma actually is. You can read more in my article What is Melasma Really? Why It’s Not What You Think, but the key point is this: the increased pigment in melasma is a protective mechanism. It’s your skin’s way of coping with the three core underlying issues: chronic inflammation, excess oxidative stress, and a damaged skin barrier (explained in more detail in my article The 3 Core Issues of Melasma).

Estrogen isn’t the only factor that stimulates melanin production in melasma either. Studies of melasma lesions show multiple contributors — immune molecules, cytokines (chemical messengers), other hormones, and growth factors — stimulate increased melanin production. The body clearly activates several different pathways to achieve this increased pigmentation — and this is not a “mistake.” The elevated melanin is protective. It serves an important purpose in response to underlying stressors in the skin.

Estrogen Is an Antioxidant

Oxidative stress is a core issue driving excess pigment production in melasma. As you learned in The 3 Core Issues of Melasma, oxidative stress occurs when your body’s defenses can’t keep up with the free radicals produced by everyday metabolism, stress, toxins, and environmental exposure.

Antioxidants are so named because they neutralize free radicals and oxidative stress. Your body has built-in antioxidant systems in place, and glutathione is perhaps the most famous antioxidant your body produces.

But did you know that estrogen also has antioxidant activity? 

Melasma lesions show both increased oxidative stress and increased estrogen receptors. Is the body wisely increasing estrogen receptors not just to stimulate pigment production locally, but also to harness estrogen’s antioxidant power? I firmly believe the body doesn’t make mistakes, and it doesn’t do anything for no reason. It makes sense that estrogen would be used to increase pigment (a protective mechanism) and to help neutralize oxidative stress and protect your skin. 

Estrogen Imbalances Are Driven by Deeper Issues

In my experience, estrogen imbalances always reflect deeper underlying problems. I don’t view estrogen imbalances as a true root cause — there is always a reason estrogen levels get wonky. Because of tight feedback mechanisms, the body rarely overproduces estrogen. More often, estrogen imbalances are driven by:

1. a lack of sufficient progesterone to oppose estrogen

Progesterone and estrogen are like yin and yang hormones — they balance each other. Progesterone is only produced if you ovulate, and the quality of ovulation determines how much progesterone is made. If ovulation doesn’t occur or it’s subpar — due to certain forms of hormonal birth control, high stress (physical or psychological), nutritional deficiencies, or mitochondrial dysfunction in the ovaries — progesterone production drops. Without enough progesterone,  estrogen exists in an “unopposed” state, creating “estrogen dominance” — a term you may have heard before.

Here, the problem isn’t estrogen itself — it’s that estrogen isn’t being balanced by progesterone. Addressing this requires supporting healthy ovulation and progesterone production.

2. sluggish estrogen detox

Your liver performs hundreds of jobs — including metabolizing estrogen, along with other toxins from food, air, water, and normal metabolism. If your liver is overburdened with toxins or lacks the nutrients needed to run detox pathways, estrogen metabolism suffers — leading to higher levels in your body.

The liver processes estrogen via “methylation.” If you have methylation issues, then this directly impacts estrogen metabolism. Genetic mutations like COMT and MTHFR can impact this process, but lifestyle, diet, chronic infections, stress, and environmental toxins can also impair methylation.

Xenoestrogens — man-made chemicals with estrogen-like activity found in plastics, personal care products, pesticides, and industrial pollutants — mimic and disrupt hormones. These toxins also rely on liver processing. If the liver is struggling, xenoestrogens accumulate in fat tissue and contribute to hormonal imbalance, including issues like melasma. 

In these cases, the problem isn’t estrogen itself — it’s impaired detox and accumulated toxins.

3. compromised estrogen elimination

After your liver processes estrogen, your body then has to get it out. This is primarily done through the gut — which is why the health of your gut has a big impact on hormonal balance.

If you have less than one bowel movement per day, your body may reabsorb estrogen into circulation, contributing to imbalance.

Your gut microbiome also plays a crucial role in this process. The “estrobolome” — gut bacteria responsible for estrogen metabolism — must be balanced for healthy hormone regulation. When the gut microbiome is imbalanced (a very common issue), it can disrupt estrogen metabolism and elimination. You cannot have balanced hormones when your gut isn’t healthy. 

In this scenario, the issue isn’t estrogen — it’s a gut health problem.

Looking Deeper: Addressing the Root Causes of Melasma

Estrogen plays a role in melasma by contributing to hyperpigmentation, but it is NOT a “root cause” of melasma. Melasma is a protective response to underlying issues such as chronic inflammation, oxidative stress, and a compromised skin barrier. Elevated estrogen stems from deeper imbalances, and increased numbers of estrogen receptors on melanocytes is the body’s adaptive response to underlying issues.

The true root causes of melasma lie deeper. They include the impact of lifestyle on ovulation and progesterone production, impaired estrogen detoxification from a liver overburdened with toxins, and compromised gut health that affects estrogen elimination. By addressing these deeper underlying factors, rather than focusing solely on estrogen, you can support your skin, optimize your hormones, and heal your melasma.

Want to understand exactly what drives your melasma and why it persists? Download my free guide Decoding Melasma to uncover the core issues, root causes, and triggers behind your stubborn hyperpigmentation. 

Ready to take action? My eBook Heal Your Melasma from the Inside Out provides step-by-step nutrition, lifestyle, and skincare strategies to help you address your root causes, reduce pigment, and support healthy, radiant skin — from the inside out.