Question
I'm 53 and in menopause. Since perimenopause, my melasma has returned. I had it my 30s due to birth control pills. I'm using TriLuma and am fanatical about sunscreen. I'm Asian and dermatologists have told me laser or other procedures might worsen it.
Answer
Melasma is typically caused in women by exposure to estrogens. For this reason, any hormone replacement you are taking that contains estrogen can contribute, so I would refrain from using estrogens. Also, the hormonal fluctuation you get in perimenopause could also cause higher estrogen levels, alternating with low levels, and could also contribute to melasma.
Typically, hydroquinone (TriLuma) or other creams have not proven to be very effective for melasma. The best thing would be a good zinc-containing sunscreen when outdoors, and staying out of the sun if possible.