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The short version
- Dry eye is about twice as common in women as in men, and it becomes more common through midlife and beyond.
- Hormones help run the glands that make your tears. Androgens, which women make too, help keep the oil glands along the eyelids working.
- Dry eye often turns up in the same years as perimenopause, but research hasn’t proven that menopause itself sets it off.
- Studies of hormone therapy and dry eyes conflict. Don’t start, stop or change it because of your eyes. Talk it over with the person who prescribes it.
- Treatment depends on your type of dry eye: the oil in your tears, the watery part, or both.
- Dry eyes together with a dry mouth are worth raising with a doctor. Sjögren’s disease is most common in people in their 40s and 50s, and most people with it are women.
Is dry eye a symptom of perimenopause?
Dry eye often turns up in the same years as perimenopause, and hormones help run the glands that make your tears. But research hasn’t proven that menopause itself causes it.
Perimenopause, also called the menopausal transition, is the time leading up to menopause, when periods stop for good. Most women begin it between ages 45 and 55, and the average age of menopause in the US is 52. You only know you’ve reached menopause once you’ve gone a full year without a period1 US National Institute on Aging, National Institutes of Health (opens in a new tab). What Is Menopause?.
These are also the years when dry eye becomes more common. A national survey of 75,000 US adults estimated that 8.8% of US women had been diagnosed with dry eye, compared with 4.5% of men, which works out to about 11.1 million women. People aged 45 to 54 had about twice the risk of those aged 18 to 342 Farrand et al., American Journal of Ophthalmology, 2017 (opens in a new tab). Prevalence of Diagnosed Dry Eye Disease in the United States Among Adults Aged 18 Years and Older..
The Women’s Health Study surveyed 39,876 US women. Dry eye, meaning a diagnosis or severe symptoms, was more common at older ages: 5.7% of women under 50 had it, compared with 9.8% of those 75 and older. The authors noted that it also affects many women in their 40s and 50s3 Schaumberg et al., American Journal of Ophthalmology, 2003 (opens in a new tab). Prevalence of dry eye syndrome among US women..
Among 1,518 women and 581 men with diagnosed dry eye in that study and a similar study of men, the women had been diagnosed at 60 on average, six years younger than the men, and 33.6% of the women reported severe symptoms on a standard questionnaire, compared with 15.6% of the men4 Sullivan et al., The Ocular Surface, 2017 (opens in a new tab). TFOS DEWS II Sex, Gender, and Hormones Report..
The link with menopause itself is less clear. The 2017 international dry eye workshop’s report on sex and hormones says the medical literature commonly assumes that menopause goes with more dry eye, but that a closer look shows definitive evidence is lacking. Dry eye becomes gradually more common with age in men as well as women, which the authors suggest may fit the slow decline in androgens with age better than the abrupt fall in estrogen at menopause4.
A 2011 international workshop report on oil gland disease notes that the largest study, of the 39,876 women above, found no association between menopausal status and dry eye5 Schaumberg et al., Investigative Ophthalmology & Visual Science, 2011 (opens in a new tab). The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on the Epidemiology of, and Associated Risk Factors for, MGD.. The National Institute on Aging’s overview of menopause doesn’t list dry eyes among the most common changes of midlife, though it does mention drier skin and vaginal dryness1.
None of this means your symptoms aren’t real or that hormones play no part. It means age, hormones, medicines and other conditions can all contribute, and each one is worth a look. Our overview of what causes dry eyes covers the rest.
How hormones affect your tears
Your tears are made of oil from glands along the edges of your eyelids, water from the tear glands, and mucin from cells on the surface of the eye. Sex hormones, estrogens and androgens alike, influence the production of all of them6 Peck et al., Journal of Mid-Life Health, 2017 (opens in a new tab). Dry Eye Syndrome in Menopause and Perimenopausal Age Group..
That’s part of why dry eye is more common in women. The international dry eye workshop calls female sex a significant risk factor, and attributes the difference in large part to hormones, from androgens and estrogens to thyroid hormones and insulin, along with differences in genes and gene activity4.
During the menopausal transition, the body’s production of estrogen and progesterone, two hormones made by the ovaries, declines greatly1. You might expect falling estrogen to explain dry eye, but the evidence on estrogen points both ways.
In one study, women aged 17 to 43 whose ovaries had stopped working early had more dry eye symptoms than women of the same age. Dry eye has also been linked with aromatase inhibitors, breast cancer medicines that block aromatase, an enzyme the body uses to turn androgens into estrogens. Yet two studies of women after menopause linked higher natural estrogen levels with worse results on tear tests and with oil gland problems4.
The oil glands and androgens
The oil that slows the evaporation of your tears comes from the meibomian glands along the edges of your eyelids6. These glands respond to androgens, the hormones often thought of as male. Androgens stimulate the glands and appear to hold back keratinization, a toughening of the cells that line the gland ducts and a primary cause of meibomian gland dysfunction. A lack of androgens is a risk factor for meibomian gland dysfunction and the evaporative dry eye that goes with it4.
Women make androgens too. Most are made in tissues throughout the body from raw materials supplied by the adrenal glands, and after menopause all of them are. An androgen shortfall typically happens at menopause, as the ovaries and adrenal glands release less, and with age in both sexes. It’s also seen with anti-androgen medicines and with autoimmune diseases such as Sjögren’s, lupus and rheumatoid arthritis. The workshop report raises the possibility that reduced androgen action, rather than extra estrogen action, is what makes dry eye more common in women4.
Oil gland trouble was very common in a study of 516 women in perimenopause from a maternity hospital’s gynecology department in Hangzhou, China: 91.3% met the study’s criteria for dry eye and 86.8% for meibomian gland dysfunction7 Jin et al., Medicine, 2016 (opens in a new tab). Hormone replacement therapy benefits meibomian gland dysfunction in perimenopausal women.. The study included only women in perimenopause, with no comparison group, so it can’t show that perimenopause caused it.
Testosterone applied to the eyelids or given as eye drops has been tested as a treatment6. In a phase 2 trial in people with meibomian gland dysfunction, reported as a 2006 conference abstract, testosterone eye drops improved the quality of the glands’ oil and eased discomfort4.
A small placebo-controlled trial in 40 women with dry eye, on average 13 years past menopause, tested testosterone, estrogen or both, absorbed through the skin, for eight weeks. None of them improved symptoms or tear tests more than the placebo, and dryness was worse with estrogen8 Golebiowski et al., British Journal of Ophthalmology, 2017 (opens in a new tab). The effects of transdermal testosterone and oestrogen therapy on dry eye in postmenopausal women: a randomised, placebo-controlled, pilot study.. The value of androgen treatments for dry eye is still debated6. Don’t put any hormone product near your eyes unless an eye doctor has prescribed it.
Does hormone therapy help or hurt dry eyes?
Studies of hormone therapy and dry eyes disagree. The international dry eye workshop calls the clinical evidence on estrogen and progesterone inconsistent4. Here’s what the main kinds of study found.
- Large population studies link it with more dry eye. In the Women’s Health Study, among 25,665 women after menopause, those taking estrogen alone had 1.69 times the odds of dry eye (a diagnosis or severe symptoms) of women not taking hormones, and those taking estrogen with progesterone or a progestin had 1.29 times the odds. Each extra three years of use went with a 15% higher risk9 Schaumberg et al., JAMA, 2001 (opens in a new tab). Hormone replacement therapy and dry eye syndrome.. In an Australian study of 1,174 people aged 50 and older, the Blue Mountains Eye Study, hormone replacement therapy was one of the factors linked with dry eye after allowing for age and sex10 Chia et al., Clinical & Experimental Ophthalmology, 2003 (opens in a new tab). Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study.. Both studies recorded what women were already taking rather than assigning a treatment, so they show a link but can’t prove that hormone therapy caused the dry eye.
- Smaller treatment studies are mixed. Some smaller studies found worse symptoms or tear tests with hormone therapy, while others reported fewer symptoms or more tears with estrogen, with or without progesterone. But none of the studies that reported better symptoms compared the treatment with a placebo. Of the three that did, one found symptoms got worse and two found no change4.
- One perimenopause study found a benefit. In the study of 516 women in China described above, 113 chose to take hormone therapy (estradiol with dydrogesterone, a progestin). Everyone got the same dry eye care: a warm, wet compress each day at home, artificial tears, and gland expression by a doctor once a week. The women taking hormones improved more in symptoms, oil gland scores and staining of the eye’s surface7. The women decided for themselves whether to take hormones and there was no placebo, so the two groups may have differed in other ways.
A 2017 review found a shortage of large, controlled studies with long follow-up on hormone therapy for dry eye around menopause6. Until there are, the question stays open.
What this means for you
Hormone therapy is a decision about your whole health, made with the person who prescribes it. Don’t start, stop or change it because of your eyes. If your eyes got worse after you started or changed hormone therapy, tell your prescriber and your eye doctor, and keep taking it as prescribed until you’ve talked. The authors of the large 2001 study suggested that doctors caring for women who take or are considering hormone therapy should know about dry eye as a possible complication9.
Medicines that can add to it
Several common medicines are linked with dry eye. Among people with dry eye in two large US studies, women were more likely than men to take two of them, antihistamines and antidepressants4.
- Antidepressants. A study in Beaver Dam, Wisconsin, followed 2,414 older adults who didn’t have dry eye for 10 years. Those taking antidepressants were more likely to develop it, even after allowing for age and other factors11 Moss et al., Optometry and Vision Science, 2008 (opens in a new tab). Long-term incidence of dry eye in an older population..
- Antihistamines. Antihistamines taken by mouth have also been linked with a higher risk of dry eye5.
- Aromatase inhibitors. These breast cancer medicines have been linked with dry eye in women after menopause4.
- Hormone therapy. See what the hormone therapy studies found, above.
Never stop or change a prescription because of your eyes. Ask the prescriber whether the medicine could be playing a part and whether there’s an alternative, and treat the dryness in the meantime. Our dry eye overview lists other medicines linked with dry eye.
Dry eyes and a dry mouth: Sjögren’s disease
Sjögren’s disease is a long-lasting autoimmune condition in which the immune system attacks the glands that make moisture in the eyes, the mouth and other parts of the body. Its main symptoms are dry eyes and a dry mouth, and many people also have fatigue and joint and muscle pain. Most people with it are women. It can start at any age, but it’s most common in people in their 40s and 50s12 US National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (opens in a new tab). Sjögren’s Disease..
That’s the same stretch of life as perimenopause. Some of its other symptoms, such as vaginal dryness, trouble sleeping, joint pain and poor concentration12, also appear on the list of common changes at midlife1, so it’s easy to put everything down to menopause. Tell your doctor if your dry eyes come with a dry mouth: a mouth that feels chalky, trouble swallowing, speaking or tasting, or more cavities than usual12.
There’s no single test. The diagnosis is based on how well the tear and saliva glands work and on signs of autoimmunity, using eye tests, saliva gland tests and blood tests for antibodies, which can’t make the diagnosis on their own. A rheumatologist, a specialist in autoimmune diseases, may make the diagnosis, and an eye doctor or dentist may run some of the tests13 US National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (opens in a new tab). Sjögren’s Disease: Diagnosis, Treatment, and Steps to Take..
For the eyes, the NIH’s advice for people with Sjögren’s includes preservative-free drops, which it calls usually essential if you regularly use drops four or more times a day, humidifiers in the rooms where you spend the most time, and protecting your eyes from drafts, breezes and smoky rooms13.
What helps
Whatever part hormones play, the right treatment depends on which part of your tears is falling short: the oil, the water or both. Our guide to the types of dry eye explains the difference, and the free Dry Eye Profile sorts your symptoms into a likely type in about three minutes. It asks about perimenopause and medicines too.
If your oil glands are involved
In one clinic-based study, 86% of the dry eye patients whose type could be identified had signs of meibomian gland dysfunction14 Lemp et al., Cornea, 2012 (opens in a new tab). Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort..
- Warm compresses Good evidence are a mainstay of treatment for meibomian gland dysfunction. A 2024 review advises a moist heat mask, microwavable or self-heating, on each eye for at least 10 minutes. Hot towels need frequent reheating to stay warm enough15 Lee, Ophthalmology and Therapy, 2024 (opens in a new tab). Evidence-Based Strategies for Warm Compress Therapy in Meibomian Gland Dysfunction.. Our warm compress guide covers how to do it and the lid massage and cleaning that follow.
- Drops that contain oil are designed to support the oil layer of your tears. Our eye drop guide sorts drops by type.
Heated eye mask
Bruder Moist Heat Eye Compress
A microwavable mask made to hold its warmth far longer than a washcloth, which cools within minutes. Steady warmth over several minutes is what thickened gland oil needs to soften.
Worth knowing. Test it on your wrist every time. Eyelid skin is thin and burns easily.
Evidence grades are for the type of product, not the brand. Amazon links are affiliate links. If you buy through them we may earn a commission, at no extra cost to you. Disclosure.
If your eyes make too few tears
- Preservative-free artificial tears Good evidence. A Cochrane review found that over-the-counter artificial tears may be safe and effective, though it rated the evidence as low quality16 Pucker et al., Cochrane Database of Systematic Reviews, 2016 (opens in a new tab). Over the counter (OTC) artificial tear drops for dry eye syndrome..
- An ointment at night. Ointments are thicker than drops and keep the eyes wet for several hours. They can blur your vision, so most people use them while they sleep13.
- A humidifier Mixed evidence in the rooms where you spend the most time, as the NIH suggests for people with Sjögren’s13.
Water-layer drop, preservative-free bottle
iVizia Lubricant Eye Drops
Povidone with hyaluronic acid and trehalose, preservative-free in a multi-dose bottle. Gentle enough to use many times a day.
Worth knowing. Water-layer drops alone often fall short if your oil glands are the real problem.
Evidence grades are for the type of product, not the brand. Amazon links are affiliate links. If you buy through them we may earn a commission, at no extra cost to you. Disclosure.
Omega-3 supplements
Mixed evidence Fish oil is often suggested for dry eye. In the DREAM trial, 535 people with moderate to severe dry eye took either 3,000 mg of omega-3 a day or an olive oil placebo for a year, and the omega-3 group did no better17 DREAM Study Research Group, New England Journal of Medicine, 2018 (opens in a new tab). n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease.. Some smaller, earlier trials suggested a benefit5, so the question isn’t completely settled, but it shouldn’t be your first step.
If home care isn’t enough
If a few weeks of steady home care haven’t helped, see an eye doctor. Prescription options include anti-inflammatory drops, Miebo and tear-stimulating treatments, compared in our guide to prescription dry eye drops. For blocked oil glands, eye doctors also offer in-office treatments such as intense pulsed light (IPL) and thermal pulsation, covered in dry eye treatments and costs. The evidence board grades all of these side by side.
The free Dry Eye Profile sorts your symptoms into a likely type and gives you a plan in about three minutes.
Contact lenses in midlife
If lenses you’ve worn comfortably for years start to bother you, changes around menopause may play a part. The workshop report lists contact lens tolerance among the things that may change in the eye around menopause, along with the cornea’s thickness, curvature and sensitivity4. Our guide to dry eyes with contacts covers which drops are safe with lenses in and the lens changes worth asking your optometrist about.
When to see an eye doctor
Book a visit with an optometrist or ophthalmologist if your eyes still bother you after a few weeks of home care, if you need drops many times a day, or if dryness is getting in the way of reading, screens or driving. Bring a list of everything you take, including hormone therapy, supplements and allergy tablets, and mention it if your mouth is dry too.
See a doctor promptly if you have
Eye pain rather than discomfort, a sudden change in vision, strong light sensitivity, one eye much redder than the other, or thick discharge. These can signal infection or inflammation that needs treatment soon. If you wear contact lenses, take them out until you’ve been seen.
Our directory lists practices whose own websites show dry eye care beyond drops, and you can filter it for oil gland treatments such as IPL and thermal pulsation. Search by ZIP code, starting in Florida.
Common questions
Can perimenopause cause dry eyes?
It may play a part. Hormones help run the glands that make your tears, and androgens in particular help keep the oil glands working. Dry eye also often appears in the same years as perimenopause. But research hasn’t proven that menopause itself sets it off, and age, medicines and other conditions can add to it.
Will hormone therapy help my dry eyes?
The evidence doesn’t support taking it for that. Large population studies linked hormone therapy with more dry eye, and in the placebo-controlled trials it didn’t improve symptoms. One study in perimenopause did report a benefit, but the women chose for themselves whether to take hormones and there was no placebo. Decide about hormone therapy with your prescriber based on your overall health, and treat the dry eye directly.
Can hormone therapy cause dry eyes?
It may raise the risk. In a study of 25,665 women after menopause, those taking estrogen alone had about 70% higher odds of dry eye, and those taking estrogen with progesterone or a progestin about 30% higher. That study shows a link and can’t prove cause. Don’t stop hormone therapy because of your eyes. Tell your prescriber and your eye doctor instead.
Do dry eyes go away after menopause?
Dry eye tends to become more common with age. In the Women’s Health Study, 5.7% of women under 50 had it, compared with 9.8% of those 75 and older. So it’s worth treating now rather than waiting for it to pass.
Are dry eyes and a dry mouth a sign of menopause?
Not necessarily. Drier skin and vaginal dryness can come with menopause, but dry eyes and a dry mouth together are the main symptoms of Sjögren’s disease, an autoimmune condition that is most common in people in their 40s and 50s. Mention both to your doctor, who can arrange tests.
Do omega-3 supplements help dry eyes in menopause?
Probably not much. In the DREAM trial, a year of fish oil supplements with 3,000 mg of omega-3 a day worked no better than an olive oil placebo for people with moderate to severe dry eye. Some small trials were more positive, so it’s a later step at best.
Sources
- What Is Menopause? (opens in a new tab) US National Institute on Aging, National Institutes of Health.
- Prevalence of Diagnosed Dry Eye Disease in the United States Among Adults Aged 18 Years and Older (opens in a new tab). Farrand et al., American Journal of Ophthalmology, 2017.
- Prevalence of dry eye syndrome among US women (opens in a new tab). Schaumberg et al., American Journal of Ophthalmology, 2003.
- TFOS DEWS II Sex, Gender, and Hormones Report (opens in a new tab). Sullivan et al., The Ocular Surface, 2017.
- The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on the Epidemiology of, and Associated Risk Factors for, MGD (opens in a new tab). Schaumberg et al., Investigative Ophthalmology & Visual Science, 2011.
- Dry Eye Syndrome in Menopause and Perimenopausal Age Group (opens in a new tab). Peck et al., Journal of Mid-Life Health, 2017.
- Hormone replacement therapy benefits meibomian gland dysfunction in perimenopausal women (opens in a new tab). Jin et al., Medicine, 2016.
- The effects of transdermal testosterone and oestrogen therapy on dry eye in postmenopausal women: a randomised, placebo-controlled, pilot study (opens in a new tab). Golebiowski et al., British Journal of Ophthalmology, 2017.
- Hormone replacement therapy and dry eye syndrome (opens in a new tab). Schaumberg et al., JAMA, 2001.
- Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study (opens in a new tab). Chia et al., Clinical & Experimental Ophthalmology, 2003.
- Long-term incidence of dry eye in an older population (opens in a new tab). Moss et al., Optometry and Vision Science, 2008.
- Sjögren’s Disease (opens in a new tab). US National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health.
- Sjögren’s Disease: Diagnosis, Treatment, and Steps to Take (opens in a new tab). US National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health.
- Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort (opens in a new tab). Lemp et al., Cornea, 2012.
- Evidence-Based Strategies for Warm Compress Therapy in Meibomian Gland Dysfunction (opens in a new tab). Lee, Ophthalmology and Therapy, 2024.
- Over the counter (OTC) artificial tear drops for dry eye syndrome (opens in a new tab). Pucker et al., Cochrane Database of Systematic Reviews, 2016.
- n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease (opens in a new tab). DREAM Study Research Group, New England Journal of Medicine, 2018.
This guide is for education and doesn’t replace advice from your eye doctor or the clinician who prescribes your medicines. Don’t start, stop or change hormone therapy or any other prescription because of your eyes without talking to your prescriber.