Dry Eyes in Menopause: Why Hormone Therapy Isn't the Simple Fix

Her eyes feel gritty by mid-afternoon. They burn, her vision blurs until she blinks, and her contacts, which she wore for twenty years, have become unbearable. Eye drops help for twenty minutes. Someone told her it was screen time.

Dry eye is one of the most common menopause-era symptoms and one of the least connected to menopause in most people's minds. It also has a twist that most articles skip.

How common it is

Cleveland Clinic reports that up to 60% of perimenopausal and menopausal women have symptoms such as dry, scratchy eyes, blurred vision, light sensitivity, and swollen, red eyelids.

Why it happens, and why it isn't just estrogen

Tears have three layers: a watery layer, a mucus layer, and an oily outer layer that stops the tear from evaporating. The oil comes from the meibomian glands in the eyelids, which are large oil glands. When those glands underperform, tears evaporate too fast, and that evaporative dry eye is the most common type.

Both estrogen and androgens are reduced at menopause, and both affect the tear-producing and oil-producing glands. But a review of dry eye in postmenopausal women found that low androgen levels are the more consistent factor, while both low and high estrogen levels have been linked to dry eye.

The hormone therapy twist

You might expect estrogen to fix it. The largest study on the question suggests otherwise. In the Women's Health Study, which followed more than 25,000 postmenopausal women, those using estrogen alone had about 69% higher odds of dry eye or severe dry eye symptoms than women who used no hormone therapy, and those using estrogen plus a progestogen had about 29% higher odds. The risk rose with longer use.

That was an observational study with self-reported outcomes, and it began in the 1990s, so it reflects the formulations of that era. Later research is mixed, and reviews describe hormone therapy as having limited benefit for dry eye symptoms and possibly worsening meibomian gland dysfunction. Dose and the age when treatment starts seem to matter. Androgen treatment, systemic or local, has shown promising early results, but it is not an established treatment.

My position is that your eyes alone are not a reason to start hormone therapy, and they are not a reason to avoid it either. I would not start testosterone for dry eye. The androgen data are early, and testosterone is not FDA-approved for any indication in women, as I covered in the testosterone article.

What to rule out

• Sjögren's syndrome. An autoimmune condition that mainly affects women and often appears in midlife. Dry eyes together with dry mouth, joint pain, or unexplained fatigue is worth testing for.
• Medications. Antihistamines, many antidepressants, some blood pressure drugs, and isotretinoin can all dry the eyes.
• Thyroid disease and vitamin A deficiency. Both can cause eye symptoms.
• Eyelid inflammation (blepharitis), allergies, and contact lens problems. All common and all treatable.

What helps

• Preservative-free artificial tears. Use them regularly, not only when the eyes are bad. Preservatives can irritate with frequent use.
• Warm compresses and lid hygiene. A warm compress for about ten minutes, followed by gentle lid cleaning, helps the oil glands flow. This is the most useful daily habit for evaporative dry eye.
• Cut down on evaporation. Take screen breaks and blink fully, use a humidifier, and keep fans and car vents from blowing on your face.
• See an eye doctor if it persists. Prescription drops that reduce inflammation, in-office treatments that open blocked oil glands, and tiny plugs that keep tears in the eye are all options.
• Be realistic about omega-3 supplements. The evidence here is clearer than for most supplements. In the DREAM trial, 535 people with moderate to severe dry eye took a high dose of fish oil or an olive-oil placebo for a year, and the fish oil did no better. Omega-3 may be worth taking for other reasons, but I would not rely on it for dry eye.

When to see an eye doctor urgently

Same-day evaluation is warranted for eye pain, sudden vision changes, marked redness with light sensitivity, or seeing halos around lights. Those are not dry eye.

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Dry eye in menopause is real, it is common, and the answer is rarely a single hormone. It usually comes from sorting out the cause and treating the eyelids and tear film directly.

References

1. Schaumberg DA, Buring JE, Sullivan DA, Dana MR. “Hormone replacement therapy and dry eye syndrome.” JAMA, 2001;286(17):2114-2119. View source
2. “Dry eye disease in postmenopausal women.” Review of hormonal influences and hormone therapy. View source
3. “The hormonal shift: endocrine mechanisms of menopausal dry eye.” mivision, June 2026. View source
4. National Eye Institute. “Omega-3s from fish oil supplements no better than placebo for dry eye” (DREAM study). 2018. View source
5. Cleveland Clinic. “29 Perimenopause Symptoms You May Not Know About.” July 2025. View source

Testosterone is not FDA-approved for any indication in women; this article mentions it only to explain why I would not use it for dry eye.