Women are nearly twice as likely as men to have dry eye, and hormones are a likely cause.
Dry eye is a common condition that happens when the body can’t produce tears that keep the eyes’ surfaces well lubricated. This can happen if the tear-producing glands don’t make enough tears or the tears they make dry too quickly.
Dry eye can happen to anyone, but women are nearly twice as likely as men to experience dry eye. What’s more, women with dry eye may find that their symptoms change during their menstrual cycles, with
Read on to learn more about the link between dry eye and the menstrual cycle, including the role of hormones in dry eye disease.
We use “women” and “men” in this article to reflect the terms that have been historically used to gender people. But your gender identity may not align with how your body responds to this disease. Your doctor can better help you understand how your specific circumstances will translate into diagnosis, symptoms, and treatment.
Many biological changes can lead to dry eye, including:
- typical aging
- nutritional deficiencies
- development of certain autoimmune conditions, such as lupus or Sjögren’s disease
The effects these changes have on the eyes may vary. For instance,
Certain vitamins, including
Though these biological factors affect the eyes in different ways, the result is similar: insufficient tear production to keep the eyes’ surfaces lubricated.
Estrogen and progesterone can
Like dry eye symptoms, estrogen levels change throughout the menstrual cycle.
The menstrual cycle involves three overlapping phases:
- follicular phase (before egg release)
- ovulatory phase (egg release)
- luteal phase (after egg release)
The follicular phase begins when menstruation occurs — the first day of menstrual bleeding is day 1 of the menstrual cycle. During menstruation, estrogen levels are low.
Estrogen levels increase quickly at the end of the follicular phase, leading to the ovulatory phase. After the egg release, estrogen levels decline again, though not quite to the levels during menstruation. Estrogen levels then begin increasing more slowly across the luteal phase before declining, leading to menstruation again.
Research has found that clinical signs of dry eye are worse during the late follicular and luteal phases, when estrogen levels are at their highest, compared with the low estrogen period of menstruation.
However, women tend to report worse dry eye symptoms when estrogen levels are low during menstruation.
The disconnect between clinical signs of dry eye and self-reported symptoms may be due to various factors, including changes in other hormone levels (such as androgen) or pain sensitivity across the menstrual cycle.
Actual changes in estrogen levels may also play a role in experiencing dry eye symptoms. People with more consistent estrogen levels — either due to oral contraceptive use (higher) or menopause (lower) — tend to report more frequent dry eye symptoms.
Hormone-related dry eye is manageable similar to forms of dry eye caused by other factors. Treatment may involve combining:
- over-the-counter eye drops
- warm compresses
- nutritional supplements
The effects of hormone therapy on dry eye symptoms are inconsistent. Some studies show a small benefit, and
If you or your doctor suspect that your dry eye symptoms may be related to the use of hormonal birth control, switching to a nonhormonal contraceptive may be advisable to see whether symptoms improve.
Hormones may play a key role in the difference in dry eye frequency between men and women. However, they likely aren’t the only cause.
A study from 2019 found that factors such as sleep, mood, and stress can affect dry eye symptoms, with more severe dry eye symptoms in people with lower sleep quality and higher anxiety. A 2023 study found that anxiety can increase the likelihood of developing dry eye by nearly
Women tend to be more likely to experience stress and anxiety than men, which may contribute to differences in the frequency of dry eye between people.
Research also suggests that women may be more likely to have bothersome dry eye symptoms than men. This could mean that women are more likely than men to discuss dry eye symptoms with their healthcare team.
Meanwhile, men can be more likely to experience symptoms such as epiphora (excessive eye watering) that may not be thought of as related to dry eye.
Changes in hormone levels can affect the experience of dry eye symptoms throughout the menstrual cycle. Other factors, including stress and difficulty getting enough sleep, may also contribute.
If you have dry eye symptoms that come and go during your menstrual cycle, your healthcare team can help you understand which steps you can take to care for your eyes and relieve symptoms as needed.