In the years during your menopause transition, you’ll go through many hormonal changes. After menopause, your body makes less reproductive hormones, like estrogen and progesterone. Low levels of estrogen can impact your health in a variety of ways and cause uncomfortable symptoms, like hot flashes.

One of the lesser known symptoms of menopause is dry eyes. Dry eyes are caused by problems with your tears.

Everyone has a tear film that covers and lubricates their eyes. The tear film is a complex mixture of water, oil, and mucus. Dry eyes occur when you don’t produce enough tears or when your tears are ineffective. This can cause a gritty feeling, like something in your eye. It can also lead to stinging, burning, blurry vision, and irritation.

As people age, tear production decreases. Being older than 50 increases your risk of dry eyes, regardless of your sex.

Postmenopausal women, however, are particularly prone to dry eyes. Sex hormones like androgens and estrogen affect tear production in some way, but the exact relationship is unknown.

Researchers used to assume that low estrogen levels were causing dry eyes in postmenopausal women, but new investigations are focusing on the role of androgens. Androgens are sex hormones that both men and women have. Women have lower levels of androgens to begin with, and those levels decrease after menopause. It’s possible that androgens play a role in managing the delicate balance of tear production.

The transition to menopause happens gradually over the course of many years. In the years leading up to menopause (called perimenopause), many women begin experiencing symptoms of hormonal changes, like hot flashes and irregular periods. If you’re a woman over the age of 45, you’re also at risk of developing dry eye problems.

Dry eyes are what doctors call a multifactorial disease, which means that several different things may be contributing to the problem. Typically, dry eye problems stem from one or more of the following:

  • decreased tear production
  • tears drying up (tear evaporation)
  • ineffective tears

You can decrease your risk of dry eyes by avoiding environmental triggers. Things that lead to tear evaporation include:

  • dry winter air
  • wind
  • outdoor activities like skiing, running, and boating
  • air-conditioning
  • contact lenses
  • allergies

Many women with menopausal dry eyes wonder if hormone replacement therapy (HRT) can help them. The answer is unclear. Among doctors, it’s a source of controversy. Some studies have shown that dry eyes improve with HRT, but others have shown that HRT makes dry eye symptoms more severe. The issue continues to be debated.

The largest cross-sectional study to date found that long-term HRT increases the risk and severity of dry eye symptoms. The researchers found that larger doses corresponded to worse symptoms. Also, the longer women took hormone replacements, the more severe their dry eye symptoms became.

Other dry eye treatment options include the following.

Over-the-counter medications

Several over-the-counter (OTC) medications are available to treat chronic dry eye problems. In most cases, artificial tears will be enough to ease your symptoms. When choosing among the many OTC eye drops on the market, keep in mind the following:

  • Drops with preservatives can irritate your eyes if you use them too much.
  • Drops without preservatives are safe to use more than four times per day. They come in single-serving droppers.
  • Lubricating ointments and gels provide a long-lasting thick coating, but they can cloud your vision.
  • Drops that reduce redness can be irritating if used too often.

Prescription medications

Your doctor may prescribe different types of medication depending on your condition:

  • Drugs to reduce eyelid inflammation. Swelling around the edge of your eyelids can keep necessary oils from mixing with your tears. Your doctor may recommend oral antibiotics to counter this.
  • Drugs to reduce cornea inflammation. Inflammation on the surface of your eyes can be treated with prescription eye drops. Your doctor may suggest drops that contain the immune-suppressing medication cyclosporine (Restasis) or corticosteroids.
  • Eye inserts. If artificial tears aren’t working, you can try a tiny insert between your eyelid and eyeball that slowly releases a lubricating substance throughout the day.
  • Drugs that stimulate tears. Drugs called cholinergics (pilocarpine [Salagen], cevimeline [Evoxac]) help increase tear production. They are available as a pill, gel, or eye drop.
  • Drugs made from your own blood. If you have severe dry eye that isn’t responding to other treatments, eye drops can be made from your own blood.
  • Special contact lenses. Special contact lenses can help by trapping moisture and protecting your eyes from irritation.

Alternative treatments

  • Limit your screen time. If you work at a computer all day, remember to take breaks. Close your eyes for a few minutes, or blink repeatedly for a few seconds.
  • Protect your eyes. Sunglasses that wrap around the face can block wind and dry air. They can help when you’re running or biking.
  • Avoid triggers. Irritants like smoke and pollen can make your symptoms more severe, as can activities like biking and boating.
  • Try a humidifier. Keeping the air in your home or office moist may help.
  • Eat right. A diet rich in omega-3 fatty acids and vitamin A can encourage healthy tear production.
  • Avoid contact lenses. Contact lenses can make dry eyes worse. Talk to your doctor about switching to glasses or specially designed contact lenses.

If you have chronically dry eyes, you may experience the following complications:

  • Infections. Your tears protect your eyes from the outside world. Without them, you have an increased risk of eye infection.
  • Damage. Severe dry eyes can lead to inflammation and abrasions on the surface of the eye. This can cause pain, corneal ulcer, and vision problems.

Menopause causes changes throughout your whole body. If you’re experiencing dry eyes because of hormonal changes, there isn’t much you can do other than treat the symptoms. However, many dry eye treatment options are available to help ease your systems.