DRY EYE AND THE MENOPAUSE
The toll that menopause can take on your body can manifest itself in several different ways. But while you might be familiar with more common symptoms like night sweats, mood swings and insomnia, there’s another perhaps unexpected symptom that can also affect your body. For some going through perimenopause and menopause, dry eyes can be a surprising symptom that appears.
Approximately 61% of those experiencing perimenopause and menopause are affected by dry eye. In fact, women over 50 years are nearly twice as likely to experience the condition compared to men of the same age.¹ A survey conducted by Eye Health UK found that 86% of menopausal women were unaware of the connection between “the change” and dry eye.² Increasing awareness of this significant connection can help those suffering from this feel less alone.
So, what causes it, how can you spot the symptoms and what can you do about it?
What exactly is the menopause?
Menopause impacts anyone who experiences periods, and it signifies the end of the menstrual period. It can occur naturally with age or be triggered by factors such as cancer treatments like chemotherapy, genetics, or certain surgeries involving the ovaries or uterus. In some cases, though, the cause is unknown.
Perimenopause is when you begin experiencing the start of menopausal symptoms, but menstruation has not yet stopped. Menopause is officially recognised as starting 12 months after the last period.
Typically, it affects women between the ages of 45 and 55, but it can occur earlier. It can also affect those who don’t identify as women, including transgender men and non-binary people.
Menopausal and perimenopausal symptoms can impact your life in several ways, from your relationships to work. Common symptoms include anxiety, brain fog, hot flashes and irregular periods.3 Luckily, there are ways this can be managed to help you feel more comfortable during this time of life.
What hormonal changes happen during the menopause?
The reason that your periods become less frequent and then stop is due to unpredictable hormone levels during menopause. The oestrogen produced by the ovaries can reduce significantly as the ovaries might not release an egg for each menstrual cycle. Since this creates an unbalance of the sex hormones progesterone and oestrogen, this can trigger menopausal symptoms like heavy bleeding, emotional instability, vaginal dryness and bladder issues.4
Why are dry eyes more common in menopausal women?
As you age, your eyes become drier, but the changes and imbalance of your hormones during menopause can further exacerbate this. The tear film of the eyes has three components that are all affected by sex steroid hormones - androgens, oestrogens and progestogens. As the androgen hormone decreases, this affects the meibomian glands in the eyelids; these glands are responsible for providing essential oils, so when they don’t function properly, it can cause tears to evaporate more quickly and eyes to feel drier5. Similarly less mucin is produced by cells in the conjunctiva, meaning that tears don’t “stick” to the surface of the eye properly, and that there is a general reduction in tear production from the lacrimal gland1.
There is some evidence that falling oestrogen levels are directly linked to dry eye symptoms, too. Oestrogen and progesterone receptors can be found in several structures within the eyes, including the cornea and meibomian gland. Research has found that when oestrogen levels decrease, it can reduce activity in the eyes, including tear production, which can contribute to dry eye.6
Are dry eyes linked to any particular stage in the menopause?
While there isn’t a clear link between dry eyes and a particular stage of menopause, for some, dry eyes can start during perimenopause and may become more common as you transition through menopause and with age. For others, dry eye symptoms might not appear until during or even after the menopause.
Symptoms of dry eye during menopause
According to The British Menopause Society, over 25% of women experiencing the menopause suffer from severe menopausal symptoms7. If you have dry eye as a result of hormonal changes, you may notice some of these symptoms in your eyes:
- Redness
- Burning
- Itchiness
- Blurred vision
- Gritty sensation
- Feeling like something is stuck in your eye
- Excessive tearing
How to treat dry eye symptoms
There are certain things you can do to help alleviate your dry eye symptoms, including: 8
- Avoiding excessively hot and dry conditions, such as air-conditioned rooms.
- Taking regular screen breaks, especially if your job involves using a computer.
- Keeping hydrated by drinking at least 2 litres of water every day.
- Avoiding triggers such as pollen and smoke that may increase irritation of your eyes.
- Eating a diet rich in Omega-3 fatty acids which can be found in oily fish such as sardines, mackerel, and flaxseed for those that are vegan9.
- Consider your daily eye care routine including eye lid cleansing and lubricating drops
Does HRT help or cause dry eyes?
Hormone treatments, such as HRT, can sometimes be prescribed by healthcare professionals to help alleviate some of the symptoms of menopause. But the jury is out on how this can affect those also experiencing dry eye. They may help to reduce the effects of dry eye by helping to balance out hormones, but the evidence is mostly inconclusive.7,8
One study, for example, found that taking HRT increased the risk of dry eye and that this was also related to the type of HRT being taken.10 However, other research has shown that HRT can improve symptoms and signs of dry eye within 1 month of starting treatment, perhaps because of improvements to secretion of oils by the Meibomian glands, but it is questionable whether these improvements are maintained in the long-term.11,12
Every person is different, and dry eye severity and causation can differ. It’s always important to discuss with your eye care professional and to follow the advice of your medical doctor before starting hormone replacement therapy.
How Théa can help
Relieving your dry eye symptoms starts with giving your eyes some TLC (Théa Loving Care). This involves regularly using dry eye drops, cleansing wipes, and warm eyelid compresses as part of a good daily eye care routine.
The Théa product range includes the Blepha Eyebag®, which is a reusable warming eyelid mask that can help soften the oily secretions in the eyelids to provide eye comfort. Blephaclean® eyelid wipes can then be used to cleanse and remove debris from the eyelids. At the end of your routine, Thealoz® Duo can be used to help protect and hydrate the eyes. TheaLipid can also support the replenishment of lipid to reduce tear evaporation.
Use our online symptom checker to help you identify the symptoms you may be experiencing. We always recommend you talk to an eye care professional who will be able to diagnose your symptoms and offer advice to support you.
When you’re navigating your way through perimenopause and menopause, it can take time to understand all the ways it might affect you. We hope this guide has helped you understand this lesser-known symptom and the prevalence it has for those going through this period.
Maintaining a good eye routine is key to healthy eyes, so we always recommend establishing proper eye care in your day-to-day.
References
1 Peck T, Olsakovsky L, Aggarwal S. Dry Eye Syndrome in Menopause and Perimenopausal Age Group. J Midlife Health. 2017 Apr-Jun;8(2):51-54.
² https://www.visionmatters.org.uk/eye-q-report/eye-q-report
3 https://www.nhs.uk/conditions/menopause/
4 Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023 Feb 7;329(5):405-420.
5 Tomo Suzuki, Yasuaki Minami, Aoi Komuro, Norihiko Yokoi, Shigeru Kinoshita; Meibomian Gland Physiology in Pre- and Postmenopausal Women. Invest. Ophthalmol. Vis. Sci. 2017;58(2):763-771.
6 Gorimanipalli B, Khamar P, Sethu S, Shetty R. Hormones and dry eye disease. Indian J Ophthalmol. 2023 Apr;71(4):1276-1284.
7 British Menopause Society: What is the Menopause
8 Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017 Jul;15(3):575-628.
9 https://www.vegansociety.com/resources/nutrition-and-health/nutrients/omega-3-fat
10 Schaumberg DA, Buring JE, Sullivan DA, Dana MR. Hormone replacement therapy and dry eye syndrome. JAMA. 2001 Nov 7;286(17):2114-9.
11 Dang A, Nayeni M, Mather R, Malvankar-Mehta MS. Hormone replacement therapy for dry eye disease patients: systematic review and meta-analysis. Can J Ophthalmol. 2020 Feb;55(1):3-11.
12 Jin X, Lin Z, Liu Y, Lin L, Zhu B. Hormone replacement therapy benefits meibomian gland dysfunction in perimenopausal women. Medicine (Baltimore). 2016 Aug;95(31):e4268.