A patient sat down in my office recently and, before we even got to her hot flashes, said, "Something is wrong with my eyes." They burned by the end of the workday. Her contact lenses, which she had worn comfortably for twenty years, now felt like they were scratching her. Her vision blurred while she read, then cleared when she blinked. Her eye doctor had told her to use drops. Nobody had mentioned that she was 47 and in the middle of a hormonal transition.
What most women are never told is that your eyes are part of your hormonal story. The changes you notice in your forties and fifties are often connected to what is happening with estrogen, progesterone, and especially androgens. Understanding that connection helps you get the right care from the right people.
Your eyes and your hormones are connected, but your care often is not.
Your Eyes Run on Hormones Too
Every time you blink, you spread a thin film across the surface of your eye. That tear film has three layers, and each one matters:
An oil layer, made by tiny meibomian glands along the edges of your eyelids, which keeps tears from evaporating too quickly
A water layer, made by the lacrimal glands, which keeps the surface moist and washes away debris
A mucin layer, which helps tears cling evenly to the eye
The glands that produce these layers have receptors for sex hormones. Androgens, the hormones we often associate with men but that women make too, appear to be especially important for healthy meibomian glands. Women's androgen levels decline steadily with age and through the menopause transition, and estrogen and progesterone fluctuate wildly during perimenopause. The international Tear Film and Ocular Surface Society has concluded that sex hormones are a major reason dry eye disease is more common in women, particularly after midlife.
When the oil layer thins, tears evaporate faster. The surface of the eye becomes irritated and inflamed, and inflammation makes the glands work even less well. It becomes a cycle, which is why early attention matters.
The Changes Women Notice Most
Dry eye. This is the big one. Symptoms include grittiness, burning, a feeling that something is in your eye, light sensitivity, tired eyes by afternoon, and blurry vision that improves when you blink. One symptom surprises many women: watery eyes. When the surface becomes irritated, the eye can flood itself with reflex tears that do not have the right composition to protect it.
Contact lens intolerance. Lenses that felt fine for years may suddenly feel dry or uncomfortable, especially late in the day. This is often an early sign of a changing tear film.
Vision that fluctuates. An unstable tear film can make your vision sharper one moment and fuzzier the next. If your glasses prescription seems "off" but tests fine, the surface of your eye may be the issue.
Trouble reading up close. This one is not hormonal, but it arrives at the same time, which causes confusion. Starting around age 40, the lens inside your eye gradually stiffens and loses its ability to focus on near objects. This is called presbyopia, and it happens to everyone. Reading glasses, progressive lenses, multifocal contacts, and prescription eye drops can all help. I mention it here because women often blame their hormones for presbyopia, or blame presbyopia for what is actually dry eye. You may have both.
Eyelid and skin changes. Collagen loss after estrogen declines affects the delicate skin around the eyes too, contributing to puffiness, drooping, and fine lines.
What About Hormone Therapy?
I want to be honest with you here, because this is where online advice often gets ahead of the science.
You might expect estrogen therapy to fix hormonally driven dry eye. The research does not show that clearly. In the large Women's Health Study, which followed more than 25,000 postmenopausal women, those using hormone therapy, particularly estrogen alone, actually reported more dry eye symptoms than women who did not use it. Other smaller studies have found improvement. Some eye specialists believe the dose, the route (oral versus transdermal), and the balance with progesterone and androgens all play a role, but that question has not been settled by good clinical trials.
Here is how I explain it to my patients. Hormone therapy is an excellent treatment for many menopausal symptoms, and decisions about it should be made with a menopause-informed clinician based on your whole picture. It is not prescribed to treat dry eye. If you start hormone therapy and notice your eyes getting worse, do not stop it on your own; tell both your gynecologist and your eye doctor so they can work together. And because androgens appear to matter so much for the eye, this is one more reason a thoughtful clinician looks at your full hormonal profile, not just estrogen.
The Bigger Picture: Eye Health in Midlife
Midlife is also when it becomes important to protect your eyes from the conditions you cannot feel.
Glaucoma damages the optic nerve silently, often with no symptoms until vision is lost. Research from the Nurses' Health Study found that women who went through menopause earlier had a higher risk of the most common form of glaucoma, which suggests estrogen may play a protective role.
Cataracts and macular degeneration become more common with age. UV protection and not smoking reduce risk.
Metabolic changes in menopause raise the risk of diabetes and high blood pressure, and both can damage the small blood vessels of the retina.
Autoimmune conditions deserve attention. Sjogren's disease, an autoimmune condition that causes dry eyes and dry mouth, most often affects women in midlife. Thyroid disease, also common in women, can affect the eyes. If your dry eyes come with a persistently dry mouth, joint pain, or fatigue, ask about testing.
Know the urgent signs. A sudden shower of new floaters, flashes of light, a shadow or curtain across your vision, sudden vision loss, or a painful red eye with halos around lights and nausea all need same-day care from an eye doctor or emergency department.
What You Can Do Starting This Week
Get a baseline eye exam. The American Academy of Ophthalmology recommends a comprehensive, dilated eye exam at age 40 for adults with no symptoms or risk factors, then follow-up every two to four years until 55, and more often after that. If you are well past 40 and have never had one, now is the time.
Give your eyes screen breaks. We blink less and less completely when we stare at screens. Try the 20-20-20 habit: every 20 minutes, look at something 20 feet away for 20 seconds, and blink fully.
Use the right drops. If you use artificial tears more than a few times a day, choose a preservative-free version. Avoid "get the red out" drops for daily use, because they can cause rebound redness.
Care for your eyelids. Warm compresses for a few minutes a day can soften thickened oils in the meibomian glands, and gentle lid cleansing helps keep them clear.
Protect your environment. Run a humidifier in dry winter months, keep car vents and fans from blowing on your face, and wear wraparound sunglasses with UV protection outdoors.
Rethink your eye makeup. Lining the inner waterline can block the meibomian glands. Remove makeup every night, replace mascara about every three months, and talk with your eye doctor about lash extensions and lash-growth serums if you already have dry eye.
Review your medications. Antihistamines, some antidepressants, diuretics, certain blood pressure medications, and acne medications can all worsen dry eye. Never stop a medication on your own, but do ask whether one of yours could be contributing.
Be realistic about omega-3s. A large, well-designed trial published in the New England Journal of Medicine found that fish oil supplements did not improve dry eye symptoms more than an olive oil placebo. Omega-3s may still be part of a heart-healthy diet, but they are not a proven fix for dry eye.
Ask about prescription options. If over-the-counter care is not enough, eye doctors now have several prescription drops that reduce surface inflammation or slow tear evaporation, a nasal spray that stimulates natural tear production, and in-office treatments that open blocked oil glands. Tiny punctal plugs can also help keep tears on the eye longer.
Bring Your Eyes Into the Menopause Conversation
Your eyes and your hormones are connected, but your care often is not. Your gynecologist may never ask about your vision, and your eye doctor may never ask about your periods or your hormone therapy. You can close that gap.
Tell your menopause provider about your eye symptoms. Tell your eye doctor where you are in the menopause transition and which hormones or medications you take. You deserve care that treats you as a whole person. Advocate for yourself, and if a provider dismisses your symptoms, find one who will listen.
Defy Menopause - Own the Change
Many women tell me: "One day I feel amazing. The next, I can barely get out of bed. Is this normal?"
Yes, it is. And no, you don’t have to suffer through it alone.
Hormonal fluctuations during perimenopause can make you feel like you’ve lost control of your body. But knowledge is powerful. And there are clear, science-backed ways to support your hormones, ease symptoms, and reclaim your energy.
That’s exactly why I created Defy Menopause: Own the Change — a 30-day program designed to give you the tools, knowledge, and support you need to move through these changes with clarity and confidence.
Inside, you’ll find:
Access to Dr. Tracy Verrico at one (1) live, group session
Clear action steps for managing symptoms naturally
Because you deserve more than just "putting up with it."
You deserve to thrive.
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Medical Disclaimer: The information provided in this blog is for general educational and informational purposes only and is not intended as, nor should it be considered, medical advice. This content does not establish a physician-patient relationship and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read in this newsletter. If you think you may have a medical emergency, call your doctor or emergency services immediately.
References
Sullivan DA, Rocha EM, Aragona P, et al. TFOS DEWS II Sex, Gender, and Hormones Report. Ocul Surf. 2017;15(3):284-333.
Peck T, Olsakovsky L, Aggarwal S. Dry Eye Syndrome in Menopause and Perimenopausal Age Group. J Midlife Health. 2017;8(2):51-54.
Schaumberg DA, Buring JE, Sullivan DA, Dana MR. Hormone replacement therapy and dry eye syndrome. JAMA. 2001;286(17):2114-2119.
Dry Eye Assessment and Management Study Research Group. n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease. N Engl J Med. 2018;378(18):1681-1690.
Pasquale LR, Rosner BA, Hankinson SE, Kang JH. Attributes of female reproductive aging and their relation to primary open-angle glaucoma: a prospective study. J Glaucoma. 2007;16(7):598-605.
American Academy of Ophthalmology. Eye Exam and Vision Testing Basics: recommended exam frequency for adults. aao.org.
Ophthalmology Times. Survey: fewer than 1 in 7 women link dry eye to perimenopause or menopause. September 2, 2026. (Industry-sponsored online survey, n = 402.)
The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
