Do your eyes feel drier or more sensitive at certain times of life? For many women, subtle changes in eye comfort are among the earliest signs of hormonal shifts. The tear film and the glands that support it are hormonally regulated. When your body produces less estrogen, progesterone or androgen — such as during perimenopause, menopause, pregnancy or even when adjusting birth control — the quality and quantity of your tears can change. Understanding this connection can help you prepare for hormonal transitions and keep your eyes comfortable through every stage.

This expanded article explores the science behind hormones and dry eye, why women are more susceptible than men, and practical steps you can take to support ocular health. We’ll cover perimenopause and menopause, thyroid disease, pregnancy, fertility treatments and the role of androgens in meibomian gland function. Whether you’re approaching midlife or experiencing changes earlier, your eyes may offer clues about your hormonal landscape.

The Hormonal Tear Film Connection

Healthy tears are a complex mix of water, oil and mucus. The watery component is produced by the lacrimal glands, while the oily layer comes from meibomian glands along the eyelid margins. These glands are rich in hormone receptors, particularly for androgens (testosterone and its derivatives) but also for estrogen and progesterone. Androgens stimulate secretion of lipids that prevent evaporation, while estrogen and progesterone modulate inflammation and mucous production.

During menopause, androgen levels decline more steeply than estrogen. This disruption leads to thinner, less stable oils and increased tear evaporation. A study from The Dry Eye Center of New York & New Jersey notes that decreasing androgen during menopause affects both meibomian and lacrimal glands, reducing oil production and tear volume. Women may notice burning, stinging or fluctuating vision long before classic menopausal symptoms like hot flashes appear.

Perimenopause and Menopause

The peri‑menopausal years (typically mid‑40s to early 50s) are characterized by fluctuating hormones. Estrogen can spike and dip unpredictably, while progesterone and androgens gradually decline. Many women report episodes of dry eye coinciding with other cycle changes. As menopause approaches and estrogen drops permanently, the ocular surface can become chronically dry. Studies show that up to 61% of peri‑menopausal and menopausal women experience dry eye symptoms.

Common ocular symptoms during menopause include:

• Burning, stinging or gritty sensations
• Light sensitivity
• Excess tearing that doesn’t relieve dryness
• Blurry or fluctuating vision, particularly when reading
• Increased redness or eyelid swelling

It’s not just about tears drying out; inflammation plays a significant role. Hormonal fluctuations increase inflammatory mediators in the tear film and eyelid tissue. If not managed early, chronic inflammation can damage glands and worsen dryness over time.

Birth Control, Fertility Treatments and Pregnancy

Exogenous hormones also influence the tear film. Some women notice dry eye symptoms when starting or switching oral contraceptives. Birth control pills containing high levels of estrogen and low androgens can reduce meibomian gland secretion. Fertility treatments often involve powerful hormones that temporarily alter oil production and tear stability.

During pregnancy, hormonal surges can lead to increased corneal thickness and changes in tear composition. Some women develop temporary dry eye or blurred vision. Fortunately, most of these changes resolve postpartum. However, if you plan to breastfeed, be aware that elevated prolactin and low estrogen may prolong dryness.

Thyroid and Autoimmune Disease

Thyroid hormones play a pivotal role in ocular surface health. Both hyperthyroidism and hypothyroidism can alter tear production and increase the risk of autoimmune conditions such as Sjögren’s syndrome, in which the immune system attacks tear and salivary glands. If you experience dry eye along with fatigue, weight changes or hair loss, ask your healthcare provider about thyroid function testing.

Autoimmune disorders like rheumatoid arthritis and lupus can also cause hormonal imbalances and dry eye. In these cases, systemic inflammation damages glands and disrupts the hormonal milieu. Management often requires collaboration between your rheumatologist and eye doctor to address both systemic and ocular symptoms.

Why Women Are More Affected Than Men

Women are two to three times more likely to develop dry eye disease. Several factors contribute:

• Hormonal fluctuations: From puberty through pregnancy, postpartum and menopause, women experience more dramatic hormonal changes than men.
• Androgen levels: Men have higher baseline androgens, which protect meibomian gland function. In women, the drop in androgens relative to estrogen during menopause leads to an imbalance.
• Medication exposure: Women are more likely to use oral contraceptives, fertility drugs and hormone replacement therapy, all of which affect the tear film.
• Autoimmune disease prevalence: Conditions like Sjögren’s syndrome are more common in women and often present with severe dry eye.

Supporting Your Eyes Through Hormonal Changes

Dry eye linked to hormones requires a holistic approach. Here are strategies to maintain comfort and protect your ocular surface:

1. Prioritize Eyelid Hygiene

Keep your meibomian glands open by cleaning the lids daily with a gentle cleanser or hypochlorous acid lid spray. Follow with a warm compress or heat mask to melt oils and encourage healthy secretion. These habits reduce inflammation and improve tear stability.

2. Nourish Your Body

Omega‑3 fatty acids are essential for producing high‑quality meibum. Supplements such as PRN DE3 Dry Eye Omega Benefit can improve tear quality and reduce inflammation. Eat a balanced diet rich in dark leafy greens, nuts, seeds and cold‑water fish. Stay hydrated; dehydration thickens tears and exacerbates dryness.

3. Use Preservative‑Free Drops

Hydrate the ocular surface with preservative‑free artificial tears. Thealoz® Duo Drops contain trehalose and hyaluronic acid to protect cells from osmotic stress and maintain moisture. If you wake up with burning or gritty eyes, ask your doctor about ointments or gels for nighttime use.

4. Manage Inflammation

If over‑the‑counter drops aren’t enough, your doctor may prescribe anti‑inflammatory medications such as cyclosporine or lifitegrast. These drugs reduce immune activity on the ocular surface and allow glands to heal. Short courses of steroid drops may provide rapid relief during acute flares, but they should only be used under supervision.

5. Maintain Overall Health

Regular exercise, adequate sleep and stress management influence hormonal balance. Chronic stress elevates cortisol, which can suppress sex hormones and worsen inflammation. Practice relaxation techniques like yoga, meditation or deep breathing. If you’re approaching menopause, discuss hormone replacement therapy with your healthcare provider. Some women find that low‑dose hormone therapy improves ocular comfort, but it’s not right for everyone.

6. Monitor Medications

Review your medications with your doctor. Some antidepressants, antihistamines, beta blockers and acne treatments reduce tear production. If possible, adjust doses or switch to alternatives. Never stop a medication without medical guidance.

When to Seek Professional Help

If you experience persistent dryness, light sensitivity or blurred vision, schedule an eye exam. Your optometrist can assess tear volume, osmolarity and gland function. They may recommend in‑office treatments like LipiFlow®, IPL or RF to unblock glands and restore oil flow. Early intervention prevents scarring and long‑term damage.

If hormonal shifts are accompanied by irregular periods, hot flashes, mood changes or other systemic symptoms, consult your primary care provider or gynecologist. Blood tests can evaluate hormone levels, and targeted therapies may alleviate both systemic and ocular issues.

Conclusion: Listen to What Your Eyes Are Saying

Your eyes reflect your internal state. Hormonal fluctuations can manifest as dry, irritated eyes long before you feel other changes. By understanding the connection between hormones and ocular health, you can take proactive steps to nourish your glands, reduce inflammation and maintain comfort. With the right combination of lid hygiene, nutrition, lubricating drops and professional care, your eyes can remain clear and comfortable through every hormonal milestone.

For expert‑approved products and personalized guidance, explore our hormonal health collection at Eye Drop Shop. We’re here to support you through every phase of life.

References

1. Schirra, F., & Richards, S. M. (2023). Hormones and dry eye disease: An updated review of clinical and experimental findings. Current Eye Research, 48(6), 573–584. https://pubmed.ncbi.nlm.nih.gov/37026259/
2. Gupta, N., Prasad, I., Himashree, G., & D’Souza, P. (2017). Dry eye syndrome in menopause and perimenopausal age group. Journal of Mid-Life Health, 8(2), 51–54. https://pubmed.ncbi.nlm.nih.gov/28706404/
3. Liu, S., Kam, W. R., Ding, J., & Sullivan, D. A. (2021). Androgen and meibomian gland dysfunction: From basic research to clinical perspectives. Frontiers in Pharmacology, 12, 658511. https://pmc.ncbi.nlm.nih.gov/articles/PMC8165631/