Dry eye, menopause and hormonal change

The lacrimal glands (which make the watery part of tears) and the meibomian glands (which make the oil that stops tears evaporating) both have hormone receptors. Androgens in particular help keep the meibomian glands producing good-quality oil.

As oestrogen and androgen levels shift through perimenopause and menopause, the oil layer often changes first — becoming thicker, less mobile, and more likely to block glands. That's why so many women describe symptoms starting in their mid-40s: burning, gritty eyes by mid-afternoon, blurred vision on the computer, watery eyes outdoors.

• • Pregnancy and postpartum. Big swings in hormones and often sleep deprivation.
• • Thyroid conditions. Both under- and over-active thyroid strongly affect the ocular surface.
• • Oral contraceptives and HRT. Can help or worsen dry eye depending on the formulation and the person.
• • Chemotherapy and hormone-blocking treatments. Often overlooked as a cause of new-onset dry eye.

The starting point is knowing what's actually happening on the surface of your eye — meibography shows whether the oil glands are blocked, dropped out, or working normally, and tear film testing shows whether evaporation, low volume, or inflammation is driving your symptoms. From there, a plan usually combines:

• • Preservative-free lubricating drops matched to your tear type.
• • Warm compresses and lid hygiene done properly — most people are under-doing this.
• • Omega-3 supplementation at a clinical dose.
• • IRPL and meibomian gland expression if the oil glands are the bottleneck. This is often transformative for hormonal dry eye.
• • Short courses of anti-inflammatory drops during flares.
• • A conversation about HRT with your GP — not to prescribe it, but because it's part of the picture.

A lot of women have been told this is "just a part of getting older." It isn't. Hormonal dry eye is measurable, treatable and responds well to a proper plan. Most people are surprised how much better their eyes feel within a few weeks of the right combination.