Dry Eyes After Menopause: Does HRT Help or Hurt?What Studies Show

Gritty, burning or tired eyes become more common with age, and many women notice them around menopause. Since hormones change at the same time, a fair question is whether hormone therapy makes dry eyes better or worse. The studies point both ways.

How common it is

A US survey of 39,876 women counted dry eye as a doctor’s diagnosis or severe dryness and irritation, constantly or often.¹

• It rose with age, from 5.7% under 50 to 9.8% at 75 and over.¹
• Overall, about 7.8% of women 50 and over had it, around 1 in 13.¹
• It also affects many women in their 40s and 50s.¹

The study that linked HRT to dry eye

Among 25,665 postmenopausal women followed for 4 years:²

Hormone use	Odds of dry eye, versus no hormones
Estrogen alone	About 1.7 times2
Estrogen plus progestogen	About 1.3 times2

Each extra 3 years of use went with about 15% higher risk.² This was an observational study based on what women reported, so it can’t prove the hormones caused the dryness.²

The trials that found improvement

Small randomized trials tell a different story.

• A review of 9 trials with 612 women found hormone therapy improved tear film stability, tear production and eye-surface staining, and eased dryness, burning and tiredness.³ The trials varied in quality and in the age of the women.³
• An earlier review of 7 trials with 358 women found better tear production but no clear change in tear stability or comfort scores.⁴

How to read the conflict

The large study followed thousands of women in everyday life over years, but couldn’t prove cause and effect. The trials could, but they were small and of mixed quality. Neither settles it.

What it means in practice:

• Don’t start HRT for dry eyes. It isn’t an eye treatment, and the evidence on eyes is mixed.
• If your eyes got worse after starting HRT, mention it to your prescriber and an eye doctor; the large study suggests a possible link, especially with estrogen alone.²
• Treat the eyes directly. See artificial tears after 50. For dryness elsewhere, see dry mouth in menopause and is menopause hormone therapy safe?

Try: “My eyes have been gritty and dry since I started estrogen. Could the two be connected, and what should I try for my eyes?”

My Body Changed. Now What? covers this kind of change in Chapter 9, “Desire, Skin and Hair,” in a section called “Give Each Concern Its Own Question.” Its Visit Brief gives each concern its own line, with your stage, top three changes and health history, so dry eyes don’t get lost in a longer conversation. See the book.