Menopause and Dry Eye: Causes, HRT, and What Really Helps

Many women notice their eyes become dry, gritty, or watery during and after menopause. But why does this happen? And can hormone replacement therapy (HRT) help? Here’s what the research says — plus practical steps to get relief.

Is dry eye linked to menopause?

Yes. Dry eye disease is twice as common in women as in men, and the risk rises sharply after age 50.

During menopause, hormone levels change dramatically:

Estrogen drops: This affects tear production from the lacrimal glands.
Androgens (testosterone-like hormones) also decline: This weakens the oil glands in your eyelids (meibomian glands), making tears evaporate faster.
Inflammation increases: Hormonal imbalance promotes irritation on the eye surface.

The result is the burning, gritty, watery feeling many women describe.

Does HRT help with dry eye?

Not necessarily — and in some cases, it can make symptoms worse.

Estrogen-only HRT: Large studies show this form of HRT is linked with a higher risk of dry eye.
Estrogen + progesterone HRT: The risk is lower than estrogen alone, but still slightly increased compared with women not using HRT.
Androgens: Because androgens support healthy eyelid oil glands, low levels are linked with more severe dry eye. Early research into androgen supplements or eye drops shows promise, but these treatments aren’t yet widely available.

👉 Bottom line: traditional HRT is not a reliable treatment for dry eye.

What do studies say about HRT and dry eye?

The Women’s Health Study (2001): In over 25,000 postmenopausal women, HRT use was linked with higher rates of dry eye. Estrogen-only therapy carried a 69% higher risk.
The Blue Mountains Eye Study (2006, Australia): Confirmed the link between HRT and more frequent dry eye, especially in estrogen-only users.
Smaller trials: Some studies testing androgen therapy (such as testosterone eye drops) found improvements, but more research is needed before this becomes mainstream.

What helps with dry eye after menopause?

Even if HRT doesn’t help, there are many effective ways to manage dry eye:

Artificial tears (lubricating eye drops): Used throughout the day to relieve irritation.
Anti-inflammatory eye drops (e.g., cyclosporine or lifitegrast): Tackle the underlying inflammation.
Warm compresses and lid hygiene: Support healthy oil glands in the eyelids.
Punctal plugs: Tiny devices that reduce tear drainage and keep the eyes moist.
Lifestyle changes: Stay hydrated, add omega-3 fatty acids to your diet, use a humidifier, and take breaks from screens.

Your eye doctor can help tailor treatment to your specific type of dry eye.

FAQs

Does HRT make dry eye worse?

Yes — especially estrogen-only HRT, which has been linked to higher dry eye risk in several large studies.

Can dry eye improve after menopause?

Symptoms often persist without treatment, but targeted therapies (like lubricants, anti-inflammatory drops, or punctal plugs) can provide long-term relief.

Will stopping HRT help my dry eyes?

Some women notice improvement after stopping estrogen-only HRT, but this isn’t guaranteed. Always discuss changes to HRT with your GP or menopause specialist.

Key takeaways

Menopause increases the risk of dry eye due to hormonal changes affecting tear production and quality.
Standard HRT (estrogen or estrogen + progesterone) does not protect against dry eye — and estrogen-only therapy may worsen it.
Research into androgen therapy is ongoing but not yet widely used.
Effective treatments for dry eye are available, from simple lubricants to advanced prescription therapies.

👁️ Bottom line: If you’re struggling with dry eye during or after menopause, don’t assume it’s something you just have to live with. HRT isn’t the solution, but modern dry eye treatments can make a big difference. Speak to your eye doctor for a personalised plan.