As women approach menopause, they may notice—with some annoyance and frustration—a number of typical symptoms: irregular periods, hot flashes, night sweats, difficulty sleeping, and vaginal dryness. They might also notice they’ve put on some weight, and could be coping with mood swings. But a significant number of women may develop symptoms of another disorder that many people don’t realize is often associated with menopause: dry eye syndrome. Dry eye symptoms include eye itching, scratching, stinging, burning, sensitivity to light, blurred vision, and even a sensation that something is lodged in the eye. They may not equate these issues with menopause, but it could be the culprit. The Hormone Factor In general, dry eye affects women more often than men. But the incidence of dry eye also goes up with age. In fact, women over 50 are twice as likely as men over 50 to have dry eye. Women also tend to report much more severe symptoms that tend to last longer or occur more frequently. Reproductive hormones seem to be a major cause. The female reproductive hormone, estrogen, can negatively affect production of oils that comprise one of three main components of tears—the other two are mucus and water. When the composition of your tears is uneven, you can develop dry eye. Women who are pregnant or taking oral contraceptives containing estrogen and progesterone sometimes experience scratchy, gritty, irritated eyes. Menopause, with its fluctuations in estrogen, seems to drive some cases of dry eye, too. But estrogen isn’t the only reproductive hormone that may play a role in dry eye. Some research suggests that dry eye may be more likely to develop in post-menopausal women because they have lower levels of a hormone called androgen. Androgen, which both men and women have, is involved in the production and release of the oil layer of tears. Unlike estrogen, androgen plays a more positive role in the composition of tears. So, when you don’t have enough androgen in your body to play that role, your tears—and your eyes—may suffer. The HRT Factor Estrogen levels tend to dip with menopause, causing those famous hot flashes and night sweats, among other symptoms. Some women turn to hormone replacement therapy, or HRT, to relieve some of the discomfort associated with menopause. Women undergoing this type of therapy receive medications that boost their hormone levels artificially. Many use a combination of estrogen- and progesterone-boosting medicines, while some women, especially those who have had a hysterectomy to remove the uterus, may opt for an estrogen-only therapy. But again, estrogen tends to affect the composition of tears. A regular dose of HRT to increase a woman’s estrogen levels may also have an unintended side effect: dry eye. Relief for Dry Eye Symptoms If you are approaching menopause and have noticed some symptoms of dry eye, talk to your doctor about possible steps to address the problem. If you’ve already gone though menopause but find yourself rubbing at dry, irritated eyes, you should also let your doctor know, especially if you’re also taking HRT. A variety of options are available to you to mitigate some of that eye irritation. Your doctor may want you to try a different medication, or you might find relief from artificial tears or certain ointments that provide lubrication to your eyes. Some prescription treatments are available, too, if the over-the-counter treatments don’t work well enough for you. Whatever you do, don’t suffer in silence if you have developed dry eye. Left untreated, dry eye can eventually lead to damage to your cornea, putting your eyesight at risk. Reach out to your doctor for guidance and resources about effective dry eye therapies.