Dry Eyes Due to Hormones: Cycle, Pill, and Menopause in Focus

What are the hormonal causes behind this?

Three hormonal situations appear most frequently in research: hormonal contraception, the natural cycle, and perimenopause. All three affect the same tear film we just described, but the evidence varies in strength from situation to situation.

With the pill, the presumed chain of events is as follows: Combined pills increase SHBG in the blood, which significantly lowers free testosterone. A large meta-analysis from 2014 quantifies this drop at an average of 61 percent. Less free testosterone potentially means less androgen signaling to the Meibomian glands, and thus a more unstable oil layer. This testosterone drop is well documented. The last step, from low testosterone to dry eye, is plausible but has not been consistently proven in any study.

And this is where it gets messy, in the best scientific sense. A large US cohort study of 4.9 million women found that regular users of hormonal contraception had a roughly 2.7 times higher risk of diagnosed dry eye than irregular users (He et al., 2021). A smaller, careful study of 97 young women, however, found no difference in tear osmolarity, an objective measurement. Two analyses, two results: This is precisely why no blanket warning can be derived from it. What is interesting is where the difference in this smaller study did become noticeable: significantly more complaints were only found in women who combined the pill with contact lenses (Chen et al., 2013).

So, if you notice drier eyes while on the pill, it is most likely in combination with contact lenses. And if you want to know more about the side effects of hormonal contraception in general, you can find a good overview in our Guide to Discontinuing the Pill.

Within your natural cycle, estrogen and progesterone fluctuate significantly, and some women report drier eyes around ovulation or just before their period. Pregnancy and breastfeeding also disrupt hormone balance, and the symptoms here are usually temporary. Honestly: The studies on cycle, pregnancy, and breastfeeding are small and inconsistent. These are more observations than a fixed rule, but the mechanism via hormone receptors on the eye surface makes them plausible.

In perimenopause and menopause, the data is most robust. Here, not only estrogen but especially androgen levels drop, and androgen deficiency is recognized as a cause in ophthalmological guidelines. The immediate thought would be: hormones back, symptoms gone. The largest study on this found the opposite. In the Women's Health Study of 25,665 postmenopausal women, the risk of dry eye was actually increased, not decreased, with hormone therapy: with an odds ratio of 1.69 for estrogen alone and 1.29 for estrogen plus progestin (Schaumberg et al., 2001). Other, smaller studies have found different results. Hormone replacement therapy is therefore not a reliable way to combat dry eyes, and whether it is suitable for you belongs in our Menopause Guideand, most importantly, in a medical consultation.

Of course, non-hormonal factors also exacerbate the picture, above all long screen times with reduced blink rates, dry heating air, air conditioning, and contact lenses. The drier the air, the faster the tear film evaporates. The honest answer to our follower's question is therefore: It is usually not an either-or. Heat and screen work additionally strain the tear film, while hormones influence the basic production and quality of tear fluid.

What really helps

In the short term, preservative-free moisturizing eye drops reliably relieve symptoms and are recommended by ophthalmologists, regardless of whether hormones are involved. If you want to address the cause, you should consider two things.

First: clarifying a possible vitamin D deficiency. Several systematic reviews found that people with dry eye had, on average, lower vitamin D levels than people without the complaint, and the correlation was stronger the more severe the symptoms were. A recent analysis of over 12 million patient data found that vitamin D deficiency increased the risk of developing dry eye by about 29 percent. Studies on targeted supplementation, each with around 100 participants, are still small, but they suggest that symptoms may improve in cases of proven deficiency.

Second: If you are using hormonal contraception or are in perimenopause and have been suffering from dry eyes for weeks, an open conversation with your gynecologist or ophthalmologist about whether a change in preparation or another method of contraception is an option is worthwhile. This is a medical decision that no one should make alone at the kitchen table.

Vitamin D and Omega-3: What these micronutrients can really do

Vitamin D is the most thoroughly researched micronutrient in connection with dry eyes. It acts on many immune cells via its own receptor and has anti-inflammatory properties that can also affect the eye surface. Several meta-analyses from recent years independently arrived at the same conclusion: people with dry eyes have, on average, lower vitamin D levels, and low levels are associated with more severe symptoms.

This is also relevant because vitamin D deficiency is more common in women who use hormonal contraception, according to some studies, and levels tend to drop during menopause anyway. This means that a widespread deficiency affects precisely the two life stages in which the risk of hormone-related dry eyes is highest, an example of an indirect effect where a nutrient deficiency and a hormonal change can mutually reinforce each other.

Hormonic Base contains vitamin D3 in a well-researched dosage and thereby supports, among other things, your immune system and normal cell division. Whether a detectable deficiency in your personal case contributes to your dry eyes can best be clarified by a blood test, as not all dry eye conditions have the same cause.

With Omega-3, an honest look is worthwhile because the picture is often painted too rosy. Some meta-analyses report improvements in dry eyes with Omega-3. However, the largest and methodologically most rigorous individual study clearly contradicts this: In the DREAM study with 535 participants, daily Omega-3 was no better than a placebo of olive oil after twelve months; both groups improved similarly, and an extension study confirmed this (Asbell et al., 2018). The evidence is thus contradictory, not clearly positive. Omega-3 is not a component of a Hormonic product, and we would not sell it to you as a reliable solution for dry eyes.

What you can do yourself

In addition to hormonal and micronutrient-related avenues, there are simple, well-documented daily measures. Screen time drastically reduces blink frequency: instead of around 15 times per minute, many people only blink 5 to 7 times, about two-thirds less, and many of these blinks remain incomplete. Without a complete blink, the oil layer is not renewed. The 20-20-20 rule helps: every 20 minutes, look at something about 20 feet away for 20 seconds, consciously blinking completely several times.

A humidifier in the office or bedroom, especially during heating season, further relieves the eyes. Warm compresses on closed eyelids for a few minutes can loosen clogged meibomian glands and support the fat production of the tear film, a simple form of lid hygiene that is particularly useful for blepharitis. If you wear contact lenses and symptoms worsen, a temporary break from glasses can relieve the eye surface.

And what about the popular tips that promise more than they deliver? Omega-3 capsules taken on a whim, the blanket advice to simply drink more, and eye drops used randomly are among them. Drinking is important, but it doesn't replace targeted measures for a disturbed oil layer, and drops without a diagnosis don't always address the actual cause. The most effective everyday measures often cost nothing: screen breaks with conscious blinking, warmth on the eyelids, lid hygiene, and higher humidity.

When you should see a doctor

If symptoms persist for more than two weeks despite eye drops, your visual acuity worsens, or you suddenly can no longer tolerate contact lenses, an ophthalmological examination is advisable. The same applies if you are considering changing your birth control pill or starting hormone replacement therapy due to symptoms: this should always be decided in consultation with a doctor.

Conclusion

Dry eyes are rarely just a matter of screen time or indoor air. If you use hormonal contraception, are in the middle of your cycle, or in perimenopause, it's worth taking a look at your hormones, as estrogen, progesterone, and androgens have been shown to affect the tear glands and meibomian glands. At the same time, the study situation is admittedly mixed: large databases show an increased risk, individual careful studies find no effect on objective measurements, and more hormones are demonstrably not the solution.

The good news: some of this can be addressed. Moisturizing eye drops provide acute relief, conscious blinking and warmth on the eyelids cost nothing, a vitamin D test shows whether a deficiency is a contributing factor, and an open conversation with your doctor clarifies whether your birth control method or a beginning hormonal change could be the cause. Thanks to our follower for the question that prompted this article.