Many women experience dry eye without realizing that hormone shifts – including those triggered by birth control or hormone replacement therapy (HRT) – could be a major contributor.
Whether you're managing menopause, considering birth control, or navigating both, understanding how hormones impact your eye health is key.
Why Hormones Affect Dry Eye
Your eyes aren’t just windows to the soul – they’re also highly responsive to your body’s hormonal environment.
Estrogen, progesterone, and androgens all play roles in the structure and function of the tear film, meibomian glands, and ocular surface. When these hormone levels shift – like during menopause or when starting birth control – tear production and quality can change dramatically.
Birth Control and Dry Eye: A Closer Look
New research presented at ASCRS 2023 found that certain hormonal birth control methods significantly increase the risk of dry eye symptoms and blepharitis.1
Key findings included:
- Estrogen-containing pills (like norgestrel-ethinyl estradiol) were linked to more severe dry eye and blepharitis than non-estrogen contraceptives.
- Using multiple forms of birth control over time increased risk of both symptoms and gland dysfunction.
- Non-hormonal methods (like copper IUDs) were associated with fewer symptoms than hormonal options.
- Some synthetic progestins (like levonorgestrel) were more irritating to the ocular surface than others.
Why does this happen?
Hormonal contraceptives can disrupt the delicate balance of oil and water in your tear film by affecting the meibomian glands – the tiny oil producers in your eyelids.
This can lead to:
- Faster tear evaporation
- Grittiness, stinging, or light sensitivity
- Inflammation along the lid margin
- Long-term gland dropout if left untreated
Hormone Replacement Therapy (HRT) and Menopause
HRT is often prescribed to manage menopause symptoms like hot flashes, insomnia, or bone loss – but it may not always help the eyes. In fact, studies have shown that:
- Estrogen-only HRT may worsen dry eye, especially when not paired with androgens2
- Postmenopausal drops in androgens (like DHEA and testosterone) are linked to meibomian gland dysfunction (MGD), which is a major cause of evaporative dry eye.
- Women on HRT with existing dry eye may see worsened symptoms unless gland function is proactively managed.
So while HRT can improve many aspects of menopausal health, it’s important to have a dry eye care plan in place, too.
How to Protect Your Eyes: A 5-Step Protocol
1. Peeq Your Eyelids Daily
Daily eyelid cleansing reduces bacteria, oil buildup, and lash mites.
🧼 Try:
- Peeq Pro Foaming Eyelid & Facial Cleanser (with tea tree)
- Hypochlorous sprays like Optase Protect or Pure&Clean
Use clean fingertips or a sponge and gently massage along the lash line.
2. Use a Warm Compress
A warm compress helps unclog glands and stimulate healthy oil flow. Apply at 104-108°F for 5-10 minutes, then gently massage lids.
🔥 Try:
- Peeq Pro Silica Bead Compress
- Washcloth heated with water (not too hot!)
3. Support with Omega-3s
Long-chain omega‑3s (EPA and DHA) improve tear quality and reduce inflammation.
- Aim for 2,000 mg/day, especially during hormonal shifts.
4. Hydrate and Blink
- Drink water regularly
- Follow the 20/20/20 Rule during screen time
- Blink fully and often – hormonal changes can affect blink rate too!
5. Talk to Your Eye Doctor
If you're considering birth control, HRT, or are in menopause, ask for:
- A meibography to check gland health
- A personalized dry eye care plan
- Recommendations for safe hormonal options (if needed)
Final Thoughts
Dry eye isn’t just a side effect of aging or screen time – it can be deeply tied to the hormonal decisions women make every day.
Whether you’re on birth control or managing menopause with HRT, your tear film deserves attention and care. The good news? You don’t have to suffer through dryness, stinging, or blurry vision. With gentle eyelid hygiene, warm compresses, and omega-3s, you can stay ahead of symptoms and protect your meibomian glands for life.
1 Charters, L. ASCRS 2023: Negative effects of several contraceptive modalities on dry eye. Ophthalmology Times, May 7, 2023.
2 Sullivan, D.A. Sex, Gender, and Hormones Report, DEWS II Report, 2017.