Can menopause or hormone changes affect my scleral lenses?

What’s known about hormones and dry eye

The National Eye Institute lists being a woman and being 50 or older among the things that make dry eye more likely. It explains that the hormone changes that happen during pregnancy and menopause can make it harder for your body to make tears.^[1]

Other things common in midlife can add to it. The National Eye Institute lists some medicines, including those for allergies, depression and high blood pressure, and health problems such as thyroid conditions, diabetes and autoimmune disorders, among the causes of dry eye.^[1]

What wearers notice

Wearers going through perimenopause or menopause often describe:

• Shorter comfortable wear time, with lenses that used to last all day feeling dry or gritty by afternoon.
• More redness, sometimes even with lenses that fit well.
• More fogging or film on the lens as the tear film changes.
• More awareness of the lens edge, which some find shifts with hormones, seasons and diet.

Some wearers say their eyes changed gradually; others, especially after surgical menopause, describe a sudden and marked change.

Find out what kind of dry eye you have

Dry eye isn’t one thing. The National Eye Institute describes dry eye as your glands not making enough tears, your tears drying up too fast, or your tears not working well enough to keep the eyes wet.^[2] Wearers who asked about menopause were commonly advised to get a full dry eye evaluation, because whether the problem is too few tears or oil gland trouble (meibomian gland dysfunction) changes what helps.

Your eye doctor may check the amount of tears your eyes make, how long it takes your tears to dry up, and the structure of your eyelids.^[2] See blepharitis and MGD for the oil gland side.

Dry eyes and dry mouth together? Mention it. The National Eye Institute notes that Sjögren syndrome, an autoimmune condition that causes dry eye and dry mouth, is more likely in women ages 40 to 50.^[1] See Sjögren’s syndrome.

Adjusting your lens routine

These are changes wearers commonly make with their fitter’s help:

• A midday removal and refill on long days.
• A different fill solution, or a thicker preservative-free drop added to the fill, which is off-label and your fitter’s call.
• A lens surface treatment or a refreshed coating if the front surface is drying out.
• Moisture-chamber glasses outdoors or in dry, air-conditioned spaces. See moisture-chamber glasses.
• Treating the lids with warm compresses and lid hygiene if oil glands are involved.

Change one thing at a time so you and your fitter can tell what helped.

Hormone therapy and your eyes

Wearers have mixed experiences. Some felt hormone therapy helped their eye comfort or redness, including at least one wearer with severe ocular surface disease whose wear time improved alongside other treatment. Others noticed no change, and at least one had sharply worse dry eye after surgical menopause despite hormone therapy. None of this tells you what will happen for you.

Hormone therapy is a decision about your whole health, made with your doctor. Don’t start or stop it for your lenses alone, and tell your eye doctor about any change.

What to ask your eye doctor

• What kind of dry eye do I have: too few tears, oil gland problems, or both?
• Could any of my medicines be drying my eyes?
• Should I be checked for Sjögren syndrome or thyroid problems?
• Would a different fill, a coating, or a midday refill help?
• Do I need a lens refit, or is this the eye surface?