Perimenopause and Your Eyes: The Changes Nobody Talks About

From dry, uncomfortable eyes to fluctuating vision, hormonal changes can affect your eyes in ways you might not expect. But not every change to your eyesight in your 40s and 50s is caused by hormones.

When we talk about perimenopause, symptoms such as hot flushes, disrupted sleep, mood changes and brain fog usually come to mind. But did you know that hormonal changes can also affect your eyes?

Perhaps your eyes have started feeling dry or uncomfortable. Maybe your contact lenses aren’t as comfortable as they used to, or your vision becomes blurry at different times of the day.

At the same time, you might find yourself holding your phone further away to read a message or struggling with small print.

It’s tempting to assume these changes are all connected, particularly when they seem to happen at the same time.

But while some eye symptoms may be influenced by hormonal changes, others are simply part of the natural ageing process.

Understanding the difference is important, because the causes — and the solutions — aren’t necessarily the same.

First, what’s the difference between perimenopause, menopause and postmenopause?

Although we often use the word menopause to describe a whole stage of life, medically it has a much more specific meaning.

Perimenopause is the transitional period leading up to menopause, when hormone levels fluctuate and symptoms may begin. It can last for several years.

Menopause is the point reached when you’ve gone 12 consecutive months without a menstrual period, provided there’s no other medical explanation. It’s identified retrospectively and marks the end of the reproductive years.

Postmenopause refers to the years following menopause.

These distinctions matter because hormonal changes can affect eye health during perimenopause, and some effects may continue into postmenopause.

How do hormonal changes affect your eyes?

Hormones such as oestrogen, progesterone and androgens (including testosterone) don’t just influence our reproductive systems. They also affect tissues throughout the body, including parts of our eyes and the glands responsible for producing healthy tears.

One of the most widely recognised eye conditions associated with this stage of life is dry eye disease.

Research has found that dry eye symptoms are common in women during midlife and after menopause. Hormonal changes may be one contributing factor, although age, medications, other health conditions and environmental factors also play important roles.

It’s also worth remembering that not everyone will experience these symptoms. Hormonal changes affect individuals differently.

Dry eyes: more than just feeling a little dry

Our eyes are protected by a delicate layer of tears called the tear film.

Although we tend to think of tears as simply water, they’re actually a carefully balanced mixture of watery, oily and mucus-like components. Together, these keep the surface of the eye smooth, healthy and comfortable.

Tiny glands along the edges of our eyelids, called meibomian glands, produce the oily component of our tears. This helps prevent them from evaporating too quickly.

Hormones, particularly androgens, help regulate these glands. Changes in hormonal activity may affect their function, contributing to tear film instability and dry eye symptoms.

You might notice:

• Dryness, grittiness, burning or stinging

• Red or irritated eyes

• Eyes that feel particularly tired towards the end of the day

• Blurry vision that comes and goes, sometimes improving when you blink

• Increased sensitivity to light

• Contact lenses becoming uncomfortable

• Watery eyes

That last symptom often surprises people.

How can watery eyes actually be dry?

When the surface of the eye becomes irritated, it can trigger a reflex response that produces extra watery tears. However, these tears may not provide the balanced protection the eye needs.

So, despite all the watering, the underlying problem can still be dry eye.

Why does my vision seem blurry at different times of the day?

One of the more frustrating changes some women notice during perimenopause is vision that seems perfectly clear one moment and blurry the next.

You might find your eyesight is fine in the morning but becomes blurry after several hours at the computer. Or perhaps it takes a few blinks to bring things back into focus.

This can happen when the tear film — the delicate layer of moisture covering the front of your eyes — becomes unstable.

A healthy tear film creates a smooth optical surface that helps us see clearly. If it starts to break up between blinks, the surface becomes irregular and vision can temporarily blur.

Hormonal changes during perimenopause may contribute to tear film instability, while everyday activities such as screen use, reading and contact lens wear can make symptoms more noticeable.

A useful clue is whether your vision improves after blinking. If it does, dry eye may be contributing.

However, fluctuating vision isn’t always caused by dry eye. Changes in blood glucose, certain medications and other eye conditions can also affect vision.

If you’re experiencing new or persistent episodes of blurred vision, it’s important to have your eyes examined rather than assuming they’re hormone-related.

What about blepharitis and rosacea?

Sometimes dry, uncomfortable eyes aren’t just about the tears themselves. The health of our eyelids also plays an important role.

Blepharitis is inflammation of the eyelid margins. It can cause red, itchy or irritated eyelids, crusting around the eyelashes, grittiness and watering.

It’s often associated with meibomian gland dysfunction (MGD), where the tiny oil-producing glands in the eyelids aren’t working as effectively as they should. This can allow tears to evaporate too quickly, contributing to dry eye symptoms.

Another condition that can be involved is rosacea. Although we usually associate rosacea with facial redness and flushing, it can also affect the eyes and eyelids. This is known as ocular rosacea.

Hormonal changes during perimenopause may influence tear film stability and meibomian gland function, potentially making existing symptoms more noticeable. However, there isn’t sufficient evidence to say that perimenopause directly causes blepharitis or ocular rosacea.

The important thing is that these conditions can overlap, and identifying what’s contributing to your symptoms helps us recommend the most appropriate care.

If you’ve noticed irritated eyelids, recurrent styes, facial rosacea or persistent dry eye symptoms, it’s worth mentioning them during your eye examination.

Why do your eyes feel worse when using screens?

If you spend a lot of time working at a computer, scrolling through your phone or concentrating on detailed tasks, you might notice your symptoms becoming worse.

When we’re concentrating, we naturally tend to blink less frequently and sometimes less completely.

This allows our tears to evaporate more quickly, particularly if the oily layer of the tear film isn’t functioning as well as it should.

The result can be irritated, tired eyes and vision that becomes temporarily blurry.

Although screen use doesn’t cause the hormonal changes associated with perimenopause, it can make existing dry eye symptoms more noticeable.

Simple changes such as taking regular screen breaks, remembering to blink fully and adjusting your working environment may help.

However, persistent symptoms deserve proper assessment rather than simply putting up with them.

Can hormonal changes affect contact lens comfort?

Yes, they can.

If you’ve worn contact lenses comfortably for years but suddenly find yourself reaching for your glasses more often, changes to your tear film may be contributing.

Contact lenses depend on a healthy, stable tear film to remain comfortable.

When the tear film becomes less stable, you may experience dryness, irritation, fluctuating vision or a reduction in how long you can comfortably wear your lenses.

But this doesn’t necessarily mean you need to give up contact lenses.

Sometimes a change in lens material, replacement schedule or wearing routine can make a real difference. In other cases, addressing underlying dry eye problems first may be the best approach.

If your contact lenses have become less comfortable, it’s worth having them reviewed rather than assuming they’re no longer suitable for you.

Why am I suddenly struggling to read small print? Isn’t that perimenopause too?

Here’s where an important misconception comes in.

Many women begin to notice difficulty focusing on close objects during their 40s, often around the same time that perimenopause begins.

But this particular change is usually caused by something completely different.

It’s called presbyopia, and it happens to everyone as they get older, regardless of sex or hormone levels.

Inside each eye is a natural lens that changes shape to help us focus at different distances.

When we’re younger, this lens is flexible, allowing us to switch easily between looking at something in the distance and something close up.

As we get older, the lens gradually becomes less flexible, making it harder to focus on nearby objects.

You might notice:

• Holding your phone or book further away

• Struggling to read small print, especially in poor lighting

• Taking longer to switch focus between near and distant objects

• Tired eyes or headaches after prolonged close work

Presbyopia typically becomes noticeable in our early to mid-40s and gradually progresses over the following years.

Perimenopause doesn’t cause presbyopia. The two simply tend to happen at a similar stage of life.

Of course, you can experience both presbyopia and dry eye at the same time, making changes to your vision feel particularly frustrating.

The good news is that there are plenty of ways to help with both conditions, once we understand what’s happening.

What about floaters? Are they connected to perimenopause?

Another visual change sometimes discussed during perimenopause is the appearance of floaters — those little dots, threads or cobweb-like shapes that seem to drift across your vision.

Floaters are commonly caused by changes in the vitreous, the clear jelly-like substance inside the eye. As we get older, the vitreous gradually changes structure, and this can lead to a posterior vitreous detachment (PVD), where the vitreous separates from the retina.

Some research has explored whether hormonal changes around menopause might influence the vitreous. However, the evidence remains limited, and there isn’t sufficient evidence to establish that perimenopause directly causes floaters.

Although many floaters are harmless, a new onset of floaters can occasionally be associated with a retinal tear or retinal detachment.

⚠️ When should you seek urgent eye care?

New flashes or floaters can sometimes indicate a retinal tear or detachment, which may threaten your sight if left untreated.

Seek urgent assessment if you experience:

• New floaters, even without other symptoms

• A sudden increase in existing floaters

• New flashes of light

• A shadow, curtain or dark area across your vision

• Sudden blurred or reduced vision

New flashes or floaters should be assessed urgently, ideally on the same day and within 24 hours, even if your vision otherwise seems normal.

A shadow or curtain across your vision, or sudden loss of sight, requires immediate emergency eye care. Do not wait for a routine appointment.

Most new floaters won’t turn out to be anything serious, but a dilated retinal examination is important to rule out a retinal tear or detachment.

Never assume new floaters are simply part of perimenopause or normal ageing.

Urgent eye care at Page & Small

At Page & Small, we’re an experienced, accredited provider of the NHS Minor Eye Conditions Service (MECS) in South East London.

Our optometrists have experience assessing a wide range of urgent eye concerns, including new flashes and floaters, and can arrange onward referral to hospital eye services when necessary.

If you experience new symptoms, please contact us promptly on 0208 293 9493 so we can advise you on the appropriate next steps.

You can also find other participating practices through the South East London MECS website: www.SEL-MECs.co.uk.

If you experience sudden loss of vision or a shadow or curtain across your sight, seek immediate emergency eye care rather than waiting for an appointment with us.

Does HRT help with dry eyes?

You might reasonably assume that if hormonal changes are contributing to dry eye, hormone replacement therapy (HRT) would improve the symptoms.

Unfortunately, the science isn’t quite that simple.

Studies investigating HRT and dry eye have produced mixed results. Some have reported improvements in certain symptoms or tear measurements, while others have found little benefit or even an association with increased dry eye symptoms.

The relationship between hormones and the ocular surface is complex, and different hormones can have different effects.

At present, HRT isn’t an established treatment specifically for dry eye disease.

Decisions about HRT should be made with your GP or menopause specialist, taking into account your overall health and menopausal symptoms.

If you’re taking HRT, or have recently started or changed treatment, it’s useful to mention this to your optometrist.

What can you do to keep your eyes comfortable?

The most important thing is not to dismiss persistent symptoms as simply another part of getting older.

There are several ways we can help, depending on what’s causing your discomfort.

For dry eyes, this might include advice on suitable lubricating eye drops, warm compresses, eyelid care, screen habits or more targeted treatment.

If you’re experiencing difficulty with near vision, we can discuss the most appropriate options for your lifestyle, whether that’s reading glasses, varifocals, occupational lenses or contact lenses.

And because not every visual symptom is caused by dry eye or presbyopia, a comprehensive eye examination is important to check your prescription and overall eye health.

How can we help at Page & Small?

At Page & Small, we believe good eyecare is about much more than simply checking whether you need glasses.

Your vision and eye comfort can be influenced by your general health, lifestyle, medications and the changes happening throughout your life.

That’s why we take the time to listen and understand the bigger picture.

If you’re experiencing symptoms during perimenopause or postmenopause, please tell us. It’s useful information that can help us understand what might be contributing to the changes you’re noticing.

During your eye examination, we can assess your vision and eye health, examine the surface of your eyes and eyelids, and look for signs of dry eye or other conditions.

As an experienced NHS MECS practice, we also assess a range of urgent eye problems, providing access to appropriate care and onward referral when needed.

Where appropriate, we can discuss further assessment or treatment options tailored to your needs.

Your eyes deserve attention too

Perimenopause and postmenopause can bring significant changes, but uncomfortable eyes and fluctuating vision aren’t something you simply have to accept.

Some changes may be related to hormones, others to the natural ageing process, and sometimes several factors are involved.

Understanding what’s happening is the first step towards finding the right solution.

Because good eyecare isn’t just about seeing clearly. It’s about keeping your eyes healthy and comfortable throughout every stage of life.

If you’ve noticed changes in your vision, eye comfort or contact lens wear, our friendly team at Page & Small Opticians is here to help.

Call us on 0208 293 9493 to arrange an appointment or discuss your concerns.

Clinical references and further reading

This article draws on published research and established clinical guidance. For anyone interested in exploring the subject further:

• TFOS DEWS III: Digest (2025) – International scientific review of dry eye disease, including the influence of hormones and ageing.

• College of Optometrists – Dry Eye Clinical Management Guideline – Evidence-based guidance on dry eye disease.

• College of Optometrists – Ocular Rosacea – Clinical guidance on ocular rosacea and associated eyelid inflammation.

• NHS – Floaters and Flashes – Patient information about symptoms requiring urgent assessment.

Clinically reviewed by the optometry team at Page & Small Opticians.

Last clinically reviewed: October 2026.

This article provides general information and isn’t a substitute for individual clinical advice. New flashes or floaters require urgent assessment. A shadow or curtain across the vision, or sudden loss of vision, requires immediate emergency eye care.