Have the dry eyes of menopause?

You don’t need to suffer. Here’s what you need to know about this common-yet-complex problem.
A common complaint among middle-aged women, there is help for dry eyes. (For Spectrum Health Beat)
A common complaint among middle-aged women, there is help for dry eyes. (For Spectrum Health Beat)

Menopause can be tough enough to handle, but when hot flashes and weight gain are accompanied by dry, scratchy, irritated and red eyes, it’s time to take action.

This condition actually has a name associated with it—dry eye of menopause—and it is a common complaint of women over 50.

Many women talk about it, ask their physician about it, and don’t like it, but there are no clear answers as to why women suffer from this condition. And, unfortunately, we don’t really know what to do about it. Is dry eye really associated with menopause, or is it a product of aging? We aren’t completely sure.

A patient I’ll call Rhonda suffered from several symptoms during menopause, including dry and irritated eyes. The 54-year-old finally decided to call our office for help.

She had been period-free for about 15 months, and her menopause symptoms were not going away. She started with night sweats and irritability roughly six months before her last period, but soon after her final period (not knowing it was her last one), the hot flashes started with a vengeance.

And the symptoms just kept coming. Rhonda didn’t sleep well, her moods became erratic, and she gained weight without changing her diet or exercise plan. For many months, Rhonda thought she could just handle everything, but after blowing up at a lady who left her cart in the middle of the aisle in the grocery store one day, she knew something had to change.

Rhonda took her first step by seeing her family practice physician. Although helpful, Rhonda wasn’t sure about her doctor’s recommendation to start taking hormone supplements.

So, instead, her doctor started her on the medicine Lexapro for the hormone-related mood changes. Lexapro increases the brain chemicals lost with poor sleep and lower estrogen levels. The medicine quickly helped with her mood swings and also cut her hot flashes in half.

Unfortunately, the weight gain continued, and she started having really scratchy eyes. She went back to her doctor thinking she had something stuck in them. After a thorough examination of her eyes with a special lamp, the doctor concluded they were clearly red and irritated despite having no foreign particles in them. She told Rhonda she had seen many women with dry eyes when they started menopause and perhaps it was time to consider hormone medication.

Rhonda left the office determined to take the next step in getting relief for this annoying symptom. She made an appointment at the Spectrum Health Medical Group Midlife and Menopause Offices with Natasha Peoples, a nurse practitioner and certified menopause practitioner. Peoples walked her through our menopause symptom and lifestyle assessments, also known as SEEDS (Seven Essential Elements of Daily Success).

The assessment confirmed that Rhonda had many of the symptoms, even though some of them were better with the Lexapro. Rhonda’s No. 1 goal was to get help for her dry eye issue, and she hoped Natasha could give her some advice. Her job required her to sit at a computer screen for several hours each day, and her eye symptoms made it difficult to concentrate.

After listening to Rhonda’s concerns, Natasha explained how the body changes with menopause, focusing specifically on the dry eye problem. We know that dry eye of menopause in women is common, no matter what age they experience menopause—at 30, 45 or 55. And, for many women, the symptoms of dry, scratchy eyes get better with estrogen. Testosterone is thought to possibly play a role in tear formation as well, and, without good studies to help us, testosterone in low doses added to estrogen could also help.

There are also some other options that may help dry eyes if a woman either can’t (because of medical reasons) or simply won’t add hormones to her daily routine. Dry eye of menopause is thought to be from quicker evaporation of tears and lower-quality tears (tears that are watery and don’t have much oil to coat the eye surface). Conversations with patients tell us that over-the-counter medications such as artificial tears and lubrication ointment can be effective for some, as well as adding fish oil or flax seed supplements to their diet. Even the basic habit of drinking water and staying hydrated can also play a positive role in eliminating this symptom.

Peoples thought Rhonda would benefit from taking hormones, but she first needed to make sure Rhonda was a good candidate. Natasha asked many questions about Rhonda’s medical history and lifestyle habits, and determined she was very healthy, except for being overweight. They talked about getting back to the basics and incorporating the SEEDS into her daily routine. And, they also worked out a plan to start menopause hormone therapy, deciding on the patch and FDA-approved progesterone capsules called Prometrium-bioidentical.

Three months later, Rhonda returned to see Peoples for her checkup and happily reported she felt better. She added one more walk to her week, started doing a DVD with weights, added yoga once a week, and began a routine of daily stretching. In addition, she drank more water, got better sleep and took a multivitamin, Vitamin D and fish oil.

Two weeks after starting the hormones, her hot flashes disappeared, and although her dry eyes weren’t completely back to normal, they were only a minor nuisance and no longer bothered her at work. Even her friends and family members noticed she was acting and feeling better.

Women, including Rhonda, do not have to suffer during menopause. Sometimes even the most basic habits can make all the difference in helping us feel better. And, even though Rhonda’s health care providers aren’t completely sure which change helped her eyes improve the most, Rhonda enjoyed feeling better than she had in a long time.

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