Cisgender women and others assigned female at birth are twice as likely as cisgender men and others assigned male at birth to develop dry eye, and hormones are a likely cause. Estrogen and progesterone can suppress the activity of tear-producing glands near the eyes.

Dry eye is a common condition that occurs when the body cannot produce tears to keep the eyes’ surfaces well lubricated.

This can happen if the tear-producing glands don’t produce enough tears or if the tears they produce dry too quickly.

Dry eye can happen to anyone, but older data from 2013 suggests that people assigned female at birth are twice as likely as people assigned male at birth to experience it.

What’s more, people who menstruate may find that their symptoms change throughout their cycle, with worsening symptoms as menstruation approaches.

Like dry eye symptoms, estrogen levels change throughout the menstrual cycle. The menstrual cycle involves three overlapping phases:

  • follicular phase (before egg release)
  • ovulatory phase (egg release)
  • luteal phase (after egg release)

The follicular phase begins when menstruation occurs — the first day of menstrual bleeding is day 1 of the menstrual cycle. During menstruation, estrogen levels are low.

Estrogen levels increase quickly at the end of the follicular phase, leading to the ovulatory phase. After the egg release, estrogen levels decline again, though not quite to the levels during menstruation.

Estrogen levels gradually increase during the luteal phase before declining again, leading to menstruation.

Research has found that clinical signs of dry eye are worse during the late follicular and luteal phases, when estrogen levels are at their highest, compared with the low estrogen period of menstruation.

However, people tend to report worse dry eye symptoms when estrogen levels are low during menstruation.

The disconnect between clinical signs of dry eye and self-reported symptoms may be due to changes in other hormone levels (such as androgen) or pain sensitivity across the menstrual cycle.

Actual changes in estrogen levels may also contribute to dry eye symptoms. People with more consistent estrogen levels tend to report more frequent dry eye symptoms.

Hormones may play a key role in the difference in dry eye frequency between sexes. However, they likely aren’t the only cause.

A study from 2019 found that factors such as sleep, mood, and stress can affect dry eye symptoms, with more severe dry eye symptoms in people with lower sleep quality and higher anxiety.

A 2023 study found that anxiety can increase the likelihood of developing female dry eye by nearly sixfold.

Women tend to be more likely to experience stress and anxiety than men, which may contribute to differences in the frequency of dry eye between people.

Research also suggests that female dry eye may be associated with more bothersome symptoms. This could mean that females are more likely to discuss dry eye symptoms with a healthcare professional.

Hormone-related dry eye is similar to forms of dry eye caused by other factors. Treatment may involve combining:

  • warm compresses
  • over-the-counter eye drops
  • nutritional supplements

The effects of hormone therapy on dry eye symptoms are inconsistent. Some studies show a small benefit, and others show worsening symptoms among people receiving hormone replacement therapy.

If you or a healthcare professional suspect that your dry eye symptoms may be related to the use of hormonal birth control, switching to a nonhormonal contraceptive may be advisable to see whether symptoms improve.

Changes in hormone levels can affect dry eye symptoms throughout the menstrual cycle. Other factors, including stress and difficulty getting enough sleep, may also contribute.

If you have dry eye symptoms that come and go during your menstrual cycle, consider making an appointment with a healthcare professional.

They can help you understand which steps you can take to care for your eyes and relieve symptoms as needed.