There’s no question that womens’ bodies go through of lot of changes in the years leading up to menopause. Waning hormones can cause symptoms you’ve probably heard plenty about: irregular periods, hot flashes and night sweats, sleep problems, vaginal dryness, and mood swings.

What you may not have heard is that menopause can also affect your eyes.

The start of hormonal changes in women is a stage called perimenopause. It can begin as early as your mid-30s or as late as your early 50s. But on average, it begins when women reach their mid-40s.

That’s when the ovaries start producing less of the hormones estrogen and progesterone, often causing irregular periods. Perimenopause typically lasts between four and eight years before women officially enter menopause, which is when they haven’t had a period for 12 months.

Although these symptoms can ease once a woman officially reaches menopause, some symptoms can continue for many years.

How Menopause Affects the Eyes

Changing hormone levels can impact the structure of your eyes and, in turn, your vision. For example, the cornea becomes more elastic, which alters the way light travels through the eye. Some women going through perimenopause and menopause often notice that their vision fluctuates — crystal clear at times, slightly fuzzy at other times. These changes might make contact lenses uncomfortable or require you to get corrective lenses for the first time.

One very common symptom is dry eye. About 61% of perimenopausal and menopausal women experience the condition, which is caused by a reduction in the quantity and effectiveness of tears. As we age, we naturally produce fewer tears, but it can be especially pronounced for women in perimenopause and menopause.

That’s because menopause causes a drop in the group of reproductive hormones called androgens. These hormones have more than 200 actions to play in women. Converting to estrogen is one of the most important. They also kick-start puberty, and in adult women they help prevent bone loss and can impact sexual desire. (Men have androgens in higher numbers. In fact, testosterone is the principal androgen.)

One of the less-talked-about roles androgens play is in tear production, says optometrist Israel Chujor, O.D., who practices at America’s Best Contacts & Eyeglasses in Atlanta. It impacts two glands: the lacrimal, located above your eyeball, and the meibomian, found in your eyelids. Meibomian glands release the oil, and lacrimal glands release the fluid, both of which make up your tears.

During perimenopause and menopause, fluctuating hormone levels can cause the glands to become inflamed. This leads to dry eye symptoms such as:

• redness 
• burning
• a feeling that something is stuck in your eye
• blurred vision
• sensitivity to light

Another potential effect of menopausal changes is a higher risk for glaucoma. This is a disease that damages the eye’s optic nerve, usually caused by high eye pressure (what eye doctors refer to as ocular hypertension). Lower levels of estrogen have been connected to higher ocular tension, Dr. Chujor says. In the early stages, this type of glaucoma doesn’t cause symptoms such as blurry vision or discomfort, so it can be tough to notice. But an eye exam can detect it.

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How Menopause-Related Vision Issues Are Treated

Fortunately, many vision issues caused or made worse by menopause can be treated, although not always cured.

One simple solution that Dr. Chujor recommends for mild-to-moderate dry eye is over-the-counter artificial tears. Look for drops that don’t have preservatives, which can contain chemicals that irritate the eyes. You can also hold warm compresses over your eyes to reduce inflammation.

If your symptoms are interfering with your quality of life, your eye doctor may recommend the insertion of small silicone gel plugs called punctal plugs into your tear ducts. These are designed to keep tears in your eyes longer. Your America’s Best optometrist can refer you to a doctor for this in-office procedure that has little to no downtime.

Ocular tension, a risk for glaucoma, can be treated with prescription eyedrops, laser treatments, or surgery.

What You Can Do to Protect Your Eyes During Perimenopause and Menopause

When you’re of menopausal or pre-menopausal age, part of your regular medical care should include annual eye exams. To make it easy to remember to schedule yours, try to book it at the same time you schedule your annual exams with your family doctor and OB-GYN.

Of course, if you’re bothered by dry eye symptoms or experiencing vision changes, don’t wait for this annual eye appointment. Call your eye doctor to be seen right away. You shouldn’t have to tough it out, says Dr. Chujor.

“For a serious underlying condition, early intervention is best,” Dr. Chujor says. On the flip side, it can be a relief to learn that a vision problem isn’t serious and to start working on a solution for it, he adds.

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Tweaking some of your daily habits can help too. If you smoke or vape, you should quit. Smoking not only irritates and dries out your eyes, but it’s also a risk factor for vision loss from cataracts and age-related macular degeneration. Smoking can also increase your risk of early menopause by 50%.

Ask your family doctor to check your blood pressure and blood sugar levels. Keeping both of these numbers in a healthy range is good for your eye health. High blood pressure can damage the tiny blood vessels that supply blood to the eyes. This can lead to optic nerve damage, distorted vision, or vision loss. High blood pressure combined with uncontrolled high blood sugar is a major risk factor for retinopathy, which is damage to the small blood vessels in the retina.

And of course, don’t forget about your diet. Healthy eyes depend on foods found largely in the Mediterranean diet, including omega-3-rich fatty fish (tuna, salmon, sardines), lean proteins, whole grains, fruits, veggies, nuts, and beans.

Ask your eye doctor and family doctor whether you’d benefit from a fish oil supplement. One study of 32,000 women 45 and older found that those who ate the most omega-3s from fish had a 17% lower risk of dry eye.

“A healthy, well-balanced diet is important for general health and is beneficial to eye health as well,” Dr. Chujor says.