Eye health

This page is about looking after your eyes in midlife: noticing changes, and knowing which checks matter. No menopause guideline, from NICE, the NHS or the Pakistan Menopause Society, has a section on the eyes. What follows is what women report, what research has found, and the one link the guidance does make clear, which runs through diabetes.

For dry, gritty or sore eyes as a symptom, see dry eyes.

What women describe in midlife tends to fall into a few groups:

• Eyes that feel dry, gritty, tired or sore, especially after screens, air conditioning or a long day.
• Contact lenses that used to be comfortable and now are not.
• Small print that has become harder to read up close, so the phone or the Quran is held further away.
• Eyes that water more, or get red more easily.

These are reports, not a list of menopause symptoms. Some have causes that have nothing to do with hormones.

On dry eye, a large international report from the Tear Film and Ocular Surface Society, TFOS DEWS II, found that dry eye disease is more common in women than men and that being female is a significant risk factor. It attributes that difference largely to hormones, including estrogen and androgens, and to genetic differences. It is a research review, not a menopause guideline.

On close-up vision, the NHS website says long-sightedness often affects people over 40, and that one cause is the lens of the eye becoming stiffer, usually with age. That is ageing, not the menopause, though the two arrive in the same decade.

The clearest link between midlife and eye health runs through diabetes.

The British Menopause Society says South Asian women show a higher rate of insulin resistance and diabetes during the menopause transition. The Pakistan Menopause Society's recommendations ask doctors to consider a fasting blood sugar or HbA1c test according to age, risk and affordability (Table 4). See diabetes risk.

Diabetes matters for the eyes because, as the NHS website explains, high blood sugar can damage the back of the eye. It calls this diabetic retinopathy and says it does not usually cause symptoms at first, which is why people with diabetes in England are invited for regular eye screening, where photographs are taken of the back of the eye.

In England, the NHS also gives free eye tests to people with diabetes or glaucoma, to everyone aged 60 and over, and to people aged 40 and over whose parent, sibling or child has glaucoma. Outside England, ask what your optician or clinic offers. Health screening covers the other checks worth asking about in midlife.

See an optician if your vision has changed, or if dry or sore eyes keep bothering you. If you have diabetes, keep every eye screening appointment, even when your sight seems fine.

The NHS website says to get urgent advice, from a GP or NHS 111 in England, for changes such as blurred or double vision, flashing lights or shapes, a dark shadow moving across your vision, pain in one or both eyes, or a red, painful eye. It says to go to A&E or call 999 if you suddenly cannot see from one or both eyes, or suddenly have severe eye pain.

If diabetes or eye disease runs in your family, say so when you have your own eyes or blood sugar checked. A parent's or an aunt's history is part of how a doctor judges your risk.

Women who use eye drops sometimes ask whether they affect the fast in Ramadan. It is a question women raise every year, and it belongs with a qualified scholar. When to use any prescribed drops around sehri and iftar is a question for whoever prescribed them.