Eye Floaters and Menopause: Is there a link?

Menopause is when your periods stop due to a reduction in sex hormone levels which causes your ovaries to stop producing eggs. It affects anyone who usually has periods and most commonly occurs in women between the ages of 45 and 55. Menopause can happen for a number of reasons. For the most part, it occurs naturally, however, things like surgeries to remove the ovaries or uterus, chemotherapy treatment, or genetic reasons can cause menopause, while sometimes the reason can be completely unknown.

When people say that they are “going through menopause” they are often actually describing perimenopause. This is the period where your hormone levels start to change and you may begin to experience menopause symptoms, but your periods do not stop completely. Perimenopause ends and you reach menopause when you have not had a period for 12 months. The most significant changes are the reduction in oestrogen and progesterone levels, with the large decline in oestrogen levels being the main cause of menopause symptoms.

Eye floaters are black or grey shadows and dark spots which you may see drifting in your field of view that move with eye and head movements. Floaters are more apparent against bright backgrounds and typically manifest with increasing age as structural and molecular changes to the vitreous humour, a clear gel-like fluid that fills the eye, cause it to liquefy and contract.

The vitreous humour (or vitreous for short) fills the space between the retina and the lens in the eye. It helps the eye to maintain its round shape and makes up around 80% of its total volume. Water, collagen, and hyaluronic acid are the major structural molecules of the vitreous and are accompanied by different antioxidant molecules and enzymes.

Molecular changes to the vitreous gel and its constituents can ultimately cause structural changes to the vitreous body. Events such as the dissociation of hyaluronic acid and collagen can cause vitreous liquefaction and the clumping of collagen proteins. The vitreous structure can further be disrupted by the formation of liquid pockets (called ‘lacunae’) within the vitreous gel, and it is processes like these which can produce floaters in your vision. 

Menopause, for the vast majority of women, occurs as a part of ageing, which is also the case for changes we see in the vitreous structure. This means menopause and eye floaters are often something which can come hand-in-hand as you get older. You only need a quick search online to find multiple forums and blog posts where women have shared their stories and expressed their concerns about developing floaters, light flashes, and blurred vision during menopause.

There is currently very little research into the direct effects of menopause on the development of eye floaters, however, what we do know are some of the key processes which contribute to disruption of the vitreous structure and floater formation (check out some of our other blogs here to learn more about how floaters can form).

So, to answer our question - can menopause cause eye floaters? – let’s examine how the changes in hormone levels we see in menopause can contribute to the processes known to be involved in the formation of eye floaters:

Oxidative stress: Oestrogens have antioxidant properties as they can bind to oestrogen receptors and increase the production of antioxidant enzymes via intracellular signalling pathways. Progesterone can act similarly, both being able to induce antioxidant enzyme production and having antioxidant properties itself. Oestrogen, progesterone, and their respective receptors have been identified in various tissues of the eye in animals and humans, including the vitreous in the case of oestrogen. This means that the reduction of these hormones seen in perimenopause may reduce the antioxidative capacity of tissues in the eye and make the eyes more susceptible to damage from oxidative stress. In the case of the vitreous, this can promote protein crosslinking and glycation events, and subsequent destabilisation of the gel structure resulting in floater formation.

Inflammation: The role which oestrogen and progesterone have on inflammation in the body is very complex and can depend on factors such as concentration and the microenvironment of the specific target organ. While specific research into how these hormones modulate inflammation in the vitreous is limited, it is known that both oestrogen and progesterone have anti-inflammatory effects in the body. These effects are enacted by binding to their respective receptors to initiate intracellular signalling cascades and produce inflammatory modulators. 

Particularly in the eye, there is research to suggest that progesterone plays an anti-inflammatory role in retinal disease and that oestrogens can play a protective role against age-related macular degradation (AMD). In the vitreous, the reduction of these hormones would therefore reduce the anti-inflammatory effects they can exert, allowing inflammation to promote the thinning of the vitreous gel and the formation of floaters.

Collagen Production: Collagen and hyaluronic acid are two of the key structural elements of the vitreous gel. Oestrogen contributes to the production of collagen as it activates the enzyme collagenase, which breaks the peptide bonds in collagen molecules and is key in collagen turnover. Also, progesterone has been shown in rats to help maintain collagen by balancing its production and degradation. The loss of these hormones after menopause may affect ocular collagen metabolism, causing constriction and liquefaction of the vitreous, and floaters to form.

A particular condition which can occur as a result of all these processes is posterior vitreous detachment (PVD). Vitreous degeneration and liquefaction can, in many cases, cause the vitreous to contract and lead to PVD, where the vitreous disconnects from the retina at the back of your eye. This can cause significant floaters, as well as flashes of light in your sight and blurred vision. A case study of 138 individuals with PVD documented an association between menopause and PVD, and it has been suggested that the higher oestrogen levels seen in premenopausal women may be protective against PVD. Studies have also shown that oestrogen has an effect on hyaluronic acid production in the skin, and is believed to also affect the posterior vitreous membrane which may contribute to the disruption of the vitreous structure and predisposition to PVD in postmenopausal women. 

Beyond eye floaters, the changes that occur during perimenopause and menopause can contribute to a number of other eye conditions.

Dry eye syndrome is a common symptom of menopause which causes itchiness and soreness due to insufficient tear production or quality, increasing the friction between the eyelid and the cornea. The eye’s outer surface is covered by a tear film made up of an outer lipid layer, an aqueous layer, and an inner mucin layer. The function of the meibomian and lacrimal glands (tear ducts) are responsible for the lipid and aqueous layers of the tear film, respectively. Studies suggest that changes and inflammation in lacrimal glands can cause dry eyes, while the loss of oestrogen can also upregulate degradative enzymes towards secretory glands, reducing the release of tears.

An interesting paradox that arises from dry eye syndrome is the occurrence of watery eyes. In response to dry eyes, the lacrimal glands produce more tears in an attempt to compensate. This, however, does not resolve the initial dryness as the tears produced are poor quality and evaporate quickly. Androgens are another type of hormone that also see their levels reduce during menopause. These hormones, such as testosterone, contribute to growth and reproduction in men and women. While predominantly considered to be male hormones, the female body also produces small amounts of androgens. Their decline affects the meibomian glands’ function, reducing the lipid layer of the tear film. This increases tear evaporation and contributes to the cycle of dryness and compensatory tearing.

Intraocular pressure, a build-up of pressure in the eye, can also be common in menopause and has been linked with the loss of progesterone and oestrogen. Both hormones have dilatory effects which help to decrease arterial pressure and promote humour outflow in the eye. Without sufficient levels of either hormone ocular tension can increase. This can also lead to glaucoma and studies have suggested that menopause is indeed a sex-specific risk factor for the disease.

Previous epidemiological studies have highlighted female sex as a risk factor for cataracts, in which postmenopausal women exhibited a higher prevalence of cataracts than men of similar age . Cataracts are caused by the clumping of proteins in the lens resulting in clouded vision. Oxidative stress and inflammation are key risk factors which result in cataract formation. Oestrogen has been shown to exert a protective effect against the apoptosis (cell death) of lens epithelial cells in rat models. This suggests the anti-inflammatory and anti-oxidative properties of oestrogen and progesterone may function to protect against the development of cataracts and as a result leave postmenopausal women more likely to develop the condition.

As we age it's more important than ever to stay on top of our eye health and for women going through menopause it’s something you should pay particular attention to.

It’s important to have eye tests at least once every two years and more regularly if you have a personal or family history of eye problems. If you are noticing changes in your vision, then always consult your doctor/optician sooner rather than later.

Many women seek out hormone replacement therapy (HRT) as a way to alleviate their menopause symptoms. This most commonly involves using oestrogen to replace the body’s own levels but there are different types and doses of HRT. While HRT is a safe and often effective form of treatment for menopause symptoms, there is a lack of consensus among researchers about whether HRT is beneficial for eye health or can indeed actually put individuals more at risk of developing certain conditions . This is particularly debated in the case of dry eye symptoms where a cross-sectional comparison study of 360 postmenopausal women found that long-term HRT increases the risk and severity of dry eye symptoms, contrary to previous assumptions. If HRT is something you are considering to help with your menopause symptoms, be sure to discuss the potential risks with your doctor or GP.

So aside from seeking medical help, what else can you do to protect your eyes through perimenopause and menopause?

A few simple lifestyle changes and additions to your eyecare routine can make a big difference to your eye health. Here are 5 tips to get you started:

Getting enough rest is key to keeping your eyes healthy. Keep a regular schedule, getting 7-9 hours of quality sleep each night. Avoid having caffeine and using electronic devices close to bedtime.

Tiredness can cause dryness, redness, and blurry vision as without sufficient sleep your eyes don’t have enough time to rest and recover. Sleep disorders have a significant association with the incidence and severity of dry eye symptoms in particular.

Staying hydrated is crucial to overall health, and for your eyes, it helps them to reduce dryness and maintain eye moisture. Make sure you are drinking at least 8-10 glasses of water a day.

You can also add eye sprays, drops, or wipes to your eyecare routine to help boost the moisture content of your eyes and prevent discomfort. For example, liposome-containing eye sprays can help protect your eyes and stabilise the tear film as the liposomes spread into the tear film and combine with the lipids secreted by the meibomian glands. Consult your pharmacist to see what options are available. 

Foods rich in omega-3 and -6 fatty acids such as oily fish (salmon, trout, anchovies), nuts, seeds (chia and flaxseed), and leafy greens (spinach, lettuce) can all help to keep your eye’s oil levels balanced, sustaining eye moisture, and preventing poor quality tear production.

Micronutrient intake can also help prevent oxidative stress. You can Increase the amount of antioxidants in your diet by having more types of fruit and veg and herbs and spices or using supplements such as Theia Bio’s Clearer ^TM which contains potent antioxidants from ingredients such as lutein, zeaxanthin, and grape seed extracts. Adding these to your diet can help protect your eyes from issues caused by oxidative damage, such as eye floaters.

Regular exercise is hugely important for your overall health, and it’s recommended you aim for at least 150 minutes of moderate exercise per week. Exercise is a great way to relieve stress to boost your mood, and also promote blood flow which can help lower intraocular pressure. It can also help to boost the body’s anti-oxidative and anti-inflammatory responses, as well as regulate blood sugar levels, providing great overall protection to your eye health. 

Smoking has negative effects on many aspects of your health and can worsen menopausal symptoms. The risk of developing eye conditions such as cataracts, glaucoma, and dry eye syndrome is increased by smoking. Consulting your doctor on steps you can take to become smoke free can be a great benefit to maintaining healthy eyes. 

In addition to menstruation, the female sex hormones play an important role in many processes within the body, such as collagen production or regulation of anti-inflammatory and anti-oxidative responses. The reduction in the levels of oestrogen and progesterone in particular, means that your eye health can be considerably affected during perimenopause and menopause, and symptoms such as eye floaters, dry eyes, and blurred vision are all common.

Changes to your vision, and any other menopause symptoms for that matter, are sometimes unavoidable, so always consult a healthcare professional if you are concerned about any symptoms you may be experiencing.

It’s extremely important for women to pay particular attention to the health of their eyes as they get older. Adding micronutrients to your diet; additions to your eyecare routine; prioritising sleep and exercise; and smoking less are all small changes you can make to your daily life to help manage your menopause symptoms and protect your eyes.