Hormone Replacement Therapy May Protect Your Vision During Menopause and Reduce Glaucoma Risk
Find out when research shows is the ideal time to start to protect your sight
Key Takeaways
- Research suggests HRT may lower glaucoma risk, especially when started early in menopause.
- Estrogen may help support eye health through several protective mechanisms.
- Experts say HRT decisions should be personalized and discussed with your doctor.
Your doctor prescribed you hormone replacement therapy (HRT)—also known as menopausal hormone therapy (MHT)—to help with bothersome menopause symptoms like hot flashes and irritability, but what if we told you it could also protect your vision at the same time? Exciting new research suggests that hormone therapy may reduce your risk of vision-clouding glaucoma. We asked the experts to break down everything you need to know, including the best time to start HRT to maximize the eye-health benefits.
How HRT supports women during menopause
“Hormone replacement therapy is a treatment that replaces hormones the body produces in lower quantities during and after menopause,” explains Maral Malekzadeh, DO, board-certified gynecologist and co-owner of The Well Westlake.. “As women age, the ovaries gradually produce less estrogen and progesterone, two hormones that play important roles in reproductive health, bone strength, cardiovascular function, mood, sleep and overall wellbeing. HRT works by supplementing these declining hormones to help relieve symptoms and support long-term health.”
The link between menopause and eye health
Sure, we all know about hot flashes, brain fog and insomnia. But menopause can have a very real effect on our vision, too. Dagny Zhu, MD, a Harvard-trained, board-certified eye specialist in cornea, cataract and refractive surgery, explains that estrogen likely plays a role in eye health due to the many estrogen receptors found throughout the tissues of the eye.
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“How much estrogen protects against some of those age-related diseases is unclear, but at least the research shows that there may be a protective effect, and it makes sense from a scientific point of view,” adds Dr. Zhu.
New research on hormone replacement therapy and vision
In a recent Journal of Menopausal Medicine study, researchers analyzed data from more than 18,000 postmenopausal women, about half of whom received hormone replacement therapy and half of whom didn’t, and tracked whether they developed glaucoma and other eye disorders. They found that women using HRT had an eight percent lower glaucoma risk than women who didn’t use HRT. Additionally, women who began HRT within one year of menopause had an even lower glaucoma risk. Lastly, women who used HRT for at least one year had a lower risk of glaucoma and retinal disorders.
“Estrogen seems to increase blood flow to some of these tissues—it has anti-inflammatory effects—and specifically to glaucoma, there’s studies showing that it increases the aqueous outflow,” Dr. Zhu explains. “What that means is naturally our eyes are producing a lot of fluid, and if that fluid builds up, the pressure goes up. That can cause damage to the optic nerve, which is what glaucoma is. For example, if you have a clogged sink and that drain is not flowing properly, the pressure builds up in the sink. But if you have something like estrogen that can potentially open up that clog and allow greater flow, you can lower eye pressure and potentially reduce your risk of glaucoma.”
If you’re worried about glaucoma, could HRT be right for you?
So if you’re someone with a higher risk of glaucoma, does this study mean hormone replacement therapy is guaranteed to prevent vision? Not exactly. “There’s no randomized control trial where we can definitively say increased estrogen protects against glaucoma,” clarifies Dr. Zhu.
“But at least from these types of studies we can say there’s an association or correlation where it seems like the group that got hormone replacement therapy has a lower risk of glaucoma,” Dr. Zhu notes. She adds what makes this study particularly interesting is that women ages 40 to 45 showed the lowest risk of developing glaucoma, which may suggest that using estrogen through HRT for glaucoma risk may be most protective in early menopause.
“I think that is the main takeaway of this study, that if you are someone who is in that early menopausal age range, maybe it’s something you want to talk to your ophthalmologist about, especially if you have a history of glaucoma,” adds Dr. Zhu.
But if you’re over 45, does that mean you couldn’t benefit from hormone replacement therapy for menopause-related vision issues? Meenal Agarwal, OD, a board-certified optometrist and leading authority on the eye-brain connection at Dr. Meenal Agarwal & Associates, says not necessarily.
“The theory is that the tissues respond more to estrogen if it’s reintroduced soon after natural estrogen levels decline, before structural changes occur,” Dr. Agarwal explains. “But we can’t say women who miss that window won’t have any benefits; it’s just the strongest association was found with earlier intervention.”
“Missing the early window is not a reason to rule out HRT entirely,” adds Dr. Malekzadeh. “Every woman’s situation is unique, and a later start can still be worthwhile depending on her overall health, symptoms and individual risk factors.”
The bottom line on hormone replacement therapy and vision
If this new research has made you curious about how HRT may not only support your menopause symptoms but also your eye health, the first step is speaking to your doctor.
“Start by scheduling a conversation with a healthcare provider who is knowledgeable about menopause and hormone therapy, such as a gynecologist, internist or menopause specialist,” says Dr. Malekzadeh. “It is also worth visiting an eye care professional for a baseline glaucoma screening if you have not done so recently, particularly if you has a family history of glaucoma or other risk factors.”
Of course, keeping up with regular eye exams, maintaining a healthy weight and getting regular exercise to help lower your blood pressure are all important steps to help prevent vision loss caused by glaucoma. As research continues to reveal new connections between menopause and overall health, what’s clear is you have more options than ever to protect your body and your vision during this transition.
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