Menopausal Status, Hormone Replacement Therapy, and Epiphora Symptoms Among Middle-Aged and Older US Women: An NHANES Study

PURPOSE: Primary acquired nasolacrimal duct obstruction is predominantly observed in postmenopausal women, indicating a potential hormonal etiology in the maintenance of the lacrimal drainage system. This study aims to explore the association between menopausal status, hormone replacement therapy (HRT), and epiphora symptoms in a nationally representative sample of US women. METHODS: A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey 2005-2008. Women aged ≥40 years with complete reproductive health and ocular symptom data were identified as the study sample. Menopausal status was categorized as premenopausal, perimenopausal, and postmenopausal. HRT use was classified as never, past, and current users. The primary outcome was self-reported epiphora symptoms. Weighted logistic regression models were employed with adjustments for age, race, body mass index, poverty income ratio, smoking, diabetes, and hypertension. RESULTS: A total of 3,842 women were included in the analysis. The weighted prevalence of epiphora was significantly higher in postmenopausal women compared with pre-menopausal women (p < 0.001). In the fully adjusted models, postmenopausal status was independently associated with higher odds of epiphora (odds ratio 1.62, 95% confidence interval 1.24-2.11, p=0.002). Among postmenopausal women, current HRT use was significantly associated with reduced odds of epiphora compared with never users (odds ratio 0.68, 95% confidence interval 0.49-0.94, p=0.021), whereas past use showed no significant protection. Furthermore, subgroup analysis indicated the protective effect of HRT was most pronounced in the 40-60 age group. CONCLUSIONS: Menopause is an independent risk factor for epiphora, while current HRT use appears to offer a protective effect against symptom development. These findings provide supporting evidence for the hypothesis that estrogen deficiency contributes to lacrimal drainage dysfunction, possibly via mucosal atrophy and fibrosis. Endocrine status should also be considered in the comprehensive management of epiphora in older women.