Can menopause cause tinnitus? Ringing in the ears, hearing and estrogen
Menopause may play a part in tinnitus, but the evidence is limited and no study has shown that it directly causes ringing in the ears. Most tinnitus in midlife is linked to hearing loss, noise or other ear problems, so a hearing check is a sensible first step.
Call emergency services if tinnitus or dizziness comes on suddenly with face drooping, one-sided weakness or numbness, slurred speech, double vision or a severe headache. Get help the same day for sudden hearing loss in one or both ears, as treatment works best when started early.5 See a doctor soon for tinnitus in one ear only, tinnitus that pulses with your heartbeat, uneven hearing loss, or tinnitus with dizziness or vertigo.2
What tinnitus is
Tinnitus is hearing a sound when there is no outside source. It may sound like ringing, buzzing, humming or whistling, in one ear, both ears or the head.1
It is common. About 10% to 15% of adults in the US have it.1,2 It often comes with some hearing loss.1
For many people it is mild and settles on its own within about six months. For others it lasts longer and affects sleep, mood or concentration.1
Can menopause cause tinnitus? What the evidence shows
There is a plausible link, but it is not proven. Parts of the ear and the brain's hearing pathways have estrogen receptors.3,4 Hearing in women after menopause has been linked to their estradiol levels.4
Most of this research looks at hearing, not tinnitus. A 2019 review of estrogen and hearing did not cover tinnitus at all.4 Much of the evidence for how estrogen protects the inner ear comes from animal studies.4
The largest study followed 80,972 US nurses from 1991 to 2013. Reaching menopause was not linked to hearing loss overall.3 Natural menopause at 50 or older carried about a 10% higher relative risk than earlier menopause.3
The same study found that longer use of oral hormone therapy was linked to more hearing loss, not less. In a group of 47,360 postmenopausal women, ten or more years of use carried about a 21% higher relative risk than never using it.3 Hearing loss was self-reported, and most women were white, so the results may not apply to everyone.3 Smaller studies of hormone therapy and hearing have given conflicting results.4
In short, there are no good trials showing that menopause causes tinnitus, or that hormone therapy treats it. Tinnitus can disturb sleep and mood,1 which are already common in menopause. See sleep problems and anxiety and mood changes.
Hearing changes and other causes
Gradual hearing loss with age is a very common reason for tinnitus in midlife. Other causes a doctor will look for include:1
- Earwax or fluid behind the eardrum, which are often easy to treat.
- Noise damage, from work, music or loud hobbies.
- Rarely, a tumor on the hearing nerve, or a heart or blood vessel problem.
Some medicines can affect the ears. If tinnitus started after a new medicine, ask your doctor or pharmacist. Do not stop a prescribed medicine on your own.
Getting it checked and treated
A doctor will ask about your symptoms and look in your ears.1 A hearing test is advised, ideally within four weeks of first seeing a doctor, if tinnitus is in one ear, has lasted six months or more, or comes with hearing problems.2
Scans are not needed for most people. They are considered when tinnitus is in one ear, pulses like a heartbeat, comes with uneven hearing loss, or with nerve symptoms.2
For tinnitus that is bothersome and long-lasting, US ear, nose and throat guidelines recommend:1,2
- Hearing aids if you have hearing loss. They can make tinnitus less noticeable.
- Cognitive behavioral therapy (CBT), which helps you cope with and react less to the sound.
- Sound therapy, using background sound from a device, app or radio.
The same guidelines advise against routine use of antidepressants, anticonvulsants or anti-anxiety medicines for tinnitus itself. Ginkgo, melatonin and zinc have not shown benefit.2
Sudden hearing loss is different and needs prompt care. Guidelines say steroid treatment may be offered within two weeks of the hearing loss starting.5 Do not wait to see if it gets better.
What helps: options rated
| Option | Evidence | What the research shows |
|---|---|---|
| Cognitive behavioral therapy (CBT) | Recommended in US ear, nose and throat guidelines for bothersome tinnitus lasting six months or more. It reduces distress rather than the sound itself.2,1 | |
| Hearing aids (if you have hearing loss) | Guidelines advise a hearing aid assessment for anyone with tinnitus and hearing difficulty, as better hearing can make tinnitus less noticeable.1,2 | |
| Sound therapy | An option in guidelines for bothersome, long-lasting tinnitus, though the evidence is weaker than for CBT.2 | |
| Treating an ear cause such as earwax | Removing earwax or treating fluid can ease tinnitus when these are the cause, which is why an ear exam comes first.1 | |
| Hormone therapy (HRT) | Not a treatment for tinnitus. Studies of hormone therapy and hearing conflict, and one large study linked longer oral use to more hearing loss.3,4 | |
| Ginkgo, melatonin or zinc supplements | Studied for tinnitus, but trials did not show benefit, so guidelines do not recommend them.1,2 |
Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.
Related
Sources
- Clinical practice guideline: tinnitus, plain-language summary for patients, American Academy of Otolaryngology-Head and Neck Surgery Foundation (2014)
- AAO-HNSF releases guideline on managing tinnitus, American Family Physician (2015)
- Menopause and postmenopausal hormone therapy and risk of hearing loss, Curhan et al., Menopause (2017)
- Auditory function and dysfunction: estrogen makes a difference, Delhez et al., Cellular and Molecular Life Sciences (2019)
- Clinical practice guideline: sudden hearing loss (update), American Academy of Otolaryngology-Head and Neck Surgery Foundation, PubMed (2019)