Could there be a possible connection between menopause and tinnitus? Some have wondered if tinnitus may be an uncommon symptom of menopause, but first, let's discuss what is menopause.
Menopause is defined by the natural decline in a woman's reproductive hormones, which typically occurs in a woman's forties to fifties. It is not a disease or disorder, but rather a natural part of ageing.
It's also possible to go through menopause earlier in life due to having certain medical conditions that require surgical removal of both ovaries.
During reproductive years, the ovaries make estrogen and progesterone which control menstruation (period) and ovulation (release of egg). The body begins to produce less and less of these hormones during perimenopause.
Menopause typically begins during ages 45 to 55, and it includes three stages:
- Perimenopause: This stage begins when the levels of hormones begin to decline. Symptoms of this can include irregular periods and hot flashes.
- Menopause: The body stops producing reproductive hormones and there is the absence of a menstrual period for 12 consecutive months.
- Post-menopause: This stage begins after a woman has not had a period for 12 consecutive months. She will remain in post-menopause for the rest of her life and will no longer be able to naturally get pregnant.
There can be symptoms of declining or low hormones in all three stages. Generally symptoms of menopause lessen or essentially go away in the post-menopausal stage. Symptoms of perimenopause and menopause can include:
- Irregular periods
- Hot flashes
- Bladder incontinence (loss of good bladder control)
- Difficulty sleeping, insomnia
- Vaginal dryness, painful intercourse
- Changes to weight, body composition, body shape
- Changes to mood and memory, cognition
- Changes to bone and heart
- Increased risk for fractures due to osteoporosis
Similarly, having tinnitus can lead to anxiety, depression, difficulty sleeping or even insomnia, fatigue, and mood changes. Specifically, symptoms of anxiety, depression, and sleep disturbance are particularly common to both tinnitus and menopause, and can lead to a reduced quality of life.
What Is The Link Between Tinnitus And Menopause?
Interestingly, it's not that the decrease in hormones is causing tinnitus but rather the pre-menopausal levels of the hormones were protective to the ear and hearing mechanism. When hormones lose their protective effect, hearing loss can occur and tinnitus can follow.
Hearing loss and tinnitus commonly co-occur and it can be helpful to understand how hearing loss leads to tinnitus. Tinnitus and hearing loss: is there a connection?
The theory of how hearing loss and tinnitus are related follows that hearing loss essentially creates a degree of auditory deprivation, which the brain interprets as a warning sign, and in response it increases its sensitivity to sound (referred to as central gain control in tinnitus and hyperacusis) and makes up sound which is referred to as tinnitus. So the connection between menopause and tinnitus implicates hearing loss as the link between the two.
There may be other signs of auditory deprivation due to hearing loss such as reduced sound tolerance which sometimes progresses to hyperacusis. What is hyperacusis and is it linked to tinnitus?
Tinnitus And Hormones
Given that menopause is marked by the decrease in women's reproductive hormones, it's natural to ask what is the connection between hormones and the auditory system:
Estrogen: Both types of estrogen receptors have been identified in the human cochlea.
Progesterone: Receptors have not been found in the auditory system but the hormone may interact with other steroid receptors and steroid binding sites which are present in the auditory system.
The two hormones may balance each other as estrogen generally has an excitatory effect on the central nervous system whereas progesterone has generally an inhibitory action.
The interaction between hormones and hearing is complex and some research is confounding: studies suggests that estrogen may protect hearing such that women who go through menopause at a later age are less likely to experience hearing loss and tinnitus, which makes sense in terms of estrogen being protective of the ear. However, other studies found that women who went through menopause at a later age and used hormone replacement therapy (HRT) were more likely to have hearing loss.
It's possible that women who use HRT reported more menopausal symptoms and that's why they elected to use HRT, and perhaps there are health differences underlying more severe menopausal symptoms that also predispose the same group of women to hearing loss. There could also be biological differences between women who go through menopause later versus earlier.
Given the complex relationship between hormones and the auditory system, you may wonder what does tinnitus have to do with hormones?
It seems as though tinnitus may be triggered by changing levels of hormones, and the tinnitus may occur in conjunction with other symptoms of menopause such as hot flashes and mood changes. Hormone fluctuations may correlate with tinnitus and other symptoms of pregnancy, premenstrual syndrome (PMS), and perimenopause.
Can Hormones Cause Tinnitus?
When it comes to hormones and tinnitus, generally it's lack thereof that causes tinnitus as opposed to hormone replacement causing tinnitus. When it comes to hormone replacement therapy (HRT), the results are conflicting, and additional research is warranted to make clear statements about the effect of HRT on hearing preservation.
Some research suggests that hormone replacement therapy (HRT) decreases the risk of tinnitus in menopausal women including for both estrogen only and combined estrogen and progesterone HRT when compared to women who do not use HRT.
On the contrary, there have been some studies that report that menopausal and post-menopausal use of HRT increases the prevalence of hearing loss with longer-term use and for women who go through natural menopause after age 50. It's possible that other factors underlie these trends and additional research is needed to make a definitive conclusion.
Monitor Your Hearing When Starting Hormone Therapy
It's a good idea to get a baseline hearing test prior to starting HRT so that if change occurs, there is a baseline against which to compare your current hearing level. It can also be reassuring to see hearing stay stable over the years.
It's also important to consider the risks and benefits of HRT, and whether a different hormone can be used or if treatment should be stopped altogether. It's important to discuss these considerations with the prescribing physician to make an informed decision about what is the best outcome for overall health and safety.
Menopause And Hearing Loss
Age-related hearing loss can occur over the lifespan and is common in the later years of the lifespan. How can you know if your hearing loss is age-related versus hearing loss due to menopause?
It may be impossible to parse out whether the change in hearing is due to menopause or is happenstance that it occurred during menopause. In fact, there can be many causes of sensorineural hearing loss and it can be the sum total of many variables such as noise exposure, genetics, use of certain medications, and others.
The good news is that if permanent hearing loss is identified, hearing aids can help both hearing loss and tinnitus.
What To Know About Plugged Ears And Menopause?
Plugged ears, ear fullness, or aural fullness may actually be a sign of hearing loss no matter if you are in menopause or not. Since hearing loss tends to occur during mid-life, it could be a sign that the hearing has started to change.
Plugged ears could also be due to conditions such as ear wax or a foreign body in the ear canal, fluid or infected fluid in the middle ear, abnormal function of the ear drum, or hearing loss that is unrelated to menopause. The best way to know why ears feel plugged is to seek evaluation by an otolaryngologist, audiologist, or general practitioner.
If there is indeed ear wax plugging the ears, it should be removed as there can be a connection between tinnitus and ear wax. Of note, during menopause, hormone changes can dry out the skin including in the ear canal and make you more prone to building up ear wax.
Perimenopause And Tinnitus
Perimenopause is when the hormone levels are decreasing and symptoms may start to occur. It's possible that tinnitus could occur at any stage of menopause, including perimenopause.
When estrogen and progesterone gradually decrease, you may hit a threshold at which they are no longer protective of the ear and hearing. After that point, you may become more susceptible to hearing loss and also notice tinnitus.
In fact, there may be an association between menstrual cycle irregularity and tinnitus including for pre-menopausal women. This study found that as the menstrual cycle irregularity duration increased, so did the odds ratio of experiencing tinnitus.
The study did not comment on confounding medical diagnoses such as thyroid disease and polycystic ovary syndrome (PCOS), two conditions that commonly affect women in this age group and that can also cause tinnitus. Extended high-frequency (>8kHz) hearing loss has been found to occur in women with PCOS and can set the stage for tinnitus.
Both hyperthyroidism (over-active thyroid) and hypothyroidism (under-active thyroid) have been associated with tinnitus. For hyperthyroidism, tinnitus is most likely the result of increased heart rate.
The best way to know if your tinnitus may be associated with PCOS of thyroid dysfunction is to consult a physician who can review your case history and symptoms and order testing, if warranted.
There is also treatment for tinnitus that can be helpful in navigating perimenopause and related symptoms. Where to find professional tinnitus help?
What Can Women Do To Protect Their Hearing?
Protecting your hearing is one of the most important things you can do to prevent permanent hearing loss. It's important to choose the hearing protection that is right for you if you may be exposed to harmfully loud noise (i.e. >85dB, roughly the intensity level of loud traffic or a garbage disposal).
We consider sound exposure as a dose, in that 85dB should be tolerable for up to eight hours before damaging hearing. For every 3dB increase in decibel level, the safe exposure time is halved.
So 88dB would be safe for four hours and 91dB would be safe for two hours and so forth.
Other places where you may be exposed to harmfully loud noise include concerts and other live music events such as at a restaurant, sporting events, using power tools, and taking the subway, for example.
Finally, maintaining good overall health by eating well, getting enough exercise, staying on top of preventative health such as vaccines, and managing health conditions can help prevent hearing loss. Establish and maintain care with a gynaecologist who can identify if you are in perimenopause, menopause, or post-menopause, and advise you regarding the best way to care for your health as a woman.
How Can Oto Help?
Check out Oto's tinnitus solution, which also includes comprehensive resources for overall wellness including sessions for improving sleep, meditation, and physical therapy.
- Bedtime tools including sleep sounds, sleep stories, mindfulness for sleep, sleep preparation, and dark mode to help you get to sleep faster and reduce sleep-time anxiety
- CBT techniques such as anchoring, breathing, visualisation, meditation, and safe spaces exercises to help manage stress and anxiety
- Physical therapy sessions that target the neck, shoulders, tongue, jaw, arms, and full body to release tension and promote relaxation
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