Better Hearing Daily

Tinnitus and Menopause: Why the Ringing Starts and What Actually Helps

Portrait of Emily Carter, wellness content writer at Better Hearing Daily By Emily Carter
14-minute read
Woman in her early fifties sitting on a garden bench at golden hour with her eyes closed, listening quietly — many women first notice tinnitus and menopause changes around the same time

For many women, the ringing shows up in the same years as hot flashes and broken sleep. That timing is not a coincidence researchers ignore, but it is also not the whole story.

Quick answer

Tinnitus and menopause are linked for many women. Research shows hearing shifts with estrogen levels, and ringing often appears or gets louder during perimenopause. For some women it eases once hormones settle, but nobody can promise that. Ringing in one ear, a sound that pulses with your heartbeat, or sudden hearing loss always needs a doctor.

For education, not medical advice. Emily Carter is a wellness content writer, not a physician, gynecologist, or audiologist. Nothing here is a reason to start, stop, or change hormone therapy or any other medicine. If your hearing changes suddenly, please get medical care the same day. This page links to our review of Audifort, which contains affiliate links. If you buy through them, we may earn a small commission at no extra cost to you.

You are lying in bed, finally cool after a night sweat, and the room is quiet. Except it is not quiet. There is a thin, high hum that was not there a year ago. Maybe it comes and goes. Maybe it is louder on the nights you slept worst. And because it started in the same season as irregular periods and hot flashes, the question is natural: is this my hormones?

Sometimes the answer is partly yes. But the menopause websites that rank for this topic tend to stop at "estrogen affects the ear, try HRT," and skip the parts that matter most: what the studies actually found (including the ones that point the other way), which kinds of ringing should never be blamed on hormones, and what you can do tonight. This guide covers tinnitus and menopause from those angles. If you want the broader picture of what tinnitus is and its many causes, start with our complete guide to tinnitus causes and natural approaches; this page focuses only on the midlife, hormone-related side.

Can menopause cause tinnitus?

Menopause can play a part, but it is rarely the only cause. Studies show women's hearing shifts with estrogen levels and declines faster after menopause, and lower estradiol has been linked with poorer hearing. Researchers have not proven that falling hormones directly cause tinnitus, so other common causes still need to be ruled out.

The best summary of the hormone-and-hearing research is a 2023 systematic review from the University of Manchester. Pulling together studies published between 1999 and 2022, the authors found that hearing in premenopausal women fluctuates across the menstrual cycle, tends to be better when estradiol is at its peak, and declines rapidly at the onset of menopause, often more sharply than in men of the same age.[1] They also noted that the exact effects of estradiol and progesterone on the brain's hearing pathways are still unclear.

Other studies fill in pieces of the picture. In 1,830 postmenopausal women in South Korea, those with hearing loss had lower blood levels of estradiol, and the link held after accounting for age.[2] A nationwide Korean survey of 4,633 premenopausal women found that irregular menstrual cycles were linked with higher odds of tinnitus, and the longer the irregularity lasted, the stronger the link.[3] Irregular cycles are, of course, the hallmark of perimenopause.

How might hormones reach the ear? Dr. Hamid Djalilian, an otolaryngologist at UCI Health, has explained that shifting estrogen may affect blood flow to the inner ear, the hair cells that turn sound into nerve signals, and the brain networks that normally filter out background noise.[4] That is an expert's working explanation, not a settled mechanism, and it is worth reading that way.

What the study found Who was studied How solid it is
Hearing changes across the cycle and drops at the start of menopause Systematic review of studies from 1999–2022[1] Moderate
Lower estradiol linked with hearing loss 1,830 postmenopausal women, Korea[2] Limited — one study
Irregular periods linked with more tinnitus 4,633 premenopausal women, Korea[3] Limited — one survey
Women on HRT were diagnosed with tinnitus less often 55,680 women aged 45–79, Taiwan[5] Limited — medical records only
Longer use of oral hormone therapy linked with more hearing loss 80,972 U.S. nurses followed for 22 years[6] Moderate — large, long study
All of these are observational studies. They show links, not cause and effect, and none of them was a trial that randomly assigned women to hormones.

One more detail that no menopause blog we reviewed mentions: the pattern of the ringing may matter. In a 2025 analysis of 2,485 peri- and postmenopausal U.S. women from a national health survey, women whose tinnitus came and went were more likely to report severe headaches or migraine symptoms than women without tinnitus.[7] If your ringing and your headaches seem to travel together, that is useful information to bring to your doctor.

It also helps to remember what else is changing in your late forties and fifties. Age-related hearing loss often begins quietly in this decade, many women start medicines for blood pressure or other conditions, and sleep gets harder. Any of these can add to the ringing, which is why our guide to age-related hearing loss is worth a read alongside this one.

Can menopause tinnitus go away?

It can, but nobody can promise it will. The NIDCD says tinnitus may improve or even go away over time, though in some people it worsens. Some specialists observe that menopause-related ringing often eases after hormones settle. When it lingers, treatment can usually make it much less noticeable, even if the sound never fully stops.

The National Institute on Deafness and Other Communication Disorders (NIDCD) is clear on two points: there is no cure for tinnitus, and it may improve or even disappear with time.[8] For menopause specifically, the UCI Health specialist quoted above says ringing may lessen after menopause as hormone levels stabilize, and that with treatment the sound can usually be stabilized and pushed into the background.[4]

What is missing is a long-term study that followed women with menopause-related tinnitus to see how many recovered and how fast. We could not find one, so be wary of any website that gives you a precise timeline. What we do know is how long the hormonal transition itself can last. According to the U.S. Office on Women's Health, perimenopause can run between two and eight years, and the average age of menopause in the United States is 52.[9] If hormones are part of your ringing, a fluctuating pattern over several years would not be unusual.

Illustrative scenario (not a real person): a 49-year-old notices a soft hiss in both ears that is worse in the week before a late period and on nights she wakes up hot. Months later, after her cycles have stopped, the hiss is still there but she only notices it in bed. Her story is not proof of anything, but it shows the kind of pattern worth writing down: when the sound is louder, what else was happening, and whether it ever fully stops.

Even when the sound stays, the distress usually does not have to. The brain is good at learning to ignore a steady, harmless signal, the way you stop hearing a refrigerator. Sound therapy, hearing aids, and cognitive behavioral therapy all work by helping that process along, and they are covered in more detail in our tinnitus guide's section on what actually helps.

Does HRT help tinnitus during menopause?

The evidence is mixed, so HRT is not a tinnitus treatment. A large Taiwanese records study found HRT users were less likely to be diagnosed with tinnitus, while a large U.S. study linked longer use of oral hormone therapy with more self-reported hearing loss. Whether HRT suits you is a decision to make with your doctor.

Search results for "tinnitus menopause HRT" often present hormone therapy as the answer. The research is less tidy than that, and you deserve to see both sides.

The study that points toward a benefit

Researchers in Taiwan used national health insurance records from 2000 to 2010 to compare 13,920 menopausal women who used HRT with 41,760 similar women who did not. Over the study period, 0.43% of HRT users were diagnosed with tinnitus, compared with 0.59% of non-users. After adjusting for age and other factors, HRT users had roughly half the risk of a new tinnitus diagnosis.[5] The authors were careful to say they could only speculate that HRT might help prevent tinnitus. Insurance records also miss everyone who never reported their ringing to a doctor.

The study that points the other way

In the U.S., the Nurses' Health Study II followed 80,972 women for more than two decades. It did not look at tinnitus; it looked at self-reported hearing loss. Women who used oral hormone therapy (estrogen alone or estrogen plus a progestogen) after menopause had a higher risk of hearing loss, and the risk rose with longer use: about 15% higher for 5 to 9.9 years of use and about 21% higher for 10 or more years, compared with women who never used it.[6] The same study found that reaching natural menopause at 50 or older was linked with a slightly higher risk, too.

What this means for you

Neither study was a randomized trial, they measured different things, and they were done in very different populations. Put honestly: there is not enough evidence to start HRT for tinnitus, and not enough to stop HRT because of it. Hormone therapy has real benefits for many menopause symptoms and real risks. MedlinePlus, from the U.S. National Library of Medicine, lists possible risks including blood clots, heart attack, stroke, breast cancer, and gallbladder disease, notes that the level of risk depends on the type of therapy, how long it is used, and your own history, and advises talking through risks and benefits with your provider.[10]

Two practical takeaways. If you are already weighing HRT for hot flashes or sleep, it is reasonable to mention your tinnitus as one more symptom on the list. And if the ringing started or changed soon after you began, stopped, or changed the dose of any hormone, tell the doctor who prescribed it rather than adjusting it yourself.

Woman in her fifties talking with her doctor in a bright clinic room — part of a proper check-up for tinnitus during menopause
A check-up with simple tests such as blood pressure and a blood count can explain a pulsing or one-sided ringing that has nothing to do with estrogen.

Is perimenopause tinnitus in one ear or pulsing like a heartbeat normal?

Do not assume it is hormonal. Ringing in only one ear, or a whooshing sound that beats in time with your pulse, should be checked by a doctor. Most causes are treatable, such as high blood pressure, anemia from heavy periods, or a benign growth on a hearing nerve, but they need a proper exam, not guesswork.

Hormone-related ringing, when it happens, is usually felt in both ears and has the steady hiss, hum, or ring that most people picture. Two patterns are different enough that they deserve their own attention.

Ringing in one ear

Many things can cause one-sided tinnitus, including earwax or an ear infection, which the NIDCD lists among common causes.[8] Less often, ringing and hearing loss on one side come from a vestibular schwannoma (also called an acoustic neuroma), which the NIDCD describes as a benign, usually slow-growing tumor on the nerve that connects the ear to the brain.[11] It is uncommon, but it is exactly the kind of cause a hearing test and an exam are designed to catch, so one-sided ringing should not be filed under "probably menopause."

Ringing that pulses with your heartbeat

Pulsatile tinnitus is a rhythmic whoosh or thump that keeps time with your pulse. A review in the German medical journal Deutsches Ärzteblatt reported that fewer than 10% of people with tinnitus have this type, and that a specific cause can be found in about three-quarters of cases. The basic checks it lists include measuring blood pressure, testing for anemia, and ruling out an overactive thyroid.[12] The NHS advises asking for an urgent appointment if your tinnitus beats in time with your pulse.[13]

Here is the menopause connection most articles miss. Periods often get heavier as menopause approaches, and the NHS lists heavy periods as one of the most common causes of iron deficiency anemia. Its list of anemia symptoms includes tiredness, a noticeable pounding heartbeat, and, less commonly, tinnitus.[14] The same review notes that some blood pressure medicines, specifically ACE inhibitors and calcium channel blockers, can favor pulsatile tinnitus.[12] Never stop a blood pressure medicine on your own; ask your doctor instead.

What you notice What it may point to What to do
Soft ringing or hiss in both ears that rises and falls with your cycle, poor sleep, or hot flashes May fit a hormonal pattern, though hearing loss and medicines are still possible Keep a symptom diary; mention it at your next routine visit; get a hearing test
Ringing in one ear only, or one ear hears worse Earwax, infection, or less commonly a benign nerve growth Book a doctor visit and a hearing test soon
A whoosh or thump in time with your heartbeat Blood pressure, anemia, thyroid, blood vessel changes, or medicines Ask for an urgent appointment
Sudden hearing drop, with or without ringing Sudden sensorineural hearing loss Medical care the same day
A rough guide to help you describe your symptoms, not a way to diagnose yourself. Based on the NIDCD, NHS, and Hofmann et al., 2013.

How can you ease tinnitus during menopause?

Start with the steps that help most tinnitus: avoid total silence, protect your ears from loud noise, improve your sleep, and lower stress. Get a hearing test, because hearing aids help many people who have both hearing loss and tinnitus. Sound therapy and cognitive behavioral therapy are established options a professional can guide you through.

None of the steps below require you to know for sure whether hormones are behind your ringing. They help tinnitus in general, and several of them also help the sleep and stress problems that so often come with the menopause years.

Give your ears something gentle to listen to

The NHS advises against total silence and suggests soft music or other sounds to take the edge off the ringing.[13] A fan, a white-noise machine, or quiet rain sounds at low volume can make the tinnitus less noticeable without masking it completely. The NIDCD lists sound therapy among the main tinnitus treatments.[8]

Protect your nights

Problems sleeping are a common part of the menopause transition, according to the Office on Women's Health,[9] and the NHS recommends finding ways to improve sleep when you have tinnitus.[13] Ringing and poor sleep can feed each other, so a calmer bedtime is one of the more useful things you can try. A simple wind-down routine might look like this:

  • Set up a low sound before you get into bed, so you are not lying in silence waiting for the ringing.
  • Keep the bedroom cool and have a light layer you can throw off, since waking hot often means waking up to the ringing too.
  • Try slow breathing or gentle stretching for a few minutes. The NHS mentions deep breathing and yoga as ways to relax with tinnitus.[13]
  • Keep a notebook by the bed to jot down how loud the ringing was and what else happened that day. Over a few weeks, patterns tend to show.
  • If you wake at 3 a.m., turn the background sound up slightly rather than checking whether the ringing is "still there."
Woman in her early fifties cooling off by an open bedroom window at night with a quiet electric fan running beside her
A low, steady background sound at bedtime, even a quiet fan, is one of the simplest ways to make ringing less intrusive.

Get your hearing tested

Tinnitus very often travels with some degree of hearing loss, and the NIDCD calls hearing aids one of the main treatment options for people who have both.[8] A baseline hearing test in your late forties or fifties is useful anyway, since it gives you something to compare against later. Our list of the early warning signs of hearing loss can help you decide whether it is time.

Ask about counseling for the stress side

Cognitive behavioral therapy (CBT) does not switch the sound off. According to the NIDCD, it teaches people to recognize the negative thoughts that make tinnitus distressing and to change how they react to it.[8] For women juggling work, aging parents, and teenage children during menopause, that kind of support can make a real difference to how much the ringing takes over.

What should you avoid if you have tinnitus?

  • Loud noise without protection. Mowers, power tools, and concerts can add to the damage. See our guide to noise-induced hearing loss for safe listening levels, and our list of everyday habits that quietly damage hearing.
  • Total silence, which tends to make the ringing stand out more.[13]
  • Stopping or changing medicines on your own. The NHS notes that some medicines, including aspirin, some antibiotics, and anti-inflammatory painkillers, are linked with tinnitus.[13] If you suspect one, ask your doctor or pharmacist about alternatives.
  • "Cure in 2 minutes" promises. The NIDCD states that there are no medications specifically for treating tinnitus,[8] so be wary of anything sold as a cure.

Nutrition questions come up often in midlife too. If you are curious which nutrients have real research behind them for ear health, our guide to the best vitamins and nutrients for ear health goes through the evidence one by one. A blood test for iron is especially worth asking about if your periods have been heavy.

A question readers often ask

Where could a hearing supplement fit into your midlife routine?

Many women in this stage of life are already rethinking sleep, movement, and nutrition, and some ask whether an ear-support supplement belongs on that list. Audifort is a liquid dropper formula that, according to its manufacturer, combines plant extracts and nutrients aimed at ear health. Our full review looks at each ingredient, what a bottle costs, and how the 90-day money-back guarantee works. The research on ear supplements is still limited, and we explain what that means in plain words. A supplement can sit alongside your check-ups, never replace them.

Check our Audifort review before you buy → Our review page contains affiliate links. If you buy through them, Better Hearing Daily may earn a small commission at no extra cost to you. This does not change our editorial view.

When should you see a doctor about tinnitus in menopause?

Get medical care the same day for sudden hearing loss, with or without ringing, because the NIDCD calls it a medical emergency. Book a prompt appointment for ringing in one ear, a pulsing sound that matches your heartbeat, dizziness, or ringing that disturbs your sleep or mood. Bring a list of your medicines and menopause symptoms.

Get care the same day if:

  • Your hearing drops suddenly in one or both ears. The NIDCD says sudden deafness should be treated as a medical emergency, and ringing and dizziness can come with it.[15]
  • Ringing comes with sudden weakness, facial drooping, trouble speaking, or a severe headache unlike any before. Call 911.

Ask for a prompt appointment if:

  • The ringing is only in one ear, or one ear hears worse than the other
  • The sound pulses or whooshes in time with your heartbeat[13]
  • You feel dizzy or off-balance along with the ringing
  • You have heavy periods, tiredness, or a pounding heartbeat that could point to anemia

Book a routine visit if: the ringing is regular or constant, is getting worse, or is affecting your sleep or concentration. These are the NHS's own reasons to see a doctor.[13] Your primary care doctor or gynecologist is a good first stop, and they can refer you to an audiologist or an ear, nose, and throat specialist.

Questions to bring to your appointment

  1. Could my tinnitus be connected to perimenopause or menopause, or should we look for another cause first?
  2. Should I have a hearing test, and can you refer me to an audiologist?
  3. Could any of my current medicines, including hormones, be adding to the ringing?
  4. Is it worth checking my blood pressure, iron levels, or thyroid?
  5. If I am considering hormone therapy for other symptoms, how should my tinnitus factor into that decision?
  6. Would sound therapy or cognitive behavioral therapy make sense for me?

The bottom line on tinnitus and menopause: hormones can be part of the story, the research on HRT points in more than one direction, and some kinds of ringing should never be blamed on menopause without a check. Write down your pattern, protect your sleep, get your hearing measured, and take the list above to someone who can examine you.

Frequently asked questions

Can menopause tinnitus go away?
It can, especially if hormones are part of the cause, but there is no guarantee. The NIDCD says tinnitus may improve or even go away over time, and some specialists see menopause-related ringing ease once hormones stabilize. If it stays, sound therapy, hearing aids, and counseling can make it far less noticeable and less distressing.
Can low estrogen cause ringing in the ears?
Low estrogen may contribute, but it has not been proven to cause tinnitus on its own. Studies link lower estradiol with poorer hearing in postmenopausal women and show hearing declining at the onset of menopause. Because hearing loss, medicines, and blood pressure can also cause ringing, a doctor should look for other causes too.
Should I start HRT to stop tinnitus?
No one should start hormone therapy only for tinnitus based on current evidence. One large records study linked HRT with fewer tinnitus diagnoses, while a large U.S. study linked long-term oral hormone therapy with more hearing loss. If you are considering HRT for other symptoms, mention your tinnitus and decide together with your doctor.
Why is my perimenopause tinnitus only in one ear?
One-sided ringing is less typical of hormonal changes and should be checked. Common causes include earwax and ear infections, and less often a benign growth on the hearing nerve called a vestibular schwannoma. A doctor's exam and a hearing test can sort these out, so book an appointment rather than waiting for menopause to pass.
Is pulsatile tinnitus during menopause dangerous?
It should never be ignored, and it deserves an urgent appointment. Fewer than one in ten people with tinnitus hear this heartbeat-like sound, and a specific cause is found in most cases. Doctors typically check blood pressure, look for anemia, which heavy periods before menopause can cause, and rule out thyroid problems or blood vessel changes.
What should I avoid if I have tinnitus?
Avoid loud noise without ear protection, long stretches of total silence, and stopping or changing medicines on your own. Be cautious of products promising a quick cure, since there is no medication made specifically for treating tinnitus. Instead, protect your sleep, keep a low background sound at night, and ask your doctor about a hearing test.

Sources

  1. Aloufi, N., Heinrich, A., Marshall, K., Kluk, K. "Sex differences and the effect of female sex hormones on auditory function: a systematic review." Frontiers in Human Neuroscience, 2023;17:1077409. Full text (PMC).
  2. Kim, S.H., Kang, B.M., Chae, H.D., Kim, C.H. "The association between serum estradiol level and hearing sensitivity in postmenopausal women." Obstetrics & Gynecology, 2002;99(5 Pt 1):726–730. PubMed.
  3. Yu, J.N. et al. "Association between menstrual cycle irregularity and tinnitus: a nationwide population-based study." Scientific Reports, 2019;9:14038. Full text (PMC).
  4. UCI Health — Menopause and tinnitus (news item quoting otolaryngologist Dr. Hamid Djalilian), August 2025.
  5. Chen, H.C. et al. "Hormone replacement therapy decreases the risk of tinnitus in menopausal women: a nationwide study." Oncotarget, 2018;9(28):19807–19816. Full text (PMC).
  6. Curhan, S.G., Eliassen, A.H., Eavey, R.D., Wang, M., Lin, B.M., Curhan, G.C. "Menopause and postmenopausal hormone therapy and risk of hearing loss." Menopause, 2017;24(9):1049–1056. PubMed; full text (PMC).
  7. Jiang, L., Cui, Y., Du, H. "Tinnitus constancy and self-reported severe headache or migraine symptoms in peri- and postmenopausal women." European Journal of Medical Research, 2025;31:139. PubMed.
  8. National Institute on Deafness and Other Communication Disorders — Tinnitus.
  9. U.S. Office on Women's Health — Menopause basics.
  10. MedlinePlus, U.S. National Library of Medicine — Hormone Replacement Therapy.
  11. NIDCD — Vestibular Schwannoma (Acoustic Neuroma) and Neurofibromatosis.
  12. Hofmann, E., Behr, R., Neumann-Haefelin, T., Schwager, K. "Pulsatile tinnitus: imaging and differential diagnosis." Deutsches Ärzteblatt International, 2013;110(26):451–458. Full text (PMC).
  13. NHS — Tinnitus.
  14. NHS — Iron deficiency anaemia.
  15. NIDCD — Sudden Deafness.