Last checked September 2026 against 8 sources · Editorial policy
Tinnitus and menopause
Tinnitus is ringing, buzzing or hissing that isn't coming from outside your ears. It often goes with hearing loss, but thyroid problems, anxiety, depression and some medicines play a role too. A Taiwanese database study of menopausal women found fewer new cases among HRT users over up to 10 years, while a large US study linked long-term oral HRT with more hearing loss. Tinnitus that pulses with your heartbeat needs an urgent appointment.
Some women notice ringing in the ears around menopause. What research says about the estrogen link, other causes to rule out, and what helps.
Tinnitus and menopause: expectation vs reality
What people often expect
“Tinnitus has nothing to do with hormones”
What the evidence shows
Researchers matched 13,920 menopausal HRT users with 41,760 non-users and followed them for up to 10 years. New tinnitus developed in 0.43% of users versus 0.59% of non-users, and after adjusting for other factors the hazard was about half. But in 80,972 US nurses, oral HRT used for 10 years or more was linked with a higher risk of hearing loss, a relative risk of 1.21. Hormones matter to the ear, but not in a simple way.
Why tinnitus can start around menopause
Estrogen and the inner ear
The inner ear and hearing pathways may respond to hormone levels. In the Taiwanese cohort, each HRT user was compared with three matched non-users, and fewer users developed tinnitus over the follow-up, with an adjusted hazard ratio of 0.505. The authors suggest estrogen might help protect hearing pathways, but the data show an association, not a treatment effect.
Hearing loss is the most common cause of tinnitus
Most tinnitus goes with some degree of hearing loss. In the Nurses' Health Study II, which followed 80,972 women, menopause itself wasn't linked with hearing loss overall, but a later natural menopause, at 50 or older, was linked with a slightly higher risk, a relative risk of 1.10. Oral HRT used for 5 to 9.9 years was linked with a relative risk of 1.15, and for 10 years or more with 1.21.
Other causes of tinnitus in midlife
Ménière's disease, thyroid problems and diabetes are on the usual list of causes, and tinnitus can be a side effect of aspirin, anti-inflammatory painkillers, some antibiotics and some chemotherapy drugs. Earwax and ear infections cause it too. Anxiety and depression often overlap with tinnitus, and stress, poor sleep and low mood in perimenopause can make the noise feel louder and harder to ignore.
Why tinnitus feels worse at night
Tinnitus often seems loudest at night, when there's less background sound to mask it. In perimenopause, night sweats and insomnia already break sleep, and lying awake makes you more aware of the noise. That can turn into a cycle of worry and poor sleep. Soft background sound and treating sleep problems help break it.
Tinnitus, anxiety and sleep in perimenopause
Tinnitus and anxiety feed each other. Worry makes the noise more noticeable, and the noise makes it harder to relax and sleep. In perimenopause, when anxiety risk rises and night sweats break sleep, that loop can tighten quickly. The NHS notes that tinnitus often improves as people learn to pay less attention to it, and talking therapies such as CBT and tinnitus counseling are designed to help with exactly that.
How common is tinnitus in menopause?
From the studies on this page
new tinnitus in HRT users versus non-users over up to 10 years in one national study
0.43% vs 0.59%
risk of hearing loss with 10 or more years of oral HRT in the Nurses' Health Study II
1.21×
Relative odds vs comparison group (1× = same odds)
Research hasn't measured how often tinnitus starts around menopause specifically. It's common at any age, and more so as hearing changes.
Causes of tinnitus to rule out
Most tinnitus comes with some hearing loss, but several treatable causes are worth checking, and one pattern needs urgent attention.
Earwax or ear infection
Muffled hearing, ear pain or a blocked feeling.
Test: Doctor's ear check
Ménière's disease
Check →Tinnitus with vertigo attacks and fluctuating hearing.
Test: ENT referral
A medicine
Started with aspirin, anti-inflammatory painkillers, some antibiotics or chemotherapy.
Test: Medicine review
Thyroid problems
Check →Tinnitus with tiredness, weight change, heat or cold intolerance.
Test: TSH blood test
A blood vessel problem
Tinnitus that beats in time with your pulse.
Test: Urgent doctor's appointment
What helps tinnitus in perimenopause
Check your hearing
First stepA doctor can look for earwax, infection or other treatable causes and check your hearing. Hearing aids are often recommended when hearing loss is part of the picture, and treating the hearing loss can make tinnitus less bothersome. Treating earwax or infection often eases tinnitus quickly.
Manage stress, mood and sleep
First stepAnxiety and depression are linked with tinnitus. Relaxation, better sleep habits, soft background sound instead of total silence, and talking therapies such as CBT or tinnitus counseling can reduce how much it intrudes on daily life. Treating night sweats and insomnia in perimenopause helps too.
Related guide →HRT and tinnitus
Limited evidenceOne observational study found lower rates of new tinnitus among HRT users over up to 10 years, but another large study linked long-term oral HRT with more hearing loss. HRT isn't a tinnitus treatment, and neither study shows that starting HRT will quiet existing noise. Decide on HRT based on your other symptoms.
Related guide →Protect your hearing
First stepLoud noise damages hearing and worsens tinnitus. Use ear protection at concerts or with loud tools, keep headphone volume moderate, and give your ears quiet time. Tell your doctor about any medicine that seems to make tinnitus worse, rather than stopping it yourself.
When tinnitus needs a doctor
Urgent: Tinnitus after a head injury, or with sudden hearing loss, facial weakness or vertigo
Go to the ER or call 911 (999 in the UK).
Urgent: Tinnitus that beats in time with your pulse
Ask for an urgent doctor's appointment. Pulsatile tinnitus can signal a blood vessel problem and needs prompt assessment.
Tinnitus that's constant, worsening or affecting sleep or mood
See a doctor if tinnitus is regular or constant, getting worse, or affecting sleep, concentration, anxiety or mood. You may need hearing tests or a specialist referral.
Tinnitus and menopause: questions women ask
Can menopause cause tinnitus?
A hormone link is possible but not proven. One large Taiwanese study found fewer new tinnitus cases among menopausal women using HRT than among matched non-users over up to 10 years. Most tinnitus is linked with hearing loss, which becomes more common with age, so a hearing check is the first step.
Does HRT help tinnitus?
It isn't a tinnitus treatment. Observational data linked HRT with less new tinnitus in one study, but a larger study linked long-term oral HRT with more hearing loss. Neither shows that HRT helps noise you already hear.
When is tinnitus serious?
Seek emergency care after a head injury or if tinnitus comes with sudden hearing loss, facial weakness or vertigo. Tinnitus that pulses with your heartbeat needs an urgent doctor's appointment. Constant or worsening tinnitus needs a routine check.
Can perimenopause cause ringing in the ears?
It may contribute, through hormone effects on the inner ear, and through anxiety, poor sleep and low mood, which make tinnitus louder and harder to ignore. Hearing loss, earwax, medicines and thyroid problems are more common causes and should be checked first.
Does HRT affect hearing?
The evidence is mixed. In the Nurses' Health Study II, oral HRT for 10 years or more was linked with a higher risk, a relative risk of 1.21, of self-reported hearing loss, while a Taiwanese study found HRT users had less new tinnitus. Neither proves cause, so hearing shouldn't decide whether you take HRT.
How can I cope with tinnitus at night?
Use soft background sound, such as a fan or low music, rather than silence. Keep a regular sleep routine and treat night sweats if they wake you. If tinnitus is making you anxious or keeping you awake, CBT or tinnitus counseling can help a lot.
Can tinnitus go away?
Often it does, especially when there is a treatable cause such as earwax, an ear infection or a medicine. When tinnitus lasts, it frequently becomes less intrusive over time as the brain learns to tune it out, and hearing aids, sound therapy and CBT help. See a doctor if it is constant, getting worse or affecting your sleep or mood.
What causes ringing in the ears in women over 40?
The most common cause is some degree of hearing loss, which becomes more likely with age. Earwax, ear infections, Ménière's disease, thyroid problems, diabetes and medicines such as aspirin or anti-inflammatory painkillers are other causes. Anxiety, stress and poor sleep, common in perimenopause, make tinnitus louder and harder to ignore.
Sources
- NHS. Tinnitus.
- Chen HC(#), Chung CH, Chen VCF, et al. Hormone replacement therapy decreases the risk of tinnitus in menopausal women: a nationwide study. Oncotarget. 2018;9(28):19807-19816.
- Curhan SG, Eliassen AH, Eavey RD, et al. Menopause and postmenopausal hormone therapy and risk of hearing loss. Menopause. 2017;24(9):1049-1056.
- Kravitz HM, Zhao X, Bromberger JT, et al. Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep. 2008;31(7):979-90.
- Bromberger JT, Kravitz HM, Chang Y, et al. Does risk for anxiety increase during the menopausal transition? Study of women's health across the nation. Menopause. 2013;20(5):488-95.
- NHS. Dizziness.
- NHS. Insomnia.
- National 911 Program. 911.gov.
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