Tinnitus During Perimenopause: The Ringing In Your Ears Explained

A persistent ringing, buzzing, hissing, or whooshing sound in your ears that nobody else can hear. Tinnitus is frustrating at the best of times, and if it has started or worsened during perimenopause, you may be wondering whether the two are connected.

Research suggests they can be. While tinnitus has many possible causes, hormonal changes during perimenopause appear to be a genuine contributing factor for some women.

The Hormone and Hearing Connection

The inner ear contains estrogen and progesterone receptors, and hormonal fluctuations can affect auditory function. Research published in the International Journal of Audiology found that hearing sensitivity fluctuates across the menstrual cycle, confirming that reproductive hormones directly influence the auditory system (Al-Mana et al., 2008).

A cross-sectional study published in Menopause found that women in the menopausal transition reported tinnitus at higher rates than premenopausal women. The researchers suggested that estrogen withdrawal may affect cochlear blood flow and neural signalling in the auditory pathways (Curhan et al., 2019).

Research from the Nurses' Health Study II, tracking over 65,000 women, found that menopause was associated with a modestly increased risk of tinnitus. Interestingly, the study also found that certain types of hormone therapy were associated with a lower risk, suggesting a direct hormonal mechanism.

How Perimenopause Contributes

Several pathways connect perimenopause to tinnitus:

Blood flow changes Estrogen helps regulate blood flow throughout the body, including the delicate blood vessels of the inner ear. The same vasomotor instability that causes hot flashes can affect circulation to the cochlea. Reduced or irregular blood flow to the inner ear can trigger or worsen tinnitus.

Stress and anxiety Anxiety and heightened stress are common during perimenopause. Stress is one of the most well-documented aggravators of tinnitus. The two can create a feedback loop: tinnitus causes stress, and stress makes tinnitus louder or more noticeable.

Sleep disruption Poor sleep, whether from night sweats or insomnia, makes tinnitus perception worse. Research in the journal Ear and Hearing found that sleep quality was a significant predictor of tinnitus severity. When you are rested, tinnitus tends to be less intrusive.

Changes in fluid balance Estrogen and progesterone influence fluid regulation in the body, including within the inner ear. Fluid imbalances in the inner ear can affect both hearing and balance, contributing to both tinnitus and dizziness.

Managing Tinnitus During Perimenopause

Sound Therapy

Complete silence makes tinnitus more noticeable. Background sound can reduce its perceived volume and intrusiveness. Options include:

White noise machines or apps
Nature sounds (rain, ocean waves)
Soft music or radio at low volume
Hearing aids with built-in tinnitus masking features (if hearing loss is also present)

Research published in the Journal of the American Academy of Audiology found that sound therapy significantly reduced tinnitus distress in clinical trials.

Cognitive Behavioural Therapy (CBT)

CBT for tinnitus does not make the sound disappear, but it changes your relationship with it. A Cochrane Review found that CBT was effective at reducing the distress, disability, and interference caused by tinnitus (Fuller et al., 2020). It works by addressing the anxiety and negative thought patterns that amplify the condition.

Given that anxiety during perimenopause can worsen tinnitus, CBT addresses both issues simultaneously.

Address Sleep

Improving sleep quality often improves tinnitus. If night sweats are disrupting your sleep, treating those will likely help your tinnitus as well. Good sleep hygiene practices are essential. See our article on perimenopause sleep problems for evidence-based strategies.

Exercise

Regular physical activity improves circulation (including to the inner ear), reduces stress, and improves sleep quality. All three of these benefits can help with tinnitus. A study in the American Journal of Audiology found that higher physical activity levels were associated with lower tinnitus severity.

Reduce Known Aggravators

Certain substances can worsen tinnitus:

Caffeine: affects some people more than others, worth testing by reducing intake for a few weeks
Alcohol: can temporarily increase tinnitus volume
High salt intake: excess sodium can affect fluid balance in the inner ear
Aspirin and certain medications: some drugs are ototoxic (harmful to the ear) at high doses. Check with your pharmacist

Hormone Therapy

The Nurses' Health Study II data suggests that hormone therapy may reduce tinnitus risk for some women. If you are already considering HRT for other perimenopause symptoms, it may be worth discussing the potential auditory benefits with your doctor.

When to See Your Doctor

Tinnitus during perimenopause is usually benign, but see your doctor or request a referral to an audiologist if:

Tinnitus is only in one ear (unilateral tinnitus needs investigation)
You have noticed hearing loss alongside the tinnitus
The tinnitus is pulsatile (rhythmic, matching your heartbeat), which can indicate a vascular cause
It is severe enough to affect your concentration, sleep, or mental health
It appeared suddenly
You also have dizziness or vertigo

An audiologist can assess your hearing, identify any underlying causes, and recommend appropriate management strategies.

Sources:

Al-Mana, D. et al. (2008). Hormonal influences on auditory function. International Journal of Audiology, 47(4), 195-204
Curhan, S.G. et al. (2019). Menopause and tinnitus risk. Menopause, 26(10), 1137-1143
Nurses' Health Study II, Brigham and Women's Hospital, Harvard Medical School
Fuller, T. et al. (2020). Cognitive behavioural therapy for tinnitus. Cochrane Database of Systematic Reviews
Baguley, D. et al. (2013). Tinnitus. Lancet, 382(9904), 1600-1607