Tinnitus is more common than you would think, menopause aside. A pooling of 113 studies found that 14.4% of all adults experience it, rising to 23.6% over 65 (PMID 35939312). So around fifty your chances are already substantial, independent of your hormones.
That figure is exactly what is missing from this topic.
Without a base rate you cannot judge whether your tinnitus came from menopause or simply started in the same years. And that difference is bigger than the pages on it suggest.
Does tinnitus come from menopause?
Probably less directly than is claimed. There genuinely are oestrogen receptors in your inner ear, demonstrated in human tissue. But the largest study of hearing and menopause found no link between menopause itself and hearing loss. So the link is mostly inferred, not measured.
That is an uncomfortable answer on a search page full of certainty.
In human inner ear tissue, one oestrogen receptor was found in the spiral ganglion and the other in the stria vascularis (PMID 11470188). The latter is the blood-rich tissue that maintains the electrical potential in your cochlea. A plausible point of action, nothing more.
Against that sits a study of 80,972 women, covering over 1.4 million person-years, in which menopausal status itself was not associated with hearing loss (PMID 28486246).
I think the most honest summary is this: it is possible, it is not established, and coinciding in time is expected at this age anyway.
So why does it seem to coincide so often?
Because menopause worsens exactly the things that make tinnitus feel louder. Poor sleep, worry and tension strongly determine how much a sound already present actually bothers you. That is not about the sound itself, but about how much room it gets.
And at night there is little else to listen to.
Of people with tinnitus, 53.5% have disturbed sleep, and among women that share is a little higher than among men (PMID 34708282). In perimenopause, lying awake from hot flushes and night sweats is added on top.
Take two women of 53 who both hear a faint ringing. One sleeps well and notices it only in a quiet room. The other has been awake at three in the morning since her hot flushes started, and then that ringing is the only thing there. Same sound, a very different life with it.
Interestingly, the only treatment with solid evidence in this whole field is a psychological one. A Cochrane review found that cognitive behavioural therapy improves tinnitus-related quality of life (PMID 31912887). Not one page on this topic leads with that, while it is the best evidenced thing available. Whether it suits you is something to discuss with your GP.
How your sleep changes in this phase is in poor sleep in menopause.
Which blood values play a part here?
Three, and none of them is named on the best-ranking pages. Iron deficiency is the strongest. Your thyroid counts, but differently from what is usually claimed. And vitamin B12 is worth naming with a large caveat.
That first figure was the most striking thing I found on this topic.
| What plays a part | What is looked at in blood | What the research shows |
|---|---|---|
| Iron deficiency with anaemia | Haemoglobin, ferritin, transferrin saturation | Across nearly 89,000 women per group, the chance of new tinnitus was almost four times higher after one year and more than twice as high after three. The link was stronger over 45, and stronger the lower the haemoglobin (PMID 41393945). |
| Overactive thyroid | TSH, free T4 | A low TSH was associated with more than twice as much bothersome tinnitus, in women only (PMID 33710990). So not the underactive thyroid everyone thinks of. |
| Underactive thyroid | TSH, free T4 | Associated with hearing loss, odds ratio 1.69 across 18 studies (PMID 39356749). That is a different thing from tinnitus. |
| Vitamin B12 deficiency | Vitamin B12, folate | One old study found low B12 more often in people with tinnitus. It was small, from 1993, and exclusively in men in noisy service (PMID 8484483). |
| Where you are in menopause | FSH, oestradiol | This is context, not a tinnitus test. No hormone value confirms or explains tinnitus. |
That last row is the most important in the table, and it is why I put it there. What your GP does with any of this depends on your story. An anaemia panel looks at the iron side, a thyroid panel at the thyroid side.
Fatigue flaring in the same period often belongs to that same iron story. That is in tired from menopause, stress or anaemia.
Does hormone therapy help tinnitus?
The two best studies point in opposite directions, and both sit on the same search page without anyone naming that. One found more hearing loss with long-term use. The other found less new tinnitus among users. They do not measure the same thing.
The numbers help show why.
In the large American study, oral hormone therapy of ten years or more was associated with more hearing loss, at a relative risk of 1.21 (PMID 28486246). In a Taiwanese dataset of 13,920 users against 41,760 comparable non-users, new tinnitus was less common, at a hazard ratio of 0.505 (PMID 29731984).
Hearing loss is not the same as tinnitus, and an insurance database is not the same as a prospective cohort. Neither settles anything.
What I make of it: tinnitus is not a reason to start hormone therapy, and not a reason to stop it without discussion either. Worth mentioning, though, if you already use it.
Which tinnitus does not belong to this story?
Four kinds, and they deserve medical assessment rather than blood testing. Tinnitus on one side only. Tinnitus that beats in time with your heartbeat. Hearing that drops suddenly. And tinnitus with genuine spinning dizziness.
For those four, blood testing is not the first step.
Dutch tinnitus guidance has separate chapters on imaging for one-sided and for pulsatile tinnitus for good reason. Yet no page in the top ten names these signals, while "pulserende tinnitus overgang" is the most searched related term.
Sudden hearing loss is the most time-critical of the four. Make contact the same day or the next.
What do you take to your GP?
Whether it is on one side or both. Whether it beats in time with your pulse. Since when it has been going on and whether your hearing changed with it. And whether you are tired in a way you do not know from yourself, because that points towards the iron side.
Note as well whether it is worse at night than during the day.
Dutch public GP guidance names noise, stress and ageing for tinnitus. On menopause, hormones or blood values it says nothing. There is also no Dutch GP standard on tinnitus, which explains why these results consist mainly of hearing shops and coaches.
Other complaints from this phase that rarely get linked to hormones are in dry eyes in menopause and frozen shoulder in menopause. For the wider picture, navigating perimenopause is the starting point.
References
- Jarach CM, Lugo A, Scala M, et al. Global prevalence and incidence of tinnitus: a systematic review and meta-analysis. JAMA Neurol. 2022;79(9):888-900. PMID 35939312.
- Curhan SG, Eliassen AH, Eavey RD, Wang M, Lin BM, Curhan GC. Menopause and postmenopausal hormone therapy and risk of hearing loss. Menopause. 2017;24(9):1049-1056. PMID 28486246.
- Chen HC, Chung CH, Chen VCF, Wang YC, Chien WC. Hormone replacement therapy decreases the risk of tinnitus in menopausal women: a nationwide study. Oncotarget. 2018;9(28):19807-19816. PMID 29731984.
- Hung KC, Weng HL, Lai YC, et al. Iron deficiency anemia and the risk of new-onset tinnitus in female patients: a cohort study. Front Nutr. 2025;12:1704946. PMID 41393945.
- Kim SY, Min C, Kim HJ, Choi HG. Low thyroid-stimulating hormone levels are associated with annoying tinnitus in adult women. Otol Neurotol. 2021;42(4):e408-e415. PMID 33710990.
- Gu L, Guo W, Wang X, Yue C. The association between thyroid disease and hearing loss: a meta-analysis. Acta Otolaryngol. 2024;144(9):495-502. PMID 39356749.
- Gu H, Kong W, Yin H, Zheng Y. Prevalence of sleep impairment in patients with tinnitus: a systematic review and single-arm meta-analysis. Eur Arch Otorhinolaryngol. 2022;279(5):2211-2221. PMID 34708282.
- Fuller T, Cima R, Langguth B, Mazurek B, Vlaeyen JWS, Hoare DJ. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev. 2020;1(1):CD012614. PMID 31912887.
- Stenberg AE, Wang H, Fish J 3rd, Schrott-Fischer A, Sahlin L, Hultcrantz M. Estrogen receptors in the normal adult and developing human inner ear and in Turner's syndrome. Hear Res. 2001;157(1-2):87-92. PMID 11470188.
- Shemesh Z, Attias J, Ornan M, Shapira N, Shahar A. Vitamin B12 deficiency in patients with chronic tinnitus and noise-induced hearing loss. Am J Otolaryngol. 1993;14(2):94-99. PMID 8484483.
- Thuisarts. I have tinnitus. Available via thuisarts.nl.
Every blood test result at Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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