Menopause can affect your hearing—and not in a good way. New research suggests that the age at which you hit menopause affects hearing loss. And so does hormone therapy—including how long you stay on it.

Background: Hearing loss affects more than the ability to understand speech. People can become socially isolated, which harms mental sharpness, quality of life and health. Hearing aids help, but they have limitations. About one-third of people aged 65 to 74…and half of people over age 75…have significant hearing loss. This age-related hearing loss usually is permanent and irreversible, so identifying modifiable risk factors that can prevent hearing loss in the first place is very important.

Some earlier studies have suggested that the decline in estrogen production that comes with menopause can hurt hearing, and a few small studies suggest that hormone therapy after menopause helps preserve hearing. But scientists actually know very little about how hormones affect hearing—although they now know more based on a new study.

Study: Researchers used data from 80,972 women in the Nurses’ Health Study. They were between the ages of 25 and 42 at the start of the study in 1989. The women responded to questionnaires every two years that asked about diet, lifestyle and various health outcomes—including hearing loss. None had hearing loss before the study began, and all reported the age at which they reached menopause—defined as 12 months after the final period. Over 22 years, more than 18,000, or about 22%, of these women reported hearing loss.

Results: At any given age after menopause, women who had reached menopause at age 50 or older had a 10% higher risk for hearing loss than women who had reached menopause when they were younger than 50. (For the record, the average age for reaching menopause in the US is 51.)

Surprising finding: Women who used oral hormone therapy after menopause, whether estrogen alone or estrogen plus progestogen, had increased risk for hearing loss…and that risk tended to rise the longer they stayed on the hormones. For example, women who used hormone therapy for less than two years had 10% higher risk for hearing loss, while women who remained on hormones for between five and 10 years had 15% higher risk.

Bottom line: Although some earlier studies suggested that estrogen is protective of hearing, the results from this study seem to suggest the opposite—that the longer you are exposed to estrogen, either natural (your menopause comes relatively later in life) or supplemented (you take hormone therapy), the more likely you are to develop hearing loss.

For women who are considering whether to try hormone therapy for relief of menopausal symptoms, hearing is one more factor to consider. It’s probably not the primary one, since the effect of hormone therapy on cardiovascular health and cancer risk is more important. But the hearing question is worth bringing up with your doctor as you make the choice.

To learn more about protecting your hearing as you age, see Bottom Line’s article “Surprising Ways to Improve Your Hearing.”

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