The decision to take hormone therapy (HT) to tame symptoms of menopause can be complex. There are benefits and risksthat you must weigh with your healthcare provider. One area of emerging research is the relationship between hearing loss, menopause and hormonetherapy.

Researchers are still teasing out how menopause affects hearing. The same is true of HT:Research with mice and preliminaryhuman studies suggest that taking estrogen can have protective effects on your hearing. However, ananalysis with the largest data pool to date on the topic actually found the opposite.

If you dont currently have hearing loss, HT could increase your risk, according to a team led by Dr. Sharon Curhan, MD, a physician and epidemiologist at Brigham and Womens Hospital in Boston. This was true for both pills and patches, and for formulas with estrogen onlyor combined with progesterone.

To get down to the numbers: When Curhans team analyzed data for more than 47,000 female nurses spanning 22 years, theyconcluded that a course of HT for five to ten years increased a woman'srisk of hearing loss by 15 percent compared to a woman not taking HT.

Risk increased the longer a woman stayed on HT. The analysis also found thatwomen who undergo menopause at an older age have a higher risk of hearing loss.

Youve probably heard that drops in estrogen can trigger symptoms like hot flashes. Estrogen, a hormone, plays a role throughout the bodyin your muscles and bones, heart and brain as well as reproductive system. Scientists know we have estrogen receptors in ear cellsand in auditory pathways, but its still unknown exactly how estrogen affects hearing.

Sex hormone levels change during a menstrual cycle, and during menstruation, your hearing can become less sensitive.During perimenopausethe years before your ovaries stop releasing eggs and your period endsyour ovaries gradually produce less estrogen. In the last one to two years of perimenopause, the drop in estrogen speeds up. After your period ends, typically after age 45, the ovaries produce little estrogen but you still get some from your adrenal glands and fat tissue.

As Curhans team reports, both human and animal studies have shown that low estrogen levels can impair hearing, possibly through alterations in blood flow to the cochlea, the hollow tube in the inner ear. A separate study that measured hearing and blood levels of estradiol (a form of estrogen) in 1,830 post-menopausal women found that the volunteers with less estradiol were more likely to have hearing loss.

Another key reproductive hormone, progesterone, begins to drop in your thirties. Progesterone, which regulates pregnancy, is the yin to estrogens yang: It reduces receptor cells for estrogen. Progesterone doesnt affect the cochlea directly but it could by reducing estrogen receptors and therefore blood flow to the ear.

The link between low estrogen and impaired hearing suggests that women who arrive at menopause later, at 50 or older51 is the average age of menopause in the United Statesmight have a lower risk of hearing loss. After all, it would make sense that women who reach menopause sooner experienced earlier drops in estrogen.

However, when Curhans team looked at a pool of data on nearly 81,000 nurses, the opposite was true: The women with late natural menopause surprisingly had a 10 percent higher chance of hearing loss. The reason for this finding is unclear, since we dont have a full picture of all the factors that affect the age of menopause, Dr. Curhan told Healthy Hearing.

If you are about to start hormone therapyDr. Curhan suggests monitoring your hearing and taking HT only as long as needed.Some women have reacted to HT with sudden hearing loss, tinnitus and vertigo. Contact your provider right away if this happens to you.

If youre considering HT, youre likely to be offered a combination with progestin (a medication like progesterone) if you still have your uterus.Estrogen alone could stimulate growth of the uterus lining and increases your risk of endometrial cancer, so it's more commonly used for women who have had a hysterectomy.

If you do opt for HT, Dr. Curhan suggests monitoring your hearing and taking HT only as long as needed.Some people have reacted to HT with sudden hearing loss, tinnitus and vertigo.

The relationship between menopause, hormone replacement therapy and tinnitus is a topic that also needs more study. Some women may experience tinnitus when starting hormone therapy for perimenopause. Butstudies have also shown that hormone therapy can actually lower the rate of tinnitus in women who are perimenopausal.

We are looking forward to understanding more about risk factors for tinnitus, Dr. Curhan told Healthy Hearing. She is studying its relation to menopause and HT.

Diet, exercise, and maintaining a healthy weight all count. We found that people who ate diets that most closely resembled the Mediterranean or DASH [Dietary Approaches to Stop Hypertension] patterns had a substantially lower risk of hearing loss, Dr. Curhan said. That means eating more fish, vegetables, and whole grainsand less meat and junk food. More: How a healthy diet helps your hearing.

Also be mindful of medications linked to hearing loss. Curhans research with the same big data pool found that using the over-the-counter pain-relievers ibuprofen and acetaminophen two or more times a week may be linked to hearing loss (aspirin is OK). But there was no tie to alcohol.

Lastly, steer clear of loud or constant background noise, get your hearing checked and wear prescribed hearing aids regularly, and youll know youve done your best to prevent hearing lossas you age.

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Hearing loss, hormone therapy and menopause - Healthy Hearing

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