Experts say online hearing tests are a useful first step – but hormone therapy may carry risks
A large-scale study has linked long-term hormone therapy to increased hearing loss in women, prompting experts to advise caution and urge anyone noticing changes in hearing to seek a clinical assessment. Online hearing tests can be a sensible, low-cost first step but they are no substitute for proper diagnosis.
When to get your hearing checked
Hearing loss is more than just a minor inconvenience. Loss of hearing can affect social life and contribute to anxiety, depression and even cognitive decline. It’s time to act if you find yourself turning up the volume on the TV, struggling to hear conversations in noisy places, or asking people to repeat themselves. Other signs include difficulty hearing higher-pitched voices.
Online hearing checks can help identify whether there might be a problem, but the NHS and RNID both stress they are screening tools only. If the result suggests a problem, or if you’re worried, speak to a GP or audiologist.
The many causes of hearing decline
Hearing loss, tinnitus and hyperacusis (oversensitivity to everyday sounds) have overlapping but distinct causes. Age-related hearing loss (presbycusis) is common, as is long-term exposure to loud noise. But other risks include diabetes, high blood pressure, obesity, certain antibiotics and chemotherapy drugs, and genetic conditions.
Hormonal changes during menopause are increasingly studied as a possible factor. Falling oestrogen levels may affect blood flow to the inner ear and influence how the auditory system works. But while the theory is biologically plausible, the evidence so far is mixed.
Hormone therapy and risk
The most detailed study to date – involving over 80,000 women tracked for more than 20 years – found no strong link between menopause itself and hearing loss. But women who started menopause later had a slightly higher risk. More significantly, the study linked long-term oral hormone therapy (oestrogen alone or combined with progestogen) to a greater risk of hearing loss, particularly when used over many years.
The findings don’t mean hormone therapy should be avoided entirely but they suggest hearing health should be part of the conversation. For women on hormone treatment who notice changes in hearing, it's worth raising with their prescribing clinician.
When hearing changes need urgent care
Most hearing loss develops gradually. But some symptoms require immediate medical review. These include sudden hearing loss, new or severe tinnitus, ear pain, or discharge.
“The vast majority of hearing loss cases are either age-related or noise-induced and the common factor with these two types of loss is that they occur gradually, over time,” said Micaela Stonestreet, a Clinical Audiologist at Hearology®. “But there are many other factors that can damage our hearing, be it hormonal or metabolic changes, diabetes, meningitis, ear infections - or even Covid-19. It is very important to investigate the cause of any sudden reduction in hearing, because it may be related to another medical condition.”
Start with a test – but don’t stop there
For anyone unsure whether their hearing is changing, clinical assessment remains essential. That’s particularly true for women going through menopause, where hearing is part of a broader health picture.
References
RNID’s online hearing check - Royal National Institute for Deaf People hearing test online
Hearing Tests at NHS - The NHS explains the range of hearing tests available on the health service, including face‑to‑face audiology assessments, pharmacy checks and simple online screening tools.
NHS Tinnitus - The NHS defines tinnitus as the perception of sound without an external source, commonly described as ringing, buzzing, hissing or whooshing. The page lists common causes, including various types of hearing loss.
NHS Noise sensitivity (hyperacusis) - The NHS defines hyperacusis as reduced tolerance to everyday sounds, making noises feel excessively loud or painful.
