Association of Menopause and Hormone Replacement Therapy with Hearing Loss

Objective: Estrogen has been found to impact cochlear blood flow and auditory function, but epidemiological studies on menopause and hearing are inconsistent. This study investigates the associations of menopause, its age at onset, reproductive lifespan, and hormone replacement therapy (HRT) with hearing loss in adult women in the US. Methods: Study cohort includes 1778 adult women (40-69 years), from the National Health and Nutrition Examination Survey 2011 to 2012 and 2015 to 2016 who had complete data on audiometry and reproductive health. Hearing loss was defined based on speech-frequency pure-tone average (0.5, 1, 2, and 4 kHz) in better hearing ear. Menopause status was self-reported. Multivariable regression analyses were performed to explore the associations of menopause, age at onset, reproductive lifespan, and HRT with hearing loss. Results: After adjusting for age, demographics, medical comorbidities, and noise exposure, there was no significant association between binary postmenopausal status and hearing loss (β: 0.92 dB, 95% CI: −1.02 to 2.86). When further considering age of menopause onset and reproductive lifespan, we found that late onset of menopause (vs early onset) was significantly associated with the better hearing (β: −4.60 dB, 95% CI: −8.42 to −0.79) and longer reproductive lifespan was significantly associated with better hearing (β: −0.16 dB per year, 95% CI: −0.32 to −0.002). Comparing reproductive lifespan quartiles, the fourth quartile was significantly associated with better hearing relative to the first quartile (β: −4.86 dB, 95% CI: −8.28 to −1.44). Among post-menopausal women, there was no significant association between hearing loss and HRT (β: 0.45 dB, 95% CI: −1.69 to 2.58). Conclusion: While menopausal status was not significantly associated with hearing loss, later onset of menopause and longer reproductive lifespan were associated with better hearing. Future studies should evaluate the clinical significance of the associations between hearing and reproductive health and potential causal relationships. Level of evidence: 2b