Menopause Live - IMS Updates

Date of release: 16 November, 2009

Voice, hearing, menopause and HRT

In one of the previous Menopause Live issues, the association of ocular pressure and HRT was discussed, as an example of a relatively unrecognized effect of hormones. Another system that rarely receives attention in this respect is the otolaryngeal system. Unfortunately, most of the publications appear in specialty journals such as Journal of Voice or Hearing Research, which are not accessible to us, as menopause specialists. However, several studies and reviews from the past 2 months sparked my curiosity and led to the commentary below. Since Menopause Live requires a citation from a very new publication, the following will serve as an introduction. Hederstierna and colleagues [1] examined 104 women with a mean age of 51.2 years at baseline. Women were tested twice with pure tone audiometry, with an average interval between the two tests of 7.5 years. Their age at their final menstrual period (FMP) was reported by all women. Hearing decline at individual frequencies was calculated. Women with a FMP 0–4 years ago had a rate of high frequency hearing decline of 0.9–1.5 dB/year in the left ear; those with a FMP 5–7 years ago had a corresponding rate of 1.1–1.5 dB/year in the right ear. In those women whose FMP was 8–13 years ago, the decline was more subtle, 0.7–1.1 dB/year in both ears. The conclusions were that menopause appeared to act as a trigger to a relatively rapid age-related hearing decline in healthy women, starting in the left ear.


The association of voice with sex hormones is very well recognized, mainly because of the changes related to puberty in boys and girls. Voice changes as a result of menopause and the alterations in the hormonal milieu were nicely summarized by D’haeseleer and colleagues in the September 2009 issue of Maturitas [2]. The most important acoustic changes in postmenopausal women were a decreased vocal frequency range, decreased fundamental frequency and a higher frequency perturbation. A few reports in the literature addressed the effects of hormone replacement therapy (HRT) on the larynx and pointed at a tendency towards a positive, organ-conserving effect of hormone treatment on the larynx and probably the voice [3]. However, an unfavorable effect of HRT on hearing was documented recently by Price and colleagues in mice [4]. Longitudinal comparisons of threshold data for auditory brainstem responses obtained at 4 months of treatment revealed statistically significant declines in auditory sensitivity over time for the combined estrogen + progestin treatment group, with the estrogen-only group revealing milder changes at 3, 6 and 32 kHz. Contrarily, an earlier clinical study suggested a protective effect of HRT in 143 Swedish women around the menopause [5]. Their data pointed at poorer hearing, mainly at 2 and 3 kHz, in postmenopausal women who were not on HRT, compared with pre- and perimenopausal women, and postmenopausal women on HRT. In another study, the mean air conduction results at low frequencies (0.25, 0.5, 1 and 2 kHz) in the estrogen-alone group were significantly higher than the corresponding findings in the estrogen + progestin group and the non-users of hormones [6]. The investigators assumed that estrogen therapy may slow down hearing loss in aging postmenopausal women. 
In conclusion, the lack of large-scale studies on otolaryngeal endpoints concerning menopause and HRT leads to uncertainty about possible related alterations. But one fact is not debated – that sex hormones have an effect on the various tissues that comprise the inner ear and the larynx.


Amos Pines
Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel


  1. Hederstierna C, Hultcrantz M, Collins A, et al. The menopause triggers hearing decline in healthy women. Hear Res 2009 Sep 23. Epub ahead of print.

  2. Dhaeseleer E, Depypere H, Claeys S, et al. The menopause and the female larynx, clinical aspects and therapeutical options: a literature review. Maturitas 2009;64:27-32.

  3. Lindholm P, Vilkman E, Raudaskoski T, et al. The effect of postmenopause and postmenopausal HRT on measured voice values and vocal symptoms. Maturitas 1997;28:47-53.

  4. Price K, Zhu X, Guimaraes PF, et al. Hormone replacement therapy diminishes hearing in peri-menopausal mice. Hear Res 2009;252:29-36.

  5. Hederstierna C, Hultcrantz M, Collins A, et al. Hearing in women at menopause. Prevalence of hearing loss, audiometric configuration and relation to hormone replacement therapy. Acta Otolaryngol 2007;127:149-55.

  6. Kilicdag EB, Yavuz H, Bagis T, et al. Effects of estrogen therapy on hearing in postmenopausal women. Am J Obstet Gynecol 2004;190:77-82.