Perimenopause and Tinnitus: Ringing Ears, Ear Pain and Dry Eyes Explained

Can perimenopause really cause tinnitus, or ringing in the ears?

Tinnitus means hearing a sound that has no outside source, so nobody else can hear it. The NIDCD, the federal institute for hearing research, says surveys put it at 10 to 25% of adults.

Perimenopause is the run-up to your final period, when estrogen rises and falls unevenly. Whether those swings can make your ears ring is a fair question. The honest answer is maybe.

The biology is real. A 2001 study of human inner-ear tissue found estrogen receptors, the docking sites hormones act through, in two key places.

One was the spiral ganglion, the nerve cells that carry sound signals to the brain. The other was the stria vascularis, a blood-rich strip of tissue that keeps the inner-ear fluid working.

Receptors show that estrogen can act on the ear. They do not prove that perimenopause makes ears ring. Research on tinnitus across the menopause transition is thin, and the studies that exist disagree.

So here is the fair summary. A hormonal role is plausible, especially when the ringing rises and falls with your cycle, your sleep or your hot flashes. It is less proven than the hormone link for dry eyes, covered further down.

Ringing ears are one of several lesser-known changes of this stage. Our guide to weird perimenopause symptoms maps the rest, from joint aches to a metallic taste.

What perimenopause ear ringing sounds like, and why it comes and goes

Tinnitus is not always a ring. People describe hissing, buzzing, humming, clicking or a thin, high whine. A whooshing sound in time with your heartbeat is a different thing, covered in the next section.

It is usually loudest at night, in a quiet room, when no other sound masks it. During a busy day you may not notice it at all.

Several changes of perimenopause make tinnitus easier to notice, even if the ear itself has not changed.

• Night sweats and broken sleep. Waking at 3 a.m. in a dark, silent bedroom is when ringing feels biggest. A tired brain also tolerates it less the next day. Our perimenopause insomnia guide covers ways to protect your nights.
• Anxiety and stress. Anxiety often rises in this transition. A tense, watchful mind tunes in to inner sounds and finds them harder to ignore. See our perimenopause anxiety guide.
• Jaw clenching. Stress and poor sleep feed clenching and grinding. The NIDCR, the federal dental research institute, lists ringing in the ears among possible signs of a jaw joint disorder.
• Migraine. In a 2025 study of 2,485 women in and after perimenopause, tinnitus that came and went was linked with more severe headache or migraine symptoms.

The NIDCD calls tinnitus chronic once it lasts three months or longer. Chronic does not have to mean distressing.

The ear, nose and throat doctors' guideline separates bothersome tinnitus, which disturbs your sleep, mood or focus, from tinnitus that is simply there. That difference shapes what, if anything, needs treating.

Picture a 47-year-old who hears a faint hiss only on nights she wakes up drenched. On weeks she sleeps well, she barely notices it. That pattern fits sleep and attention more than ear damage, though a hearing test still makes sense.

Sudden hearing loss, pulsing ringing and other signs that need a prompt visit

Most midlife tinnitus is not dangerous. The American Academy of Otolaryngology-Head and Neck Surgery, or AAO-HNS, the society for ear, nose and throat doctors, flags a few patterns that need prompt care.

• Sudden hearing loss in one ear. The AAO-HNS defines sudden as loss over about three days, often with loud ringing, dizziness or ear pressure. Its guideline calls for a hearing test within 14 days and says steroids may be offered within two weeks, so see a clinician within days.
• Ringing that pulses with your heartbeat. This is called pulsatile tinnitus. It can come from blood vessel changes near the ear, so the AAO-HNS makes it an exception to its advice against routine scans.
• Ringing or hearing loss in one ear only. The AAO-HNS asks for a prompt hearing test here. Rarely, the cause is an acoustic neuroma, a slow-growing noncancerous tumor on the hearing and balance nerve. An MRI scan finds it.
• Ringing with spinning attacks. The NIDCD says Ménière's disease, an inner-ear disorder, brings vertigo lasting 20 minutes to 12 hours. Hearing loss, ringing and fullness usually affect one ear.
• Ear pain with fever, discharge or swelling. These point to an infection that needs treatment, not home care.
• Unexplained ear pain after 50 with a normal-looking ear. A review in American Family Physician advises a blood test to help rule out temporal arteritis, an inflammation of arteries in the head.
• A painful red eye, or vision that stays blurry after blinking. The NEI, the federal eye institute, warns that severe dry eye left untreated can damage the cornea, the clear front of the eye.
• Ringing with numbness, weakness, a drooping face or slurred speech. These are nerve warning signs. Call 911.

The NIDCD notes Ménière's is most common between ages 40 and 60. Our guide to perimenopause headaches and dizziness explains how to tell it apart from other kinds of vertigo.

What else makes your ears ring in your 40s

Ordinary causes explain most tinnitus at any age, and several of them start showing up in midlife. Each one is worth ruling out before hormones get the credit.

• Hearing loss. The NIDCD calls hearing loss strongly linked to tinnitus. It says about 5% of adults aged 45 to 54 have disabling hearing loss, rising to 10% at 55 to 64. Gradual loss is easy to miss without a test.
• Noise. Years of loud work, concerts or earbuds add up. The NIDCD lists noise exposure among the main causes.
• Earwax. A plug of wax can cause muffled hearing, ringing, ear pain and itching, according to the AAO-HNS earwax guideline.
• Medicines. The NIDCD lists some antibiotics, NSAIDs like ibuprofen and some antidepressants at high doses. If the ringing began with a new prescription, that timing is worth raising.
• Frequent pain relievers. In a study following 69,455 women, frequent NSAID or acetaminophen use was linked with higher risk of lasting tinnitus. Low-dose aspirin was not.
• Jaw joint problems. TMD is the name for disorders of the jaw joint and chewing muscles. The NIDCR says it is twice as common in women, especially between 35 and 44.
• Blood pressure. A review of 19 studies suggests high blood pressure may be one risk factor for tinnitus. Whether one causes the other is still uncertain.
• Thyroid. Both an overactive and an underactive thyroid have been linked with tinnitus. A TSH blood test, the standard thyroid screen, checks for it.
• Caffeine. Cutting coffee is common advice with little support. In a study of 65,085 women followed for 18 years, higher caffeine intake was linked with lower risk of new tinnitus.
• Alcohol. There is no clear guidance either way. A two-week diary shows whether drinks change your ringing.

Does hormone therapy help, or hurt, tinnitus and hearing?

Hormone therapy, often called HRT, is not a treatment for tinnitus. The AAO-HNS tinnitus guideline does not list it, and the research points in both directions.

The largest study comes from the Nurses' Health Study II, which followed 80,972 US women from 1991 to 2013.

It found no overall link between going through menopause, natural or surgical, and self-reported hearing loss.

Among women past menopause, oral hormone therapy was linked with a higher risk of hearing loss. The longer women used it, the higher the risk.

The authors concluded that older age at menopause and longer use of postmenopausal hormone therapy are associated with higher risk of hearing loss. Hearing was self-reported, not measured, and the study looked at hormone pills.

Tinnitus studies conflict outright. A Taiwanese insurance study of 13,920 hormone users found fewer tinnitus diagnoses than in matched non-users.

A Korean survey study found the opposite. Longer hormone use was linked with more tinnitus, and the authors called for more research before drawing conclusions about cause.

Both are observational studies, which show links, not proof. Put together, hormone therapy is not something to start for ringing ears.

If you take it for hot flashes or sleep, note any change in your tinnitus, in either direction. Hormone therapy may also make dry eyes worse, as the dry eye section explains.

Our pillar guide to hormone therapy in perimenopause covers who it is meant for and what it does treat.

What actually helps tinnitus

The AAO-HNS tinnitus guideline focuses on adults whose ringing has lasted six months or more and bothers them. Most of its advice involves no pills at all.

• A hearing test. The guideline calls for a prompt one when tinnitus is in one ear, has lasted six months or comes with hearing trouble. An audiologist, a hearing specialist, does it.
• Hearing aids, if you have hearing loss. The guideline recommends a hearing aid evaluation for anyone with hearing loss and bothersome tinnitus.
• Over-the-counter hearing aids. Since October 17, 2022, the FDA allows them without an exam or prescription. They are for adults 18 and older with perceived mild to moderate hearing loss.
• When OTC aids are not the right start. The FDA says to see a professional first for sudden hearing change, hearing loss or ringing in one ear, ear pain, drainage or dizziness.
• Sound therapy. This uses background sound, such as a fan, white noise or a small sound generator, to make the ringing less noticeable. The guideline lists it as an option.
• Cognitive behavioral therapy, or CBT. This is talk therapy that teaches you to spot and change thoughts that drive distress. The guideline recommends it for persistent, bothersome tinnitus.
• Education. Understanding what tinnitus is and is not lowers the fear around it. The guideline asks clinicians to explain management options.

A bedside fan or a sound app at night is sound therapy in its simplest form. Many people start there.

The guideline is just as clear about what to skip.

• Routine drugs for the tinnitus itself. It advises against routinely using antidepressants, seizure medicines, anti-anxiety drugs or injections into the ear for tinnitus.
• Supplements. It recommends against ginkgo biloba, melatonin, zinc and other dietary supplements for tinnitus. The NIDCD adds that none of the advertised supplements has been proven to work.
• Magnetic brain stimulation. It advises against transcranial magnetic stimulation as a routine treatment.
• Routine scans. It advises against head and neck imaging unless the ringing is one-sided or pulsing, hearing is uneven, or there are nerve symptoms.
• Acupuncture. The guideline makes no recommendation either way.

Medicines for sleep or mood still have a place when insomnia or depression travel with the tinnitus. The NIDCD notes they treat those problems, not the sound.

Ear fullness or pressure in perimenopause

A plugged, full feeling in the ear has a short list of usual suspects. None of them has a proven hormonal cause.

• Eustachian tube problems. The Eustachian tube is a small channel from the middle ear to the back of the nose that balances air pressure. A cold, sinus infection or allergies can keep it from opening, so the ear feels blocked or crackles.
• A tube that stays open. Doctors call this a patulous Eustachian tube. You hear your own voice or breathing too loudly, with a full feeling.
• Weight loss and an open tube. A 2026 literature review describes cases after rapid weight loss, including bariatric surgery and GLP-1 weight-loss drugs. The authors say a cause has not been established.
• Earwax. A wax plug can feel like pressure, and it often muffles sound too.
• Jaw tension. Problems in the jaw joint sit right in front of the ear and can feel like ear trouble.
• Ménière's disease. Fullness in one ear with spinning attacks and fluctuating hearing is its classic pattern.
• Sudden hearing loss. The AAO-HNS lists ear pressure among its symptoms. A full ear with muffled hearing that came on over a few days belongs in the prompt-visit section above.

You may read that estrogen changes fluid balance inside the ear. That idea is still a hypothesis, so the usual causes get checked first.

Perimenopause ear pain: what's behind it

Ear pain with a normal-looking ear is common in adults. Doctors call it referred pain, meaning pain felt in the ear that starts somewhere nearby.

• The jaw joint. An American Family Physician review names jaw joint problems among the most common causes of referred ear pain. Clenching at night is a frequent trigger.
• Teeth. Dental disease, such as a cracked tooth or a cavity, is another common source of ear ache.
• Throat and neck. A sore throat or arthritis in the neck can also send pain to the ear.
• An outer ear infection. Often called swimmer's ear, it usually starts with severe ear pain, according to the Merck Manual. Water and cotton swabs make it more likely.
• Middle ear pressure. A blocked Eustachian tube after a cold can ache as well as feel full.

For jaw-related pain, the NIDCR suggests simple steps first. Eat soft foods, use heat or cold on the jaw with gentle stretches, and cut back on clenching and gum chewing.

A dentist can check for grinding wear on your teeth. The ear-pain signs that need a prompt visit are listed in the prompt-visit section above.

Itchy ears in perimenopause

Skin often gets drier around menopause, and the ear canal is lined with skin too. Dry skin is one of several reasons for that itch you cannot quite reach.

• Dry, flaky canal skin. Low oil in the ear canal leaves it itchy and flaky.
• Eczema, psoriasis or seborrheic dermatitis. These skin conditions can settle in the ear canal. The Merck Manual notes the damaged skin can then pick up infections.
• Contact allergy. Nickel earrings, hairspray, lotions and hair dye can all inflame ear skin, according to the Merck Manual.
• Fungal infection. Fungal ear infections tend to itch more than they hurt.
• Earwax buildup. The AAO-HNS earwax guideline lists itching among the symptoms of a wax plug.

The fix starts with what you stop doing. The AAO-HNS earwax guideline advises against cleaning ears with cotton swabs or small objects.

The guideline also reminds patients that earwax is natural and does not need removing every time. Swabs can scratch the canal, push wax deeper and keep the itch going.

Dropping triggers like a new hair product or nickel earrings helps contact allergy. For eczema in the canal, the Merck Manual describes steroid drops or creams and diluted aluminum acetate drops prescribed by a doctor.

Dry eyes in perimenopause: why it happens and what helps

Dry eye is the best-supported symptom on this page. The NEI lists being female and being 50 or older as risk factors.

The American Academy of Ophthalmology says dry eye is more common in women, especially after menopause. It adds that people make fewer tears with age because of hormonal changes.

TFOS DEWS II is an international expert review of dry eye. Its hormones report concluded that sex hormones, including estrogens and androgens, play a major role in the eye surface.

The same report ties hormones to why women get dry eye more often than men. Its epidemiology report adds that the gap between women and men becomes significant only with age.

Androgens are hormones like testosterone that women make too. They help the meibomian glands, tiny oil glands along the eyelid edge, make the oil that stops tears from evaporating.

Typical signs include a gritty or sandy feeling, stinging, red eyes and blurry vision when reading. Watery eyes can be a sign too, because irritated eyes flood with poor-quality tears.

Why hormone therapy may make dry eyes worse

The Women's Health Study analysis looked at 25,665 postmenopausal women and their hormone use.

Women taking estrogen alone had about 70% higher odds of dry eye than non-users. With a progestogen, a progesterone-like hormone, the rise was about 29%.

Each extra three years of use raised the risk by about 15%. The authors concluded that women who use hormone therapy, especially estrogen alone, are at increased risk of dry eye.

That was an observational study, and some smaller studies found hormone therapy eased eye symptoms. If your eyes got drier after starting hormones, that timing is worth mentioning to whoever prescribes them.

What helps, step by step

• Artificial tears. The NEI calls these the most common treatment for mild dry eye.
• Preservative-free drops. The American Academy of Ophthalmology advises them if you use drops more than six times a day, because preservatives can irritate.
• Warm compresses and lid care. Warm compresses, gentle eyelid massage and eyelid cleaners help the oil glands work.
• Your surroundings. A humidifier and regular breaks from screens help, per the NEI.
• Punctal plugs. These tiny silicone or gel plugs block the tear drains so your own tears stay longer.
• Prescription drops. Cyclosporine, sold as Restasis and Cequa, is approved to increase tear production when inflammation from dry eye has lowered it.
• Other prescription options. Lifitegrast, sold as Xiidra, and perfluorohexyloctane, sold as Miebo, are approved for the signs and symptoms of dry eye disease. So is varenicline nasal spray, sold as Tyrvaya.

Fish oil is a common suggestion with weak support. In the DREAM trial, 535 people with dry eye took omega-3 capsules or an olive oil placebo for a year.

Symptom scores improved by similar amounts in both groups, with no significant difference.

Dry eyes and dry mouth together: when to think of Sjögren's

Sjögren's disease is an autoimmune condition, meaning the immune system attacks the body's own tissue. It targets the glands that make tears and saliva.

MedlinePlus says it occurs most often in women aged 40 to 50, the same window as perimenopause.

The Sjögren's Foundation says nine in ten people diagnosed are women. It also warns the disease can mimic other conditions, so it is often overlooked.

Besides dry eyes and dry mouth, it can cause fatigue and joint pain. Some people have trouble swallowing dry food, more tooth decay or swollen glands near the jaw.

Think of it when dryness affects both your eyes and mouth and does not let up. Diagnosis usually involves several pieces.

• Blood tests. These look for antibodies called anti-Ro or SSA and anti-La or SSB, plus ANA and rheumatoid factor.
• A Schirmer test. A thin paper strip under the lower lid measures how many tears you make.
• A salivary gland biopsy. A small sample, often from inside the lip, can confirm the diagnosis.
• A rheumatologist. This specialist in autoimmune and joint diseases usually leads the workup.

Other eye changes in your 40s that aren't hormones

Struggling to read a menu or your phone is usually presbyopia, the stiffening of the eye's lens that makes close-up focus harder. The NEI says it usually starts after age 45.

It is a normal part of aging, not a hormone effect. Eye strain and headaches from squinting are common until you get reading glasses or the right prescription.

Long screen sessions also make dry eye worse, because you blink less while you stare. The NEI lists screen time among dry eye triggers.

An eyelid that twitches for days usually follows poor sleep, stress, caffeine and dry eyes. Our guide to perimenopause skin sensations covers eye twitching in detail.

Getting checked: which doctor and which tests

The NIDCD suggests starting with your primary care doctor for tinnitus. From there, the right next stop depends on the symptom.

• Primary care. An ear exam for wax or infection, a blood pressure check, a review of your medicines and a TSH thyroid test.
• An audiologist. A full hearing test, called an audiogram, plus advice on hearing aids or sound therapy.
• An ENT doctor. An otolaryngologist sees ringing that is one-sided, pulsing, sudden or long-lasting, and ear fullness that does not clear.
• An eye doctor. An optometrist or ophthalmologist can measure your tears and check the oil glands in your lids.
• A dentist. Grinding wear, jaw pain or tooth trouble behind an ear ache.
• A rheumatologist. When dry eyes and dry mouth come together and persist.

Bring a few notes. Write down when the ringing started, which ear, what it sounds like and whether it pulses. Add your cycle, hot flashes, sleep and any new medicines.

Hormone blood tests swing too much in perimenopause to explain a symptom like ringing. Our perimenopause labs guide explains which tests are useful, and our perimenopause symptoms list helps you see the whole pattern.