Why Perimenopausal Women Are at Higher Risk for Hearing Loss and Cognitive Decline

Haver emphasizes that the current medical system treats hearing, cognition, and hormones as three separate systems, when in reality they are tightly coupled. Because perimenopause marks a dramatic drop in neuroprotective estrogen, the auditory system—richly populated with estrogen receptors—becomes more vulnerable at exactly the same time that midlife brain changes increase dementia susceptibility. By proactively testing hearing during perimenopause, women can catch auditory decline before it manifests as communication difficulties or cognitive strain, potentially using interventions like hearing aids, auditory training, or lifestyle adjustments to preserve brain function. She frames this not as an optional check for those with complaints, but as a preventative step analogous to blood pressure screening, made urgent by the compounding risk of unaided hearing loss and estrogen loss on dementia.

Mary Claire Haver explains that estrogen receptors are present from the cochlea all the way up to the central auditory structures of the brain. Estrogen acts as a neuroprotective agent for hearing. When levels fall in perimenopause, that protection is lost, leading to reduced auditory sensitivity, poorer speech-in-noise processing, more tinnitus, and measurable changes in brain responses to sound. A UK Biobank analysis of over 214,000 women confirmed that both natural and surgical menopause independently raise the risk of hearing loss, with premature menopause conferring the highest risk. The article in Trends in Cognitive Science ties these changes directly to dementia risk: hearing loss already accounts for roughly 7% of population-level dementia risk, and women with hearing loss suffer greater cognitive decline than men with the same hearing deficit. Haver argues that the simultaneous disruption of estrogen to both auditory and cognitive systems creates a compounding effect that is largely unrecognized in clinical practice, where 69% of symptomatic menopausal women receive no treatment and one in three sees multiple providers before learning they are in perimenopause.