by Neil Bauman, Ph.D.

A lady explained:

I have recently started taking HRT [hormone replacement therapy] (estrogen only) via a transdermal patch 50mcg, for the last 11 weeks. Since starting HRT I have had a constant pain deep inside my left ear, with intermittent nerve pain radiating behind the ear. It can happen anytime and last from 1 min to 1 hr to all day.

My doctor has examined my ear but can not find anything wrong. I decided to stop the HRT for one week. The pain subsided quite dramatically, however my menopausal symptoms got worse. My doctor suggested I start a lower dose 25mcg. With the lower dose, the pain is mild compared to what it was, (I can live with it), the pain behind the ear has gone and my menopausal symptoms are manageable.

Do you think HRT could have caused this ear problem?

I haven’t heard of ear pain specifically associated with HRT, although it is a reported side effect of Progesterone and a number of “hormone” drugs, so I wouldn’t be at all surprised if that is what is happening. (Incidentally, a number of antidepressants have ear pain as a side effect too—all the SSRIs for example.)

The fact that when you stopped the HRT the pain went away is very strong circumstantial evidence that the pain was indeed related to the HRT. Also, the fact that the pain came back when you restarted the HRT is strong corroborating evidence. The clincher is that taking a reduced dose gives you reduced pain.

Obviously, taking the lowest dose that will control most of your symptoms is a wise way to go. Alternately, you could dump the HRT completely and use alternate medicine—herbals, etc. which can help relieve your symptoms without the painful side effects.