Tinnitus

Tinnitus is hearing a sound that does not come from outside you. The NHS says it is not usually a sign of anything serious and may get better on its own.

NHS inform, the health information site of the NHS in Scotland, lists tinnitus among the common symptoms of the menopause. The main NHS website's menopause pages do not, and NICE NG23 does not mention it. So the link is on record, but it is a light one, and other causes matter.

The NHS lists the sounds people hear: ringing, buzzing, whooshing, humming, hissing, throbbing, and sometimes music or singing. It can be in one ear, both ears or inside the head. It may come and go or never stop.

For many people the sound is only half of it. The other half is lying awake listening to it, finding it hard to concentrate, and feeling low or anxious because it will not stop. The NHS names sleep, concentration and anxiety as reasons to see a GP, so those effects count.

NHS inform lists tinnitus with the menopause but does not explain a cause, and we will not guess one.

The NHS tinnitus page says the cause is not always clear, and that it is often linked to some form of hearing loss, Ménière's disease, conditions such as diabetes, thyroid disorders or multiple sclerosis, anxiety or depression, and some medicines. It names some chemotherapy medicines, some antibiotics, anti-inflammatory painkillers and aspirin.

That list is why a check-up matters. A GP looking in your ears may find something simple, like earwax or an infection, before anything else is considered.

The NHS tinnitus page lists these ways to cope:

• try to relax; it mentions deep breathing and yoga
• look after your sleep, with a bedtime routine and less caffeine
• avoid things that make tinnitus worse, such as stress and loud background noise
• avoid total silence; soft music or sounds, called sound therapy, can take your attention off it
• try not to focus on it; hobbies and activities can help
• join a support group, because talking to others with tinnitus may help

If poor sleep is part of the picture, see sleep disruption.

The NHS says a GP will look in your ears for something treatable, like an infection or a build-up of earwax, and may check your hearing or refer you to a specialist.

If the cause is unknown or cannot be treated, the NHS lists talking therapies a GP or specialist may refer you for: CBT, to change how you think about tinnitus and ease anxiety; tinnitus counselling; and tinnitus retraining therapy, which uses sound to help you tune it out. It says it is unclear whether retraining therapy works for everyone. If you have hearing loss, hearing aids may be suggested. CBT for menopause explains what CBT involves.

The NHS says to see a GP if you have tinnitus regularly or all the time, if it is getting worse, or if it is affecting your sleep or concentration or making you anxious or low. Its dizziness page adds that ringing in the ears with dizziness is a reason to see a GP too.

Ask for an urgent appointment if the sound beats in time with your pulse.

Get emergency help if tinnitus comes after a head injury, or with sudden hearing loss, weakness in the muscles of your face, or a spinning feeling.

The quietest hours are often the ones women keep for themselves: tahajjud, Fajr before the house wakes, a few pages of the Quran at night. In a silent room, tinnitus is hard to ignore. The NHS advice to avoid total silence is worth knowing for those hours, and how you fill them is yours to choose.

At home, a symptom nobody else can hear is easily doubted. Writing down when it happens, and how it affects your sleep, is evidence you can take to your appointment.