BACKGROUND: Epidemiological studies have shown that women have better high-frequency thresholds than men in virtually all age groups, and that age-related hearing decline starts after 30 in men but not until after the age of 50 in women. This coincides with the menopausal transition in most women, thus leading us to hypothesize that the menopause triggers auditory deterioration, possibly due to reduced levels of endogenous estrogens, which are known to have protective effects on the auditory system. METHODS: 104 women with a mean age 51.2 at baseline, were tested with pure tone audiometry twice with an average interval of 7.5 years. The age at the final menstrual period (FMP) was reported by all women. Hearing decline at individual frequencies was calculated. RESULTS: Women with a FMP 0-4 years ago, had a rate of high frequency hearing decline of 0.9-1.5dB/year in the left ear, those with 5-7 years since the FMP had a corresponding rate of 1.1-1.5dB/year in the right ear, and 8-13 years after the FMP the decline was more subtle, 0.7-1.1dB/year in both ears. CONCLUSION: The menopause appears to act as a trigger of a relatively rapid age-related hearing decline in healthy women, starting in the left ear.