Peri‐ and Post‐Menopausal Hormone Replacement Therapy and Voice Disorder Risk: A TriNetX Study

OBJECTIVES: The aim of this study was to elucidate the risk of developing voice disorders among peri- and post-menopausal female hormone replacement therapy (HRT) users. METHODS: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Females aged 40-60 years old were included and stratified into two cohorts: HRT users (n = 16,586) and HRT non-users (n = 248,725) while excluding for head and neck radiation/neoplasms, smoking, benign laryngeal lesions, thyroid disorders, gender dysphoria, and any other systemic hormone use. Voice and resonance disorders (VRD) and dysphonia were separately assessed at 3-month intervals post-HRT initiation after propensity score-matching for age, sex, race, and ethnicity. Odds ratios (ORs) with 95% confidence intervals (CIs) and risk differences (RD) were generated to compare outcomes. RESULTS: HRT users had significantly higher odds of dysphonia, but not VRD, within 0-9 months (OR 1.72; 95% CI (1.01-2.95), OR 1.66; 95% CI (0.99-2.79), respectively). For HRT users with elevated BMI, the 1-year VRD incidence was not significantly different than non-HRT users (RD 0.19%, p = 0.069). Overall, the incidence of VRD and dysphonia within 1 year in both groups was < 0.5% and showed no significant difference at most times between groups. CONCLUSIONS: HRT may not have any significant clinical impact on the peri- and post-menopausal voice. Although higher odds were noted earlier after treatment, HRT users did not have higher odds of voice issues after 1 year. This study highlights the lack of consensus in literature and urges future research to fully understand the impact of HRT on peri- and post-menopausal voice.