Hormonal Contraception and Vestibular Disorders: A Narrative Review of Clinical Implications, Diagnostic Challenges,...

Hormonal influences on inner ear physiology are increasingly recognized, particularly in cochlear function; however, their role in vestibular physiology remains incompletely understood. Hormonal contraceptives represent a major source of exogenous hormonal exposure, yet their effects on vestibular function, symptom expression, and vestibular diagnostic testing remain poorly defined. This review aimed to synthesize current evidence regarding the interactions between hormonal contraceptives and the vestibular system, including biological mechanisms, clinical implications, and diagnostic considerations. A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and Web of Science databases (January 1990-February 2026). Experimental, observational, and translational studies evaluating hormonal effects on vestibular or related neuro-otologic systems were included. Findings were synthesized qualitatively because of methodological heterogeneity and the absence of randomized controlled trials. Available evidence demonstrates the presence of estrogen and progesterone receptors in peripheral and central vestibular structures, supporting the biological plausibility of hormonal modulation. Proposed mechanisms include alterations in ion transport, endolymphatic homeostasis, microvascular perfusion, neurotransmission, and central sensory integration. Clinically, vestibular disorders such as vestibular migraine, Ménière's disease, and persistent postural-perceptual dizziness show female predominance and symptom fluctuation during hormonal transitions. However, evidence directly linking hormonal contraceptive use with consistent changes in vestibular disease onset, severity, or progression remains limited and heterogeneous. Across vestibular diagnostic modalities, including video head impulse test, vestibular evoked myogenic potentials, videonystagmography, caloric testing, and posturography, no reproducible or clinically significant hormonal effects have been consistently demonstrated in healthy individuals. Current evidence suggests that hormonal contraceptives may act as modulators of vestibular symptoms in susceptible patients, although causality remains unproven. Further prospective vestibular-specific studies are required to clarify their impact on vestibular physiology and clinical disease expression.