According to the 2009 Chorus Impact Study by Chorus America, 18% of the United States’ general population has one or more adults in their home singing in a choir ¹, many of them women, and yet even today, you find very little information on how menopause effects the female voice. In their recent publication, Singing Through Change: Women’s Voices in Midlife, Menopause and Beyond, authors Nancy Bos, Cate Frazier Neely and Joanne Bozeman shine a light on this rarely mentioned aspect of menopause, discussing the vocal challenges women face as a result of hormonal alterations. And although all three of these authors are professional singers and voice teachers, all women need to be aware of these potential vocal side effects.

The term menopause, (la méné-pausie) was penned in 1821 by the French doctor, Charles Pierre Louis De Gardanne². It officially begins twelve months after a woman’s last period³ and signals the end of women’s reproductive days ^4. Although the actual onset of menopause arrives on average at the age of 51, peri-menopause, can begin 2-10 years prior⁵ bringing with it a slew of vocal disruptions. While most women are familiar with other menopausal symptoms like hot flashes, mood fluctuations, headaches, insomnia and decreased concentration⁶, vocal changes are not commonly known.

My own menopausal journey began in my early 40’s when I began to experience joint pain, heart palpitations and back to back heavy periods. A simple hormone test revealed an estrogen level commonly found in menopausal women. My doctor immediately prescribed HRT for my bone health, but it also stabilized my singing voice. Most women may not notice or be concerned about vocal issues that occur during this period of their lives, but as a professional singer, vocal upheavals caused by peri-menopause proved to be both mentally and physically stressful.

As children we begin our lives with sexless voices⁷ until puberty when both males and females go through a physical, emotional and vocal evolution. Sex hormones are major players in the development of the voice throughout our lives, especially for females. From menses to pregnancy to menopause, women experience a continuum of vocal ups and downs.⁸

The larynx, where the vocal folds live, contains receptors for the reproductive hormones estrogen, progesterone and androgens.⁹ Variable and erratic changes to our hormonal equilibrium impose adjustments to our vocal behaviors. Androgen, a male hormone, becomes dominant when estrogen and progesterone levels drop. They thicken the vocal folds which lowers the voice¹⁰ (now you know why older women often sing in the tenor section!). Vocal fold secretions decrease and become more dense¹¹, contributing to frequent throat clearing, vocal dryness and hoarseness ¹². Edema is common in menopausal women¹³ because fewer cells¹⁴ and the diminished permeability of capillaris in the surface layer tissue of the vocal folds make room for fluid to move in, causing them to swell.¹⁵ Not surprisingly, this condition negatively affects the efficiency and ease of vibratory function so important in singing.

Hormonal changes also play havoc with the neuromuscular system. Low estrogen levels cause fiber loss and deterioration of laryngeal muscles, and stiffening and reduced mobility of neuromuscular junctions^{16 .} This adversely effects the cricoid thyroid muscles, limiting their ability to stretch the vocal folds (necessary for singing high notes) and the arytenoid muscles to firmly open and close them (creating difficulties with breath management). Complaints of unsteadiness and unresponsiveness to the vocal demands of singing are often heard during these years from female singers who keenly sense their diminishing vocal strength and power. ¹⁷

Other neurological issues involve delayed response times of the vagus nerve as a result of lowered estroprogestational hormones¹⁸. The chemicals involved in the nerve transmissions between the cortical, motor and sensory systems essential for the motor control of voice production, change significantly, slowing interactions.¹⁹ As the vagus nerve is responsible for innervating the laryngeal muscles, both articulation speed and vibrato rate are subsequently impeded making rapid enunciation difficult and creating what is often referred to as a wobble in older voices.²⁰

As if this was not enough, as we age, the respiratory system suffers loss of lung elasticity and abdominal muscle tone, declining oxygen diffusion, and up to 40% shrinkage of vital capacity (maximum volume of air that can be exchanged with the outside).²¹ This reduced lung power makes it difficult to sustain pitches, generate volume and maintain stamina throughout phrases.

So what does all this mean for you and your voice?

During my peri-menopausal years, my voice broke and cracked all over the place, and nothing I tried seemed to help. Even my voice teacher was befuddled. It never occurred to me that a dramatic drop in estrogen along with the constant fluctuation of my hormone levels, could be the reason behind my vocal problems, leaving me to navigate my singing through very stormy waters.

There was not much research back then on the effect of menopause or other hormonally produced vocal changes in women. Fortunately, this has changed somewhat, although much more research needs to be done. Even today, you will rarely find information on vocal side effects from menopause on most current websites that deal with this subject.

Since I was still singing, I continued my hormone therapy until my early 60s. Initially concerned about the consequences to my voice when I did stop, I began to enjoy a new vocal dependability and consistency. I have gradually accepted the evolution of my voice through not just menopause but the aging process. While I occasionally grieve the loss of my high notes, I admit to finding pleasure in the more robust, rich sound I now have in my lower range. I just knock songs down a few notches and have expanded my repertoire to include smoky jazz tunes!

The good news is, like any other muscle, exercise and training can keep voices fit and healthy (make sure that vocal symptoms are not the result of a medical condition). It can improve flexibility, accuracy and endurance. Menopause may leave our bodies with a different hormonal set up, but eventually it settles into a new equilibrium, providing for a more solid vocal foundation. At 68 I still teach voice and sing professionally and hope to do so for as long as I am able (Judy Collins is still giving concerts at 81!). I have students, both men and women, in their 60s and 70s whose voices are clear and youthful sounding.

Don’t give up singing, or shy away from speaking in front of a group if you experience any of these vocal difficulties. Our voices, like fingerprints, not only identity us, but gift us with a means to express ourselves. Keeping it strong and healthy allows us to continue to contribute and share who we are with the world.