Menopause…

While I’m sure this musical is a riot (and it’s better to laugh than to cry!), for many people, menopause causes massive changes and disrupts so many aspects of life and singing. Every person experiences it differently, and unfortunately, it can be far from funny.

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What happens during menopause?

Hormonal Change	Effect in body and on voice
Progesterone is reduced in premenopause	Irregular menstruation
Ovaries stop producing estrogen and ovarian follicles eventually disappear	No more menstruation Tissue atrophy and dryness (due to decreased muscle mass and lowered collagen synthesis), hoarseness
Higher levels of androgens	Affects brain (cerebral cortex), genital organs (uterus, ovaries, breasts) and striated muscles (which includes vocal muscles) Deepen the voice *after a certain period of time, this is irreversible
Fewer hormones	Thickened mucosa (can lower the voice as the folds are larger), folds less supple More swelling (edema in the Reinke’s space of the folds)

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Vocal syndrome of menopause

“…characterized by lowered vocal intensity, vocal fatigue, a decreased range with loss of the high tones and a loss of vocal quality.” (Abitbol 1999, 425).

• First symptoms are loss of high notes and pianissimi. Deterioration is progressive and slow.
• Loss or decrease in formants and consistent loss of harmonics, often described as feeling a loss of colour in the voice – confirmed by spectrographic analysis
• Loss of speed in staccato, loss of intensity at extremes of range
• Vocal smears (similarly to cervical smears) show significant reduction of glandular cells meaning the vocal folds will become very dry (Abitbol 1999, 440).

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Treatment?

• Seeing an endocrinologist or gynecologist with a special interest in endocrinology is best for treating patients who sing as therapy is highly individualized
• Early treatment at the start of menopause or before is critical as androgens can lower the voice permanently
• Replacement hormone therapy improves quality of life – prevents osteoporosis, cardiovascular risks, central nervous system diseases, dermatologic aging changes
• After 3 months treatment, should vocal fatigue persist, one should seek voice (laryngologic) therapy. This combined hormonal and voice therapy is most beneficial and has had good results.
• Laryngological clinical tests have shown good results with multi-vitamin therapy (magnesium, mineral salts, B5, B6, E) – to improve tone, amplitude and hydration of vocal folds (Abitbol 1999, 443).
• Begin planning repertoire which maybe sits lower and perhaps more comfortably in the voice

To show the possible effects and treatment outcomes of menopause on the voice, here are the results of a respected 1998 study done on 100 menopausal women:

Of the 100 women:

• 58 had no vocal trouble: scored fine on acoustic tests and dynamic vocal exploration. No treatment necessary.
• 42 women received replacement hormone therapy
  • 17 suffered postmenopausal vocal syndrome, but saw results after 6 months
    • 14 of the 17 saw dynamic vocal exploration return to normal (amplitude of vibrations) and no signs of muscle atrophy (regained normal contour of muscle); staccato speed and acoustic exploration also improved; vocal timbre improved. Some irregular/occasional high frequencies skidded.
    • 3 of the 17 regained anatomical functioning, but experienced little vocal improvement (amplitude, suppleness, volume). They needed to continue to transpose their pieces down.
• 38 had mild esophageal reflux. Inflammation and swelling were noted and treatment was given for these issues (Abitbol 1999, 441).

17% of the women in the study suffered postmenopausal vocal syndrome. Only 3% continued to have vocal difficulties after hormone therapy. If you are experiencing bothersome vocal changes, consider seeing a doctor to help. Don’t suffer and stress silently!

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So, should you suspect premenopause or menopause is at the root of new vocal issues, look for a doctor who can help you track your symptoms and help you through these changes so you can continue making music happily and healthily!

[toggle title=”References”]Abitbol, J., Abitbol, P. & Abitbol, B. (1999). Sex hormones and the female voice. Journal of Voice, 13:3, 424-446. https://doi.org/10.1016/S0892-1997(99)80048-4.

Lindholm, P., Vilkman, E., Raudaskoski, T., Suvanto-Luukkonen, E., & Kauppila,A. (1997). 
The effect of postmenopause and postmenopausal HRT on measured voice values and vocal symptoms, Maturitas, 28:1, 47-53. https://doi.org/10.1016/S0378-5122(97)00062-5.

Schneider, B., van Trotsenburg, M., Hanke, G., Bigenzahn, W. & Huber, J. (2004). Voice impairment and menopause. Menopause, 11(2), 151-158. doi: 10.1097/01.GME.0000094192.24934.46.[/toggle]