Many women between the ages of 40 and 60 may experience vocal changes such as hoarseness and frequent throat clearing. A 2017 study revealed that approximately 46% of postmenopausal women reported changes in their voice, with 33% experiencing vocal discomfort.(1) These voice changes often stem from hormonal imbalances. Fluctuations in estrogen can affect the larynx, leading to increased mucus accumulation on the vocal cords and altered voice quality.
Understanding the connection between menopause and voice changes is crucial, as it empowers individuals to proactively manage these symptoms and take steps towards maintaining vocal health. Hormone replacement therapy (HRT), voice therapy, and certain lifestyle modifications are considered to be effective in supporting vocal function.
Mechanism of Voice Formation
The larynx, located in the throat, plays a critical role in breathing, swallowing, and voice production. It houses the vocal cords, which open to allow breathing and vibrate to create sound when speaking or singing. The resulting sounds are then shaped into speech by the tongue, lips, and teeth.(2)
How Menopause Affects the Voice
The voice is remarkably sensitive to subtle changes within the body. The larynx, or voice box, responds to hormone fluctuations, leading researchers to identify it as a "hormonal target." The shifts in hormone levels during menopause can cause noticeable changes in the voice.(1)(3)
These changes can particularly impact women who use their voices professionally, such as singers or public speakers. Many may find themselves unable to hit high notes or maintain their vocal range.
Research involving 100 professional female singers found that 17% experienced menopausal voice syndrome, which is characterized by reduced vocal intensity, increased voice fatigue, and a narrower vocal register.(1)
In broader studies, postmenopausal women frequently reported a variety of vocal symptoms:(1)
Throat dryness
Discomfort and voice fatigue
Frequent throat clearing
Lower voice frequency
Increased roughness and hoarseness
How can hormonal declines cause voice changes?
The decline in estrogen and progesterone during menopause can impact various body tissues that rely on these hormones for maintenance and health. For example, common menopausal symptoms include vaginal dryness and the thinning of tissues.
Similar effects are observed in the larynx, where reduced estrogen levels can lead to a loss of collagen and muscle mass, affecting the vocal cords.
Which hormones affect the vocal cords?
Studies have shown that vocal cords have receptors for estrogen and progesterone, highlighting their role in vocal health. Estrogen promotes the secretion of mucus from glandular cells around the vocal folds, improving mucosal viscosity and enhancing the permeability of blood vessels in the vocal cords. This leads to better tissue oxygenation, contributing to a clearer and stronger voice quality.(4)
Influence on the Larynx and Vocal Cords
The structural changes in the larynx during menopause mirror those seen in other hormonally sensitive tissues, such as the cervix. Studies indicate that postmenopausal women not on HRT often exhibit changes in the vocal folds akin to those seen in cervical tissue, showing signs of atrophy and dystrophy.(1)
These changes can manifest as vocal fatigue and dryness, posing specific challenges for individuals who depend heavily on their vocal abilities.(1)
The reduction in hormone levels can also contribute to dryness of the mucous membranes, complicating the recovery of normal vocal strength and endurance. These issues can impair vocal function, and for some individuals, it may take 48 hours to recuperate.
Professional Impact
Professional voice users often experience more pronounced effects of these changes, including muscular atrophy of the vocal folds and thinning of the vocal fold mucosa. These changes can result in increased vocal demands and a heightened awareness of vocal deterioration. Clinical studies, such as those conducted by Schneider et al., show that many menopausal women with vocal complaints exhibit symptoms like viscous mucosa, edema, or swelling of the vocal folds.(1)(5)
Voice Changes During Various Life Stages
Hormonal fluctuations impact women throughout their lives, not just during menopause but also around the menstrual cycle. For instance, hormonal fluctuations occurring a few days before menses can lead to physical and emotional symptoms known as premenstrual syndrome (PMS), which may include voice changes. This continuous variation in hormone levels highlights the significant influence of hormonal changes on vocal quality across a woman's lifespan. Menopausal changes are further compounded by age-related alterations in the larynx, such as the stiffening of vocal folds and potential ossification of cartilages, which can further affect vocal quality.(1)(6)
Other Reasons for Voice Changes
Hoarseness can stem from various causes beyond hormonal changes, such as the following:
Common Cold: Viral agents responsible for the common cold, such as rhinovirus and parainfluenza virus, can affect the vocal cords and cause hoarseness.(7)
Hormonal Disorders: Hypothyroidism and adrenal gland disorders can cause a hoarse voice by affecting vocal cord function.(8)
Medication Use: Certain drugs, particularly corticosteroids, can cause hoarseness if administered in high doses.(9)
Cancer: Laryngeal cancer can manifest in various ways and significantly impact voice quality.(10)
Managing Voice Changes During Menopause
The following approaches are considered effective for maintaining vocal health during menopause:(1)(3)
Voice Therapy: This can provide substantial benefits by incorporating techniques to rebuild muscle tone and enhance vocal efficiency, helping to reduce voice fatigue.
HRT: This form of treatment replaces declining hormones externally, helping improve vocal quality and overall well-being. Studies have shown that HRT can enhance both singing and speaking voice qualities.
Lifestyle Modifications: To effectively manage voice changes, it’s helpful to maintain adequate hydration to keep the vocal cords lubricated, use humidifiers to add moisture to the air (especially in dry environments), avoid irritants and smoke, and limit alcohol consumption to prevent dehydration and further impacts on the voice.
