Menopausal Voice Syndrome and How to Overcome It
Menopause often occurs between the ages of 40 and 60 years old and there are a number of symptoms that a woman will endure as her body is changing. One symptom includes changed to your voice, which can dramatically affect the way you sing. The change to a woman's voice after menopause is inevitable but not often talked about, so here is a guide to what you should know about singing with menopause.
Menopausal voice syndrome refers to alterations in a menopausal woman's voice as her hormone levels change. Her voice may become hoarse, dry or fatigued, lose volume or range, deepen, or produce more mucous. These changes can be managed through healthy living, vocal exercises and hormone therapies.
Below you will find a more detailed explanation of the relationship between menopausal hormone levels and the changes they make to your voice. Most importantly, I have included management strategies for singing through menopause.
Hormonal Changes in Menopausal Voice Syndrome
Estrogen is the primary hormone responsible for the development and maintenance of female characteristics in the body. During menopause, estrogen levels start to decrease.
One known side effect of this is the drying out of particular body tissue, including the vocal cords. Just as women experience vaginal dryness, their vocal cords also experience the same changes.
A drop in estrogen also causes tissue, particularly muscle, to atrophy. This means they become thinner and weaker. Essentially, anything that you don't use regularly will start to lose muscle mass (if you don't use it, you'll lose it!). There are several muscles in the throat that contribute to your singing voice that can be affected by this.
Like estogen, progesterone also starts to decline during menopause. Lowered progesterone levels can cause cartilage tissue, such as that in the larynx, to stiffen (ossify). Stiffened tissue in the voice box then makes it harder to sing and can lead to vocal fatigue.
Progesterone has also been found to protect neural tissue (nerves), and therefore a decline in progesterone in the body can lead to less control over the voice. This is why many woman experience instability in their singing voice, which can also lower their confidence.
There are a number of androgens in the body that contribute to the hormonal balance which begin to increase during menopause. These are a group of hormones, which includes the hormone testosterone.
Testosterone is the leading hormone responsible for the development and maintenance of male characteristics in the body. It is high in men, but woman also always have low levels of testosterone present in their bodies.
The subtle increase in androgens within a menopausal woman's body causes the vocal cords to thicken and contributes to the stiffening of the voice box. I will explain more about the effect that each of the above hormones have on a woman's singing voice below.
What Changes Can I Expect with Menopause?
Here is a list of what you can expect when you (ladies) inevitably journey through menopause. You may only experience one or two of these changes, but some woman can experience all of them.
Understandably, this can be devastating to a singer. But don't worry, once you have prepared yourself for these changes, you can find ways of managing these changes further down.
Deeper Voice and Change in Tone
If you've ever spoken to an elderly woman over the phone, you may have noticed that many older women develop a lower voice than they had in their younger days. This is thanks to the increase in androgens I mentioned earlier. Much like a boy going through puberty, an increase in hormones such as testosterone causes the voice to deepen and change tone.
Having a deeper voice automatically makes it harder to reach those higher notes when you sing, but menopausal women can also experience a decrease in their range.
Unfortunately, the stiffening of the vocal cords and weakness of the surrounding muscles, means that the vocal cords can no longer be stretched as far and wide as they could before. This is what allows us to sing higher and lower.
Less Volume and Fatigue
Weaker muscles, due to atrophy, also make the voice become fatigued more easily. This is similar to if you haven't been for a walk in a long time and then try to climb up a hill. You muscles would tire much more quickly than if you had been walking and keeping those muscles strong.
One key difference with this walking analogy is that this change happens regardless of whether or not you have been singing regularly. The hormonal changes are inevitable, but don't need to be permanent. You can find out more about building this muscle tone below.
The stiffening of the voice box, due to ossification of cartilage and other factors, also contributes to this fatigue. Your muscles have to work even harder to produce the same sound because the entire voice box is no longer as elastic as it was before. As a result, you may also find that the overall volume of your voice is lower as well.
Frequent Throat Clearing
Some of these hormonal changes also cause a build-up of mucous in your throat. This is why many menopausal woman find themselves clearing their throat more often. Excess mucous also makes the voice less stable, causing it to cut in and out and crack unexpectedly.
Hoarseness and Dryness
Both frequent throat clearing and the structural changes mentioned above can cause the voice to become quite hoarse. These changes can be likened to those observed in long-term smokers.
As I mentioned earlier, despite having excess mucous in the throat, the vocal cords can also become quite dry. Vocal cords are made of the same body tissue as that found in the vaginal canal. Therefore, women who experience vaginal dryness during menopause are likely to also suffer from dry vocal cords.
Dry vocal cords can lead to damage from small tears, much like your knuckles cracking when your skin is too dry. If this damage is ongoing, it can have long-term effects, such as chronic thickening of the vocal cords or the formation of nodules. These can then contribute to the hoarse sound of the voice.
Overcoming Menopausal Voice Syndrome
This may all seem like doom and gloom to a professional singer. However, menopause does not have to be the end of your singing career. Some of these changes are only temporary and can right themselves once your hormones have levelled out (which aligns with when the hot flashes start to disappear).
The main concern is the permanent changes to the voice box that can occur with improper care. Chronic dryness and atrophy of the muscles are both something that can be overcome with appropriate care. Permanent changes to the hormone levels however, may require hormone therapy if you do not want their effects to be permanent.
Hormone therapies aim to supplement the lack of estrogen and progesterone in the body to bring your hormone levels back to their pre-menopausal levels. These therapies range from pills ('HRT') to creams and patches. Some offer synthetic hormone replacement, while others offer more natural hormones.
Hormone therapy is a personal choice and the side effects of taking these should be considered carefully, particularly with the use of synthetic (man-made) hormones. Each therapy comes with its own side effects and improper use can cause major problems if the hormone levels are tipped too far the other way.
In saying that, many women have found they were able to reverse the effects that menopause had on their voice by using a hormone therapy. Bringing the estrogen and progesterone levels back up to where they were before counteracts the rise in androgens and also counteracts muscle atrophy, stiffening of the voice box, etc.
Preventing Muscle Atrophy
If you prefer to choose a more natural approach to managing your menopausal voice, or hormone therapy is not working for you, you can try strengthening the muscles around your vocal cords. Stronger muscles are able to handle the increased stiffness of the cartilage and vocal cords and will not tire as easily.
You may have already been doing vocal exercises on a regular basis, but these are the key to keeping your muscles strong and healthy. Like I mentioned earlier, if your don't use them, you'll lose them. You may even benefit from a vocal coach who can target exactly which muscles you need to strengthen, and which exercises you can do.
To keep these muscles strong, you should ideally be doing vocal exercises each day, stretching your voice to its (comfortable) limits. This includes exercises such as ascending and descending scales, sirens, vocal yawns, etc. Also, training your muscles will allow you to produce a large controlled sound with minimal effort.
However, you must always listen to your body. If your voice is tired, let it rest. Those that go to the gym allow their muscles to recover and only push themselves to their limits. Continuing to use your muscles beyond their limits can result in damage.
Preventing Dry Vocal Cords
Preventing dry skin is a lot easier than preventing dry vocal cords because it is easy to use lotions to moisten the skin. Vocal cords require more disciplined care. It takes approximately three hours for the water your drink to hydrate your vocal cords, so you need to make sure you are drinking regularly to stay hydrated.
As a recommendation, you should be drinking a little bit of water every half hour to maintain constant hydration. Assuming you are awake for 14 hours each day, this equates to approximately 1/3rd of a cup every half hour, which can be easily achieved by keeping a drink bottle nearby to sip throughout the day.
You can also consider using a vocal steamer to hydrate your vocal cords before a performance or rehearsal. The warm moist air from the steamer provides instant (although temporary) relief from dry vocal cords.