Singing during the years around menopause can bring unforeseen challenges for some women. To Elaine, a 56-year-old professional singer and voice teacher, her voice has felt like a mystery for the last few years. Her vibrato was wider than it used to be, her usual songs didn’t feel good anymore, and her flexibility and agility had decreased.

On top of that, the vocal transition, or break, between her high and low ranges was difficult to navigate. She was frustrated and sad, not knowing if she would ever enjoy singing again. “I couldn’t figure out what I was doing wrong. Plus, I felt I was losing my vocal identity.”

Like other women, she wondered if she was good enough to sing performances anymore. The burden of self-doubt and anxiety impacted everything she sang. There was more going on as well. “During perimenopause, I experienced horrible night sweats which meant very poor sleep. I am still not sleeping well and rarely sleep through the night.”

We want to help every woman who sings understand she is not alone.

Until recently, voice changes from menopause and aging have been almost unmentionable. If a woman talked about her challenges, especially if she was a professional singer, it could have meant decreased opportunities and even the end of her career. Most women have stayed silent, coping as best as they can, assuming that they have to deal with their baffling voice issues by themselves. But that is not the case. Millions of women around the world are on the same path, and we no longer need to walk that path alone. Working together gives us a better understanding of the vocal issues women might face and how to minimize them.

So how exactly do menopause and the changing hormonal landscape that women experience impact the voice?

Estrogen is a major player, vocally speaking.

Estrogen:

• causes suppleness of the vocal folds’ upper surface (the mucosal layer)
• supports the glands that produce the thin mucus that coats the surface of the vocal folds
• maintains tone and bulk of skeletal muscles, including the deepest layer of the vocal folds, which produce lower pitches, and the tiny muscles that produce higher pitches
• blocks the effects of androgens (testosterone), preventing lowering and thickening of the voice
• increases oxygenation to the folds by improving the permeability of the blood vessels and capillaries

Progesterone has positive and negative effects on singing.

Progesterone:

• balances effects of estrogen throughout the body
• encourages the surface of the mucous membrane of the folds to slough off
• causes decreased and thickened secretions of the outer layer of the vocal folds, resulting in drier vocal folds
• decreases permeability of the fold capillaries, leading to swollen vocal folds
• may be involved in neuromuscular activity, supporting quick responsiveness of the laryngeal muscles

Androgens, including testosterone, are naturally secreted in women’s bodies.

Androgens can:

• cause the vocal folds to thicken, which lowers pitch
• increase dryness of the vocal folds due to changes in the glands that secrete fluids near the vocal folds

During the perimenopausal phase, there will be times when hormones fluctuate substantially from day to day. The voice, unfortunately, can then become unreliable and unpredictable because of the hormone roller coaster. At certain phases of the hormonal journey, many women need empathy and skilled assistance. Support comes through respecting what singers are experiencing, assisting with solutions as needed and encouraging them to continue singing. Knowing they are not alone can be an enormous relief. Voice is intimately linked with identity. When a woman’s voice is not functioning as expected, it can throw her life off balance. We encourage women to listen to their bodies and hear what their bodies are telling them through their symptoms.

Fortunately, not all women experience serious voice problems in the menopausal transition. It’s not our aim as researchers and authors to create only negative expectations. However, saying nothing or highlighting only positive experiences is not helpful for the women who do have trouble. For those with no major vocal issues during these years, learning about the hormonal shifts versus the effects of aging can also be beneficial and empowering.

But how do we know when we need help to sort out our voices? Most adults have an idea of when they don’t feel well and need to see a primary care doctor, go to a clinic, or to the emergency room. We generally know the typical symptoms of something that needs immediate attention or when our condition warrants a “wait and see” approach.

Decisions about voice care, however, may not be so obvious to us. But, if we learn the basic symptoms, we’ll have a better idea about whether a voice condition needs immediate care or whether we can wait and see if the voice gets better over time.

The therapeutic aspects of voice lessons and the community of a choir can make a world of difference for a singer. There are no guarantees of quality, regardless of experience and training of the coach. Ideally, choir directors or singing teachers should be able to help a singer explore vocal issues and refer to other appropriate voice specialists when necessary.

Another valuable resource for women who are sorting out voice issues are singing voice-qualified speech-language pathologists. These specialists can help a woman re-balance her voice, deal with technical frustrations that may have developed, and establish appropriate singing habits. They are well-equipped to help singers through a vocal rough patch with targeted voice therapy and singing technique.

Because of a variety of factors, many women have few options for help. But if there are multiple possibilities, seek out a person with patience, compassion, healthy personal boundaries, flexibility, humor, and the ability to inspire.

The good news is that because of rapid advances in communication and health sciences, women all over the world are now able to find help to overcome these vocal issues and the emotional challenges throughout this potentially disruptive time.

Nancy Bos, Cate Frazier-Neely, and Joanne Bozeman are voice teachers and authors of the book Singing Through Change: Women’s Voices in Midlife, Menopause, and Beyond.

Image credit: Shutterstock.com