Menopause and Your Voice: Why It Changes and What Can Help
Have you noticed that your voice doesn't sound quite like it used to?
Maybe it's a little deeper or raspier. Maybe it gets tired more easily, or you have trouble projecting it at the end of a long day. If you're a singer, some of the high notes that used to be easy suddenly aren't.
Voice changes are a common part of menopause, but we don't talk about them nearly as much as hot flashes or sleep problems. Studies suggest that up to about 46% of menopausal women notice perceptible changes in their voices.
Your voice is produced in the larynx, or voice box, which sits at the top of your windpipe. Inside the larynx are two vocal folds, often called vocal cords. Air coming up from your lungs passes between them and makes them vibrate, producing sound. The muscles and tissues surrounding the vocal folds then control the pitch, volume, and quality of that sound.
And those tissues are influenced by sex hormones.
You can see this most clearly during puberty, when testosterone causes the larynx and vocal folds to grow larger and thicker, deepening the voice, while estrogen and progesterone contribute to the smaller larynx and thinner folds typical of the female voice. Those same tissues keep responding to hormonal shifts for the rest of your life, which is exactly what happens at menopause, too.
What happens to your voice during menopause?
As estrogen and progesterone decline, the vocal folds and surrounding tissues change. The larynx has receptors for both hormones, and estrogen affects collagen, muscle, blood vessels, glands, and the mucosal surface that helps keep your vocal folds flexible and hydrated.
With menopause, the vocal folds can become less pliable and their mucosal surface can become drier. Changes in connective tissue and muscle can also affect how efficiently the folds vibrate. The result can be a lower pitch, changes in vocal quality, hoarseness, and vocal fatigue. Across studies, postmenopausal women's average speaking pitch is roughly one semitone lower than premenopausal women's, though individual changes vary.
There's also an androgen piece to this. Estrogen levels fall much more dramatically than testosterone levels during menopause, changing the balance between estrogen and androgens. The relative effect of testosterone and other androgens can therefore become more apparent, contributing to thickening of the vocal folds and a lower-pitched voice.
For most women, the changes are subtle: you often feel them before others hear them. Your voice may take longer to warm up, need more effort to project, or feel tired by the end of the day, and you might notice yourself clearing your throat more often.
For women who use their voices professionally, the same underlying changes can have a much bigger impact.
What about your singing voice during menopause?
The female voice is affected by hormonal fluctuations even before menopause. During the menstrual cycle, changes in estrogen and progesterone can affect the vocal-fold tissues and their mucus, which can alter how easily the folds vibrate. Some singers notice that their voices feel less flexible or that their highest notes are more difficult to reach around their periods.
Menopause takes those temporary hormonal fluctuations and replaces them with a much more sustained change in the hormonal environment. That can mean a lasting change in vocal range or quality, and the difference between a voice that is slightly deeper and a voice that has actually lost some of its upper range can be enormous to a professional singer. A few notes may make little difference in conversation but can change which music a singer can perform comfortably.
An older study of professional female singers found that 77% reported experiencing voice changes around menopause, most often difficulty reaching the highest notes, reduced flexibility, and changes in vocal control. This was a small study of professional singers, so the 77% figure shouldn't be applied to women generally. More recent research has similarly found that many female singers report menopause-related changes in vocal power, flexibility, endurance, and range.
Singers aren't the only ones whose careers depend on their voices. Teachers, lawyers, clergy, broadcasters, actors, therapists, physicians, and anyone else who spends much of the day speaking can find that a voice that becomes tired or difficult to project affects their work, even when the change would seem minor to someone listening to them.
Can menopause hormone therapy (MHT) help?
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