Vocal coach Rebecca Reid explores how Menopause affects the singing voice and the best ways to manage symptoms.
It is widely accepted that the voice is a sensitive instrument, affected by ageing, allergies, infection and hormone fluctuations. Menopause, caused by deducing reproductive hormones, such as oestrogen and progestogen, is the natural female transition from reproductive to non-reproductive life.
Symptoms of Menopause
Natural Menopause can begin as early as the mid-30s or as late as the mid-50s and commonly lasts for over a decade. During this transition women experience a variety of physiological and psychological symptoms that vary in type and severity. Symptoms typically include, hot flashes/flushes, night sweats, depression, anxiety, insomnia, irritability, tiredness, fatigue, loss of concentration, mental clarity and mood swings, to name a few. Medical literature, however, consistently fails to mention vocal changes under the list of potential symptoms.
Menopause and the voice
Overall there is very little research that investigates the extent and effects of Menopause on the voice. This is partly due to the lack of understanding of how the Menopause or hormone fluctuations directly impacts the vocal mechanism. There is also the added difficulty of differentiating between symptoms relating to Menopause and those of general aging. The side effects of Menopause can affect a singer in several ways; physically, psychologically and vocally.
Both physiological and psychological symptoms can impact a singer’s performance. Physiological symptoms such as hot flushes/flashes and night sweats can potentially create an uncomfortable, anxious and an embarrassing performance experience. Equally, psychological symptoms can inhibit a singer’s ability to effectively memorise new repertoire or recall old repertoire. Whilst this does not directly affect the voice, in some cases this can result in singers discontinuing from public performance.
Vocal changes during and after Menopause vary in symptoms and severity. The most commonly reported vocal problems include loss of high notes, dryness, loss of flexibility, agility, decreased stamina and difficulties with breath management. This can lead singers to inappropriately moving down a voice type and can increase vocal health issues and prevent participation in public performances.
Vocal changes and management
Unfortunately, there is no definitive guide to managing either menopausal symptoms or vocal changes during and after Menopause because symptoms and the severity of those symptoms vary so widely. Menopausal symptoms are most prevalent during the perimenopause phase (the first two to five years) and are likely to improve as complete cessation of menstruating is complete. Vocal changes occurring as the result of Menopause, rather than related to technical flaws, are permanent and irreversible as the larynx is directly affected by the reduction in the body’s production of oestrogen.
There is also some research that demonstrates that using Hormone Replacement Therapy (HRT) can help prolong and/or minimise the effects of Menopause and/or ageing on the voice. Whilst HRT has proven to improve psychological signs of ageing, i.e., reducing the risks of developing dementia and Alzheimer’s, it has been strongly associated with the risks of developing cancer. If concerned about the range and severity of menopausal symptoms or vocal changes, seek advice from a health care professional who can advise appropriately.
Alternatives to HRT
If HRT is unsuitable, for whatever reason, there are alternative forms of treatment including, homoepathy, acupuncture, massage, reflexology, Tai Chi, yoga, osteopathy and Alexander Technique. Natural and/or herbal supplements such as, red clover, black kohash (believed to balance hormones), dong quai (to reduce hot flushes/flashes and night sweats), hops and valerian (for insomnia), St John’s Wort (anti-depressant), evening primrose oil (pre-menstrual stress), ginseng (increase energy levels and balance hormones), yarrow (lowers body temperature) and motherwort (anxiety and sleep) have been reported to improve symptoms.
Vocally, existing literature suggests that maintaining a healthy lifestyle, through diet and exercise, is key to maintaining a healthy voice. Engaging in activities such as, yoga and pilates is not only good for stretching out tense muscles but also maintaining the respiratory symptom, improving stamina and breath management. Vocalising every day has also been declared as essential to preventing further deterioration of vocal ability.
It is therefore important not to underestimate the importance of a good singing teacher. Investing in regular singing lessons, with a qualified and experienced teacher, can help with ironing out technical flaws, improving overall vocal health and assist with discovering the parameters of the new voice. As singing technique largely replies on the development of muscle memory, which can take at least three to four weeks to change, undertaking monthly, rather than weekly, lessons is an inexpensive and easy to fit around other work and family commitments.
At present, vocal pedagogues still have a lot to learn about how Menopause truly affects the voice. There is ongoing research and developments in technologies that are continuously improving our understanding. However, until we have acquired a definitive answer, Menopause is unavoidable and, a very personal experience, it is therefore essential to discover heathy strategies for managing menopausal and vocal symptoms that allow singers to continue to sing and perform for as long as possible.