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Voice changes in perimenopause

I’m fresh from The Menopause Society Annual Meeting and have so much to tell you. The next few weeks will feature information you won’t want to miss!

This week’s article is all about voice changes in perimenopause and menopause. Next week’s article will cover the conference and my biggest takeaways, the ones you will be most interested in and the most practical for us. I’ll also explain what all of the excitement over The Menopause Society is about.

Voices Carry

Are you perimenopausal and noticing unexpected changes in your voice? Is it something that is low-key bothering you, or have you seen major changes? Have you considered that it could be perimenopause-related?¹

Have you noticed:

• Hoarseness

• Vocal fatigue (pain, reduction in the ability to talk, pitch issues, unstable voice)

• Scratchy throat

• Throat clearing

• Chronic cough

• Scratchy voice

• Deeper voice (or your voice sounding differently to you)

Here’s a sample of my voice from the afternoon. It sounds different to me than in my younger days.

I deal with throat clearing a lot, especially in the morning. Had I recorded this sample in the morning, you would have heard the unevenness in my voice, as if I were a boy going through puberty.

If you’re comforted by my voice and want to listen to it for 45 minutes, listen to my recent podcast guest appearance to talk about Perimenopause & Disordered Eating: The Surprising Connection with

Jane Pilger

.

Are You Super Duper?

Voice superusers are those who use their voices for a living, such as singers, call center representatives, and teachers. A superuser is anyone who relies heavily on their voice throughout the day (Do screaming parents count?).

Special consideration should be taken by these individuals as well as everyone else to try to preserve their voices, so the first steps are understanding what’s happening, why it’s happening, and what to do about it. Let’s chat!

Talking Loud and Clear

“The human voice carries identity, love, emotions.” - Dr. Yael Bensoussan, director of the University of South Florida Health System Voice Center (see more about her in the footnote).

Our voice helps us to connect with people, be understood, and express our emotions. It gives us power and influence, helps us educate, and keeps our families safe (“No, Timmy, don’t touch the stove!”). Laughing, which is so fundamental to our mental health, is also tied to our voices.

Our voices are unique to us. Even identical twins can have different voice characteristics.

Our voices are the legacy we leave behind either through recording or being imprinted into our loved ones’ brains.

So when changes happen to our voices and cause us to not feel or sound like ourselves, they can be very alarming. As you can imagine, I’m not thrilled by the changes in my voice, especially added to everything else going on in my body. When I hear my voice now, it’s just another reminder that I’m aging.

Why Do Voice Changes Happen in Perimenopause?

Voice is controlled by an organ called the larynx (also called the voice box) in our throat. It looks like a vulva (the entrance area of the vagina). Breathing supports our voice.

As we age and go through perimenopause, some changes start happening to our vocal cords (a muscle within the larynx) and our larynx that cause structural changes:

• Muscle atrophy (vocal cords break down)

• Gets dry

• Gets thinner

• Doesn’t perform its function as well (the larynx vibrates, which is needed for speech)

Where else do these symptoms typically appear? As I mentioned above, the larynx resembles a vulva. The same changes that are happening with your vulva and inside your vagina are the same things happening that can affect your voice.

These changes can deepen the pitch of our voices, how clear our voices sound, the smoothness of our voices, and our ability to project our voices like when we’re speaking without a microphone. These changes start in perimenopause and continue past menopause into your post-menopausal years.

Prior to perimenopause until around age 35, the average adult female voice pitch is 180 - 250 Hz, while the average male voice pitch is 100 - 150 Hz. The pitch is what makes us sound more female or male.

Through these hormonal changes and aging, our voice pitch can be significantly affected. Female voices around the age of 55 “typically drops to between 130.4 and 150 Hz.” As women age, our pitch becomes more similar to the male voice.² In other words, we start sounding like dudes.

Respiratory function also declines in perimenopause. I don’t like to “blame” one hormone over another for causing this, but some scientists are recognizing that progesterone may have an effect on our respiration in addition to estrogen. More research is needed. Researching hormones and hormonal functions is still in its infancy of understanding. However, we know that the larynx is dependent on estrogen.

33% of women will experience impactful changes to their voices during perimenopause or menopause, per Dr. Bensoussan.

Let’s Give Them Something to Talk About

Testosterone hormone supplement and voice changes

I haven’t posted my article on hormone therapy yet, but for now, I can tell you that The Menopause Society does not support the use of testosterone in perimenopausal women.³ Why? There isn’t enough evidence that A) it works and B) the benefits outweigh the risks. I know this may anger you or leave you confused because you’re hearing that women are taking testosterone, especially for low libido or sexual functioning.

Dr. Bensoussan cautioned against using testosterone hormones because it may affect our voices, which could be long-lasting and possibly permanent. She recommended that all medical providers counsel their patients about the effects supplemental testosterone has on our voices.

She has noticed a “rough quality” to the voices of women using testosterone and a deepening of the voice pitch closer to a man’s pitch (closer than what it would sound like without supplemental testosterone).

She said she notices vocal changes in her patients who use testosterone around 15 months after starting it, but it could take up to 24 months to develop. ⁴ This happens because vocal cord testosterone receptors receiving supplemental testosterone make the vocal cords thicker, which brings down the pitch. She has also had female patients who report getting confused for a man on the phone, “sir.” The women in her clinic were not counseled by their prescribing provider on the risks of taking testosterone and came to her clinic in tears about their voices.

If you think about it, it makes sense. Testosterone is given to women during gender transition to help them to look and sound more masculine. Granted, more testosterone is given to this population, and the effects on our voices are dose-dependent (meaning how much testosterone is given), as well as the testosterone concentrations in our body (which tend to build up over time when given hormonal testosterone).

Let me clarify: There are no FDA-approved testosterone hormone therapies for women in the US. This means, in practical terms, that if you could get a doctor to prescribe it for you, it most likely wouldn’t be covered by insurance. The decision is made by experts who follow the science, and the science right now says that there isn’t enough evidence.

Might it help, and science just hasn’t figured it out yet? Maybe, but it’s possible the risks outweigh the benefits. Male pattern side effects such as hair loss, acne, and facial hair have been reported when taking testosterone by women (especially oral vs. transdermal on the skin).⁵ We also don’t know the long-term consequences of using supplemental testosterone. Might your vagina grow balls? Who knows! But seriously, we don’t know the long-term effects on our hearts, our brains, our bodies, our healthspan (how long we can live a healthy, non-bedridden life), and our lifespan. Another area where more research is needed. Someone should start keeping a list.

What can we do about our changing voices?

I’m disappointed to realize that I’m going to have to stop screaming now that I’m perimenopausal if I want to preserve my voice. That can be hard when we’re also dealing with perimenopause rage, short tempers, and aggravation.

The first thing we can do is not to assume that all voice changes are due to perimenopause. There are other conditions that can mimic these changes, so it’s best to start with your primary care physician. Acid reflux and other conditions can affect our voices and should be addressed by a physician.

Luckily, there is plenty that can help our voices during this time:

Water and water-filled foods: Drinking the right amount of water can help your body be hydrated and your larynx from drying out. Alcohol and caffeine can affect your voice by being a drying agent. Watermelon and other fruits and some veggies like cucumber provide high cellular hydration and are very refreshing to our bodies. Warm water may also be helpful.

Protect Your Voice: Try to limit shouting and screaming as much as possible.

Warm Up: If you are giving an important talk or singing performance and want to sound clearer, warm up your voice with vocal exercises. I’m sure that there are a ton of resources on YouTube or call up Taylor Swift who I’m sure will be happy to give you some pointers.

Improve Breathing: By the time we reach adulthood, we often become chest breathers instead of belly breathers. Relearn how to breathe properly to support your voice. Breath by James Nestor is a popular book.

Lifestyle: Same old advice, but it works - eat healthy, exercise, take care of yourself. Smoking can cause a “smoker’s voice.” Dr. Bensoussan says that there hasn’t been too much science available to understand the effects of vaping on voice, so if this is something that concerns you, stay tuned for further research from her.

Humidifier: A humidifier in dryer and colder climates may help increase the humidity in your home. Humidity = moisture.

Medical Help: If you have concerns, check your insurance to see if you can self-refer to an ENT (ear, nose, and throat doctor) otherwise start with your primary care provider. A speech-language pathologist (SLP) can diagnose vocal changes and recommend treatments. Speech therapy may be helpful, or surgery may be needed.

Everybody’s Talkin’

This is one of my favorite songs, thanks Harry Nilsson.

I also learned during this lecture that voice can now be used as a biomarker of health thanks to new AI diagnostic tools. This means that the medical community can diagnose issues within our bodies using our voices, not just voice-related issues. Although it was believed to be the case within the industry, they had to prove it, and now, with these new AI tools, it has become evident that health and voice are linked.

Fun fact: Any AI tool developed that is diagnostic must be approved by the FDA in the US.

The moment I realized I lost my voice….

I was speechless! Folks, I’m here all week. If I don’t laugh about my voice changes, the only alternative is to cry.

Has perimenopause got your voice down?

If you enjoyed this article, please consider leaving a comment, liking it, or sharing it with a friend.

Be well, stay cool…

Disclaimer, Content Use Policy, Privacy Policy

1. The voice lecture at the 2024 The Menopause Society Annual Meeting was given by the amazing Yael Bensoussan, MD from the University of South Florida’s health system, Tampa (USF Health Voice Center). She specializes in voice surgery and is an NIH funded researcher. Her passion for this topic was contagious. She brought this topic to life and made it applicable and practical. Her talk was titled “Voice as a Biomarker of Health.”

2. Scott, Carolyn. “Menopause, Confidence Loss and the Voice.” Nursing in Practice, 18 Oct. 2023, www.nursinginpractice.com/clinical/womens-health/menopause-confidence-loss-and-the-voice/#:~:text=As%20women%20age%2C%20their%20pitch%20becomes%20similar%20to%20the%20male%20voice.&text=Research%20has%20suggested%20that%20at. Accessed 19 Sept. 2024.

3. “Testosterone therapy is recommended for management of hypoactive sexual desire disorder in select, appropriately screened postmenopausal women.” per The Menopause Society’s Statement on Misinformation Surrounding Hormone Therapy published on 9/30/24. Hypoactive sexual desire disorder is a clinical diagnosis, not a self-reported symptom. During perimenopause, testosterone levels are stable, and it’s not until after menopause that they begin to decline, which may be one reason testosterone supplementation is not recommended until after reaching menopause. Declining testosterone is usually a function of aging and not the menopause transition.

4. Huang G, Pencina KM, Coady JA, Beleva YM, Bhasin S, Basaria S. Functional Voice Testing Detects Early Changes in Vocal Pitch in Women During Testosterone Administration. J Clin Endocrinol Metab. 2015 Jun;100(6):2254-60. doi: 10.1210/jc.2015-1669. Epub 2015 Apr 15. PMID: 25875779; PMCID: PMC4454796. https://pubmed.ncbi.nlm.nih.gov/25875779/

5. Al-Imari, Lina, and Wendy L. Wolfman. “The Safety of Testosterone Therapy in Women.” Journal of Obstetrics and Gynaecology Canada, vol. 34, no. 9, Sept. 2012, pp. 859–865, www.jogc.com/article/S1701-2163(16)35385-3/pdf, https://doi.org/10.1016/s1701-2163(16)35385-3. and more up-to-date Martínez-García A, Davis SR. Testosterone use in postmenopausal women. Climacteric. 2021 Feb;24(1):46-50. doi: 10.1080/13697137.2020.1796961. Epub 2020 Jul 24. PMID: 32705895.