Monthly cycles

Some women's voices fluctuate just as their monthly hormones predictably ebb and flow. Usually, these changes show up in the voice right before menstruation occurs, although some women note changes during ovulation.

Voice changes — due to falling estrogen levels — usually occur on day 21 or so:

• loss of (singing) high notes;
• vocal instability or fatigue;
• pitch uncertainty;
• decreased vocal efficiency;
• huskiness;
• reduced vocal power or flexibility.

Hormone shifts cause changes inside the larynx. Tissues hold fluid and blood vessels dilate, increasing vocal fold bulk. Puffier vocal folds vibrate differently, making speaking and singing more effortful.

Interestingly, due to these effects, European opera houses used to excuse singers from singing during premenstrual and early menstrual days.

Pregnancy

Imagine the wild hormonal ride your vocal system endures in pregnancy. When a woman is expecting, estrogen and progesterone levels surge, causing swelling of vocal fold tissue, which are heavier and more sluggish to vibrate.

Expectant and lactating mothers may notice:

• breathiness
• hoarseness
• prolonged warm-up time
• a muffled voice quality
• vocal fatigue
• increased vocal effort.

A key point: Changes in vocal folds usually tempt us to speak in a compensatory way. Often, this results in muscle tension in the head and neck, tongue-base, jaw and throat, as we are adding chores to structures not used to be worked this way. An end result is often vocal fatigue and hoarseness.

Breast-feeding

In simple terms, breast-feeding mimics the pregnancy hormonal state.

Following childbirth, the hormone prolactin (responsible for stimulating breast milk) skyrockets. In a hormonal sequence of events, prolactin ultimately reduces estrogen production. So — just like menstruation — estrogen drops may cause voice breaks, breathiness or hoarseness, fatigue, difficulty phonating on certain pitches, a lack of vocal flexibility, a loss of high notes, and vocal instability.

Once breast-feeding ceases, hormone-related changes disappear.

Menopause

Menopause to most women means the (often welcome) end of monthly periods and the (often unwelcome) beginning of hot flashes. Also it brings:

• drier larynxes;
• less lung power;
• weakened laryngeal muscles;
• stiffer laryngeal cartilages;
• thickened vocal folds;
• more "man-like" voice;
• fewer elastic and collagen fibers.

Unfortunately, menopausal voice effects haven't been studied as much as the premenstrual phase. Often reported changes are breathiness, a decreased range, less breath control, vocal fatigue, and — for singers — pitch inaccuracies and vibrato changes.

Until recently, women were often offered hormone replacement therapy to combat menopausal body changes. However, recent links to an increased incidence of cancer may make hormone replacement unsafe. Women should address concerns to their doctors.

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