March 16, 2004 -- A new study sheds light on a menopause symptom that is often ignored: A woman's voice often deepens over the years.
But some women have more severe vocal changes that are often ignored by doctors, writes researcher Berit Schneider, MD, a speech pathologist at the University of Vienna in Austria, whose paper appears in the recent issue of Menopause.
Schneider has special insights into the problem: Austria, the land of music, is suffering the pangs of an aging population. The country's older sopranos are having vocal problems -- losing their range, unable to hit the highest notes, suffering with raspy voices.
"Some women have minimal discomfort, but others complain of moderate or even severe problems," writes Schneider. In previous studies, women have complained of lower pitch, a deeper singing voice, inability to hit the highest notes, and more hoarseness. However, few researchers have linked these changes with menopause symptoms.
In this study, Schneider and colleagues assessed the vocal quality of 107 women between ages 37 and 71 -- all postmenopausal. Each was asked about vocal changes and discomfort; each had tests of their speaking and singing voices.
Of this group, 46% mentioned vocal changes; one-third of them also had vocal discomfort; 54% reported no changes in their voice nor vocal discomfort.
Voice changes mentioned:
- Throat dryness
- Frequent throat clearing
- Lower voice frequency level
- Increased roughness and hoarseness
Of the 49 women with vocal problems, 10 were taking hormone replacement therapy (HRT) -- although eight of those were taking low-dose HRT. Nearly all had thick mucous on their vocal chords, evidence of a hormonal imbalance.
In doctors' offices, women talk about hot flashes, heart palpitations, and vaginal dryness problems -- but voice changes are rarely discussed, writes Schneider. However, an increasing number of women between ages 40 and 60 complain of vocal problems.
These findings make sense because various body tissues rely on the presence of the hormone estrogen to stay healthy (estrogen dependent), the authors write. Menopausal women often suffer from dryness and thinning of many body tissues because of loss of collagen and muscles mass -- which likely affects the vocal chords, she writes. Smoking likely intensifies this problem, since it causes earlier menopause -- and because it deactivates estrogen.
Voice Therapy Helps
Indeed, "for most [menopausal] women [who come to my clinic], the No. 1 complaint is voice discomfort or fatigue -- it takes a lot more effort to talk," says Edie Hapner, MD, speech pathologist at the Emory Voice Center in Atlanta.
Tissue dryness is a primary menopause symptom, and it can affect vocal chords. "When the vocal fold tissue dries, it takes more respiration effort to make it vibrate," she tells WebMD. "That respiratory effort over time contributes to vocal fatigue -- you're working harder to use your voice."
"If you're a teacher or anyone else who has to talk throughout the day, every day, by Friday you're exhausted, and it takes the entire weekend to recuperate," says Hapner.
Even younger women feel it during premenstrual syndrome (PMS), she notes. "A lot of professional singers report this. But when you think about it, it makes sense. With PMS, we have swelling, we feel achy. A lot of singers fear onset of perimenopause and menopause because of these changes."
Voice therapy can help relieve vocal fatigue, Hapner tells WebMD. "We have exercises that work quite well with the aging voice, to rebuild muscle tone and make production of voice more efficient."
The link between hormones and voice is "very interesting," she notes. "Many singers don't mind taking HRT to extend their careers -- to increase hydration, prevent lowering of pitch. Other researchers talk about finding the right balance between [the important hormones] estrogen, testosterone, and progesterone."
Since professional singers and other women have much at stake with these vocal changes, Hapner expects this group of Austrian researchers to keep working to find the right HRT balance for women, to relieve this menopause symptom.