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Menopause, confidence loss and the voice

Menopause, confidence loss and the voice

Chris Palmer, voice coach and senior lecturer, suggests that voice loss in menopause may have more impact on women’s confidence and mental health than is widely recognised.

The menopause is an important and popular topic for discussion, but the effect of the menopause on the voice and how this might impact the lives and careers of women at this life stage goes largely unnoticed.

In my career as a voice coach, I have observed that many women of all ages do complain of vocal disfunction.

Many women on my client list complain of voice fatigue, sore throat, an increase in throat clearing, jaw tension, sore gums, and many more symptoms related to the speaking voice.

In my working environment as head of voice and senior lecturer at the Guildford School of Acting, University of Surrey, I am very aware of the voice changes experienced by adolescent girls during a growth spurt in length of the vocal folds.

I have also been aware for many years that female performers notice a notable change in their voices during premenstrual syndrome. Researchers have observed an effect of menstrual cycle hormone variability on the voice in compromising tone quality, agility, and stamina, and that premenstrual vocal syndrome creates vocal fatigue, and reduces pitch range, power, and volume, which can last up to a week before menstruation.1

I have set out to explore voice-related issues during the peri-menopausal phase and beyond.

Scheneider et al2 reported that 46% of women at menopause experience vocal changes and in 33% of the cases these changes are associated with vocal discomfort. The main symptoms were frequent throat clearing, dryness, and loss of certain vocal frequencies.

This may be happening at a time where women are reaching their working life potential, and finding that their confidence is knocked; their loss of self-esteem punctured, and their value perhaps lessened by feeling that their voice is weakened.

The impact of hormones on the voice

Oestrogen gives a suppleness to the vocal folds, which maintains pitch and tone, and when oestrogen is lost or depleted there are changes in the mucus membrane in the vocal tract. The laryngeal tissues absorb water causing the folds to swell and become heavier, and this in turn affects the fundamental frequency (pitch). The presence of oestrogen acts as a barrier to androgens (testosterone), preventing thickening and lowering of the voice.

Increased levels of progesterone causes dryer swollen vocal folds by encouraging the outer surface of the mucous membrane of the folds to drop off and can cause a decreased and thickened secretions of the outer layer of the vocal fold creating dryer vocal folds.

Androgens cause the vocal folds to thicken, resulting in increased dryness. Dry folds can cause polyps, due to vocal misuse such as over throat clearing and coughing.

Some research suggests that the larynx is impacted by fluctuations of the sex hormones. Jean Arbitol, a laryngologist, worked alongside his wife Dr Beatrice Abitol, a gynaecologist, on a joint study to examine cells from the vocal folds and the cervix at different stages of the menstrual cycle.1 They concluded they could not tell which cells were from the cervix and which were from the vocal folds.

Vocal fold atrophy during the menopause may be considered as analogous to the changes elsewhere in the body that result in vaginal dryness and vaginal atrophy.

Pitch of the voice

Women’s voices typically sound measurably deeper at menopause than earlier in their lives.

‘Fundamental frequency’ (Fo) is defined as the average number of vibratory oscillations of the vocal folds (under an oscilloscope) per second and is measured in Hertz. The number of vibrations per second affect pitch.

During puberty, the impact of oestrogen and progesterone on the female voice produces a typical fundamental frequency during conversation of 180-250Hz, which is maintained until the age of about 35 years.

While men’s voices stay in the range of 100 to 150 Hz through their whole lives, this typically drops to between 130.4 and 150Hz for women by the age of around 55 years of age. As women age, their pitch becomes similar to the male voice.

Lack of confidence

Research has suggested that at perimenopause women reported a lack of vocal volume, power, flexibility, and also a reduction in pitch, leading to a lack of confidence, and a perceived loss of status.3

In some cases, this was found to have caused women to consider leaving their profession or retiring early, with a direct impact of a loss of earnings and pension.

Survey of menopausal women

Common themes were observed when reviewing the data of women reporting vocal issues on my client list. I began to research this further, and this work is ongoing.

Our research questionnaire explores voice-related issues including: age; vocal symptoms; frequency of symptoms; whether this relates to viral infection; colds; flu; sore gums; headaches, and when and how often these vocal issues occurred. Further questions are asked about the sound of the voice.

Asking these questions can often cause an emotional response.

Maintaining our voices

The spoken voice is not often considered an aspect that requires training and support in the workplace, and yet we all use our voice in our careers – some even more than others, from carers, teachers, and lecturers to those working as workshop leaders or presenters.

While professional voice users will more often critically reflect on their voices and make informed choices about how to best exercise it for their work, the typical menopausal working woman is less likely to have this information readily available.

Yet we can all learn to use simple voice exercises that can keep the voice, supple, flexible and understand its use and power for the rest of their working lives.

Voice training for the workplace may be one way to keep the vocal folds flexible, and joining a choir could be another. Women can practice daily humming up and down the musical scale, and some deep breath work to support vocal volume. A short daily practice of some simple vocal exercises can help to keep the vocal folds supple.

Our voice forms a large part of our personality, and keeping this function healthy and flexible is a positive thing.


Chris Palmer BA, PGDip, SFHEA menopause advocate is head of voice and senior lecturer at the Guildford School of Acting, University of Surrey


  1. Arbitol, et el. Sex hormones and the female voice. Singular Publishing group. 1999.Vol13, no 3: 11
  2. Scheneider, B, Van Trotsenburg, M, Hanke, G, Bigenzahn, W, and Huber, J. Voice Impairment and menopause. Menopause: The Journal of North American Menopause Society 11. 2004

Further reading

  • Arbitol, J. The female Voice. San Diago: plural Publishing, 2019.
  • Bos. N, Bozeman, J, Frazier-Neely, C. Singing and the change. 2020. StudioBos media.
  • D’haesleer, E, Herman D, Claeys, S, Van Borsel, J, and Van Lierde, K. The menopause and the female Larynx, clinical aspects, and therapeutic Options: a literature review. Marturitas: The Journal of the Climacteric and postmenopausal 64, no 1. 2009.
  • Kaye. S. An overview of premenstrual syndrome: definition, treatment, and future trajectories. March 2020. National Library of Medicine
  • Moseley-Morgan, R. How to get the best out of a mature female singer. isingmag. 2019


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