Menopause and Voice Changes: What Women Need to Know

Menopause is a natural part of a woman’s life and results in a gradual decline in estrogen and progesterone production. The loss of these hormones can cause uncomfortable symptoms such as hot flashes and vaginal dryness. Loss of estrogen can also cause dryness in the larynx, or “voice box,” resulting in voice changes.

What is menopause?

Menopause is a natural biological process that marks the end of a woman's reproductive years. During menopause, the production of estrogen and progesterone hormones declines. A woman’s testosterone, typically considered a male’s sex hormone, also decreases.

The menstrual cycle becomes irregular during this transition before it stops completely. As the reproductive hormones estrogen and progesterone dwindle, a woman may experience the cardinal symptoms of menopause: hot flashes and night sweats.

After a full year of having no period, a woman is officially postmenopausal but can still suffer from the effects of menopause. The hormonal imbalances can affect many areas of a middle-aged woman’s life.

In addition to the hallmark symptoms of menopause, women may encounter other bothersome symptoms related to the loss of hormones. Estrogen is the chief lubricator hormone, and symptomatic dryness occurs as the sex hormone dissipates. Symptoms resulting from estrogen loss include a dry mouth, itchy skin, vaginal dryness, and urinary incontinence.

Additionally, hormonal changes can also affect the mucous membranes in the larynx, which can become drier and less lubricated. The dryness due to lack of estrogen leads to throat irritation, coughing, and vocal cord inflammation. This dryness can also mean a woman’s voice may change.

How does menopause affect the voice?

The larynx, also called the “voice box,” is the area in the throat that contains the vocal cords. It also plays an essential role in breathing, swallowing, and talking. The larynx is structurally similar to a woman’s cervix, a reproductive organ affected by menopause. So, it makes sense that the larynx also becomes sensitive to the loss of estrogen.

The tissues surrounding the vocal cords become thinner and less flexible with age, contributing to voice changes. Laryngeal muscles decrease in size, and cartilage hardens. The changes of aging, in general, can affect vocal cords.

One of the most common voice changes during menopause is decreased vocal range. Additionally, menopausal women may experience vocal fatigue or hoarseness due to the drying of vocal cords. A woman may also share a deeper voice due to decreased throat muscle tone.

When should voice changes be concerning?

A hoarse voice can be due to other serious reasons. A woman may have voice changes due to the following conditions:

• Cancer in the throat or mouth
• Certain drug side effects (e.g., steroids)
• Disorders of the adrenal gland
• Hypothyroidism
• Throat infections
• Tuberculosis

It is essential to see a healthcare provider to determine if the voice changes are due to a depletion of estrogen or another health issue. A provider may order blood tests to see if any infection or hidden bleeding may contribute to the voice change. To determine a cause for the voice changes, a laryngeal biopsy or laryngoscopy test may also occur during an examination.

Not all women experience vocal changes during menopause, and the degree and type of change can vary widely among individuals. If a woman is experiencing significant voice changes during menopause that is causing concern, a woman should speak with a healthcare provider or a speech-language pathologist for an evaluation.

Managing voice changes in menopause

To counterbalance the loss of estrogen, a provider may prescribe hormone replacement therapy (HRT) to replenish hormone levels. Hormone replacement may be a weekly patch, daily pill, or topical cream. The provider may test hormone levels to determine optimal dosages and follow-up tests to see if the HRT is beneficial.

HRT may have side effects, so it is essential to be cared for by a knowledgeable and experienced provider. Some women with particular health histories, such as certain cancers, history of blood clots, or liver disease, may need to avoid HRT.

Other ways to treat a hoarse voice are:

• Adequate hydration and humidification
• Avoid irritants
• Avoid smoke
• Limit alcohol
• Manage gastric reflux
• Obtain treatment for allergies
• Rest

Women may be reluctant to speak at work meetings if voice changes are aggravating. Those who use their voice professionally, such as teachers or singers, must find time to rest their voices. Managing voice changes in everyday life can be challenging.

During menopause, counseling may be beneficial to process voice changes and other menopausal symptoms emotionally. A speech or voice therapist can also help modify voice changes. Specific voice exercises can rebuild muscle tone in the throat. Seeking professional help can help a woman optimize control over their symptoms.

Finding the right balance for coping with voice issues can bring harmony to a menopause journey. Managing symptoms through HRT, hydration, and exercises can help a woman feel and sound her best.