Women all over the world are no strangers to the effects of fluctuating or declining hormones. What you may not be aware of is that those same hormones can have an effect on your voice, especially if you are a singer. This is an overlooked symptom of hormonal decline. I am a 55 year old voice teacher and performer, and through necessity, have been researching this topic to find relief from my peri-menopausal symptoms. My reason for writing this article is to share my experiences in the hope that it will inspire other singers to research other possibilities to further their vocal longevity and overall health.
As I have read (and experienced first-hand!) fluctuating or declining hormones can cause hoarseness, breathiness, reduction in range, vocal fatigue and loss of flexibility. While some women breeze through this transition, for others it is the mother of all wake-up calls as Dr. Christiane Northrup refers to it. I started noticing in my late 40's that I was becoming pitchy, especially at the end of phrases, and had less vocal stamina. This prompted me to start voice lessons again. The lessons definitely helped, but as I entered my 50's, my voice gradually became less consistent and unreliable. "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 cords. "When the vocal fold tissue dries, it takes more respiration effort to make it vibrate. That respiratory effort over time contributes to vocal fatigue - you're working harder to use your voice."
Jean Abitbol, a leading otolaryngologist, who I saw at a NATS conference in New York a few years ago, did a study on the effects of the menstrual cycle on the voice, in partnership with his wife, Beatrice Abitbol, a gynecologist. He would take a smear test of a singer's vocal folds at different stages of the menstrual cycle. He would then send the singer down the hall to his wife who would do a cervical smear. When we put the two sets of slides together, we could not tell whether it was the vocal fold or the cervix, he said. This proved that the larynx is indeed a target organ for hormonal changes. The vocal chords are very much like the vagina - when one is dry, the other is also.
Singing, which is a joy in my life, started to become an effort. Vocalizing was not something I looked forward to, so I wasn't putting in as much time to practice. Coupled with the other symptoms of hot flashes, insomnia and anxiety, my quality of life was greatly diminished.
As singers, we identify ourselves by our voices. If I have a good voice day, life is just better! The positive benefits of singing on the psyche and body are well documented. The studies of sound healing and music therapy are a testament to this. With that said, if a reduction in the way the voice responds prevents a singer from expressing themselves fully through the music, this can be frustrating and discouraging. If you are a voice professional, it can also be scary, as it may affect your ability to work.
WHAT I FOUND OUT
Dr. Ronald Brown, author of the book Discovering Your True Balance With Bioidentical Hormones, states that people's hormones don't decline because they age, but people age because their hormones decline. From a biological perspective, we are finite beings, with built-in obsolescence, as it were. Mother Nature is merely doing her job by decreasing our hormonal levels! As we have made great medical strides in keeping people alive longer, quality of life has become a greater issue. This has opened the door to the relatively recent study of anti-aging medicine.
There are two types of hormone therapy, HRT (hormone replacement therapy) and BHRT (bio-identical hormone therapy). The basic difference is that traditional HRT is made from pregnant mares urine and BHRT is made from yams and soybeans. It all started in the 1930's, when a chemistry professor, Russell Marker, discovered a chemical process to convert diosgenin (a plant steroid) into progesterone that is a molecular copy of the progesterone in the human body. Today, there are individual and combination therapies available, along with a variety of delivery methods, to treat hormone imbalance and deficiencies.
There has been controversy with regard to the health risks of the use of one versus the other. I researched this for about a year before I decided to move forward with the BHRT therapy. In one article, Ken Holtorf, MD compared the effects of bioidentical and synthetic hormones. He states in his conclusion, Based on both physiological results and clinical outcomes, current evidence demonstrates that bioidentical hormones are associated with lower risks than their nonbioidentical counterparts. Until there is evidence to the contrary, current evidence dictates that bioidentical hormones are the preferred method of HRT. I also noted that there is a wide range of opinion between practitioners regarding the delivery system of BHRT, whether it be oral, transdermal (through the skin), inserted pellets or transmucosal. There are also different dosing protocols. Each comes with it's own advantages and disadvantages.
I started out by making an appointment for a consultation with a compounding pharmacy. The pharmacist took a medical history, and gave me a saliva test. Based on the results of the test, she then made recommendations for a treatment plan, including the type of hormones and dosages. I was prescribed topical progesterone and Bi-est cream (a combination of estriol, estradiol and testosterone) after an appointment with a doctor who specialized in BHRT.
After a few weeks, my hot flashes disappeared and I was sleeping through the night again. The anxiety and bouts of depression lessened and I was more calm (ask my husband!) I also noticed my voice was becoming more consistent, and it felt more flexible. My vibrato, which was turning into a wobble, regained some of it shimmer. As the weeks progressed, I started to adjust the dosing based on how I felt, with input from the compounding pharmacist.
Of course, I am still working on fine tuning the dosing of the hormones, and have just started with a new specialist in BHRT.
I know that there is no "magic bullet" that will solve everything, and that this therapy comes with some side effects. I don't believe it will reverse my aging process, as some claim, just make it more comfortable! It is also a very individualized therapy, as all women do not react the same way. This has made me become a "good listener" to the signs my body gives me.
If you decide to research this yourself, and I certainly encourage you to do that, you will find many disparate opinions on this therapy. There is so much information online - more than I am able to write about here. I will be updating this blog with my progress and will share any new information that I come across, so stay tuned!
Voicing the Problem by Carol Petersen, Women’s International Pharmacy
Interview of Dr. Jonathan Wright by Dr. Mercola
Website of Dr. Barbara Hoffman, women's health advocate (check her out on YouTube too)
Disclaimer: None of the information in this blog is meant to diagnose or treat any medical condition. I am not a medical doctor and I am not suggesting any of these medications or products should be used by anyone reading this blog. I am merely stating that I use these products. Please consult your physician about using any of these products or methods.