The human larynx is a hormonal target organ. Many studies have proved this over recent years. When hormonal changes occur, women may find that their vocal production is affected. Singers, professional or otherwise may particularly notice changes. Others who may be affected are public speakers, teachers or women who use their voices often. Premenstrual syndrome (PMS) is commonly described by women as affecting them in the time prior to menstruation. It is during the pre-menstrual phase that women most often notice vocal changes.
When estrogen levels drop prior to menstruation, water-retention levels in vocal tissue increases causing an increase in blood supply to vocal cords. Vocal hoarseness can result due to the increase of thyroid gland activity. Other changes that estrogen can cause is the increase in the secretion of glandular cells above and below the vocal fold edges causing greater mucus production. Enhanced by progesterone production, which occurs at the same time, viscosity and acidity of these mucus secretions increases, while the volume of the secretions is reduced causing dryness of the vocal folds.
Some of the other effects singers can experience during pre-menstrual (and sometimes during the menstrual stages) of their cycles are difficulty singing high notes, having a husky or fuzzy quality, decreased volume, breathy quality, and intonation problems.
Other problems can include vocal fatigue, decreased range, auditory disorders and opthalmalogical (pertaining to the eye) disorders. The inability to wear contact lenses or glasses could affect a performer’s ability and confidence, or if she is relying on a conductor, upset the flow of a performance.
Auditory dysfunction can include decreased or increased hearing acuity, hypersensitivity to volume, hypersensitivity to repetitive rhythmic pattern, dizziness, ringing in the ear, change in middle and inner ear response and even transient deafness.
Disorders of energy metabolism such as changes in appetite causing weight gain may affect the singer psychologically and physically. Consciousness of weight could affect a singer negatively, especially if she is to be video-taped or televised, or will perform to an audience.
Fatigue can be a major issue with those suffering with PMS. General physical attributes such as endurance and vitality, pitch stability and voice quality could be altered. The larynx is especially sensitive and vulnerable to fatigue.
Psychological or neurological disorders such as difficulty in concentrating, migraine headaches or feelings of vulnerability and being overwhelmed may be felt by PMS sufferers. She may be highly emotional and sensitive to criticism, or even angry and hostile. A singer who appears to be having extreme emotional reactions may have her reputation harmed and if professional, her career interrupted.
The cause and effect of these vocal changes can be a very personal issue. For professional women singers there could be loss of confidence affecting self-image and earning power if one admits to voice problems. This may be why this issue is not discussed very openly by those affected by it, or acknowledged by the music industry. There may also be a certain taboo on discussing issues relating to women‘s hormonal health.
How can women singers manage some of the symptoms described?
Being aware of how individual vocal production is affected is a good start. Keeping a monthly chart may help. Limiting caffeine, salt, refined sugars and alcohol can reduce the effects. Doing aerobic exercise such as jogging, swimming and dancing may assist general well-being. Stress management programs such as yoga, relaxation or hypnotism could be considered.
Physical and vocal rest when symptoms are at their worst may be needed. Vitamin and mineral supplements can also help. Beneficial supplements may be vitamin B6, magnesium, calcium and potassium ; vitamin D for leg cramps, iron for anemia, a combined multivitamin and mineral supplement for overall symptoms. Using lozenges or honey in hot tea may assist the vocal hoarseness, dryness and vocal fatigue. Drinking plenty of water is always beneficial to singers.
Non-prescription medications can help, but avoid aspirin as it can increase vocal hemorrhage. (seek medical practitioners’ advice). Treatments such as hormone therapy, “The Pill” or surgery for premenstrual voice syndrome could be considered.
The advice of a medical practitioner should always be obtained when considering any treatments. Individuals may experience a range of effects in differing degrees.
Being aware of the possibility of the effects of PMS may be a relief to women who have noticed voice changes through their menstrual cycle. Changing singing behavior around menstrual cycles may be needed. For professional vocalists, recognition of these effects needs to be more widespread within the music industry, so that women can more comfortably pursue singing careers.