The Impact of Menopause on Women’s Voices

Up to 46% of women experience vocal changes during menopause, according to a research review published in Menopause, the journal of The Menopause Society. Changes can be attributed to the effect of hormonal decline on the larynx.

“The larynx is a target organ for sex hormones—particularly estrogen, progesterone, and androgens—which regulate mucosal hydration, collagen turnover, muscle tone and neuromuscular coordination,” lead authors Yael Bensoussan, M.D., director of the University of South Florida Health Voice Center, and Rupal Patel, Ph.D., professor at Northeastern University, write in the review. “As women transition through perimenopause and menopause, the decline in these hormones leads to structural and functional changes in the voice, often resulting in noticeable alterations in vocal quality.”

Although the effects of menopause have been studied on other body systems, less is written about its effect on the larynx. These knowledge gaps inspired Bensoussan and Patel to conduct a literature review of research from January 2005 to January 2025, using the PubMed database

Vocal changes such as hoarseness and reduced range may lead to loss of confidence and shorter career longevity, especially for women with occupations that rely on their voice, who make up nearly one-third of the global workforce. Occupation examples include teachers, call center workers, broadcasters and performers.

One study of professional singers found that 77% of women singers experience noticeable vocal changes around age 50, specifically breathiness, less vocal control and difficulty reaching higher registers.

In a separate study of 100 women, 17 reported vocal changes. Upon further inspection, all 17 women showed signs of vocal muscle atrophy, reduction in the thickness of the mucosa and reduced mobility in the cricoarytenoid joint.

Menopause is not the only time that hormones affect a woman’s voice. During puberty all three sex hormones increase, making the vocal tract size increase, potentially leading to a frequency a third lower. This change is more evident in males, whose voices typically drop by an octave.

Testosterone therapy, sometimes prescribed to women to address other menopause symptoms, such as low libido, fatigue and mood changes, can also impact voice, sometimes lowering voice permanently, according to Bensoussan and Patel’s own clinical observations.

Symptoms of vocal change can be addressed through voice therapy, steaming and hydration or intranasal hormone therapy, which involves local application of estradiol.

More drastic measures such as fat injection laryngoplasty, bilateral vocal fold augmentation and thyroplasty may also be taken.

AI-driven biomarkers have emerged as a noninvasive diagnostic tool for vocal changes and are able to track changes over time, such as fundamental frequency, jitter and shimmer. However, future research should focus on whether changes are due to menopause or age.

Bensoussan is currently leading an NIH-funded study that is building a database of AI-analyzed human voices to identify potential disease biomarkers, according to a news release.

Bensoussan and Patel write that in addition to more research on menopause-related voice changes, there needs to be collaboration between otolaryngologists, speech-language pathologists, endocrinologists and gynecologists.

“Voice changes during menopause result from a complex fluctuation of hormonal, structural, and functional transformations that may impact the quality of life for a significant proportion of women affected,” Bensoussan and Patel write. “This review highlights the critical role of interdisciplinary collaboration in understanding and managing menopausal voice disorders.”