June 15, 2017

Vocal Cord Changes Throughout the Menstrual Cycle

It is not unheard of that a fertile female singer experiences slight fluctuations in the quality of the voice throughout the menstrual cycle. In particular, in the immediate premenstrual period, up to 40% of female singers may note a deeper shift in the vocal range, tone inaccuracy, and/or tendency to develop vocal cord hemorrhage.

Such vocal changes are hypothesized to be secondary to the affect of estrogen and progesterone on the vocal fold tissues, and especially any blood vessels that may be present. Such changes may include vascular dilation, vocal cord edema, and reduced laryngeal muscle tone.

An interesting study came out in 2017 assessing the anatomical and functional features of the vocal cords during different phases of the female menstrual cycle. In particular, the laryngeal vascular changes were described in 17 healthy fertile female volunteers not using hormonal contraception.

Two examination were performed, the first early in menstrual cycle when progesterone levels are lowest and the second during pre-menstruation when progesterone levels are highest.

Not surprisingly, increased laryngeal vascularity was seen when progesterone levels are highest suggesting increased vocal cord congestion during premenstrual days.

These findings may explain any hormone-related alterations which may lead to variable vocal performance in some, but not all women. (Most women do not experience any vocal changes throughout the menstrual cycle.)

In particular, women who experience a larger difference between peak and trough levels of progesterone may experience greater variability in vocal quality due to more dramatic changes in laryngeal vascularity.

In such female singers who suffer from vocal quality variability in relationship to the menstrual cycle, birth control pills have been helpful to minimize this fluctuation both from a hormonal as well as vocal perspective.

Menstrual Cycle, Vocal Performance, and Laryngeal Vascular Appearance: An Observational Study on 17 Subjects. J Voice. 2017 Jun 5. pii: S0892-1997(17)30113-3. doi: 10.1016/j.jvoice.2017.05.001. [Epub ahead of print]

Variations in vocal frequency perturbation across the menstrual cycle. Journal of Voice. September 1989Volume 3, Issue 3, Pages 233–243

Does a hormonal vocal cord cycle exist in women? Study of vocal premenstrual syndrome in voice performers by videostroboscopy-glottography and cytology on 38 women. Journal of Voice. June 1989Volume 3, Issue 2, Pages 157–162

The impact of hormonal fluctuations on female vocal folds. Curr Opin Otolaryngol Head Neck Surg. 2004 Jun;12(3):180-4.

Voice and speech changes in various phases of menstrual cycle. J Voice. 2013 Sep;27(5):622-6. doi: 10.1016/j.jvoice.2013.02.006. Epub 2013 Mar 15.

The Effect of Menstrual Cycle on Singing Voice: A Systematic Review. J Voice. 2017 Mar;31(2):188-194. doi: 10.1016/j.jvoice.2016.04.018. Epub 2016 May 24.

A study of voice changes in various phases of menstrual cycle and in postmenopausal women. J Voice. 2010 May;24(3):363-8. doi: 10.1016/j.jvoice.2008.10.005. Epub 2009 Jan 29.

Association between birth control pills and voice quality. Laryngoscope. 2004 Jun;114(6):1021-6.

Effect of the menstrual cycle on voice quality. Arch Otolaryngol. 1978 Jan;104(1):7-10.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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