The Female Singing Voice : Managing Menstruation, Pregnancy, Postpartum Issues, Lactation, and Menopause

Making beautiful music with our voices is not the only blessing we female singers enjoy—we also have the ability to be mothers. Many of us have succeeded at doing both. (I am the mother of six.) All of us, however, share the trials and tribulations of being a woman. The various changes that occur throughout the female life-cycle affect our voices. What sort of vocal management is most beneficial during these times of change?

Menstruation: It belongs to us all

The two hormones that affect the voice most strongly—estrogen and progesterone—are at their lowest levels just before the onset of menstruation. Estrogen is the primary female sex hormone; it causes the changes in the epithelium, or top layer of tissue, inside the vagina. Progesterone works in tandem with estrogen and their levels are sensitive to each other.

What does this have to do with our voices? Amazingly, everything! The tissues of the vagina are identical under the microscope to the tissues of the vocal folds. And, equally amazing, vocal folds contain hormone receptors and react to hormone changes.

In other words, just before you menstruate expect the changes going on in your vocal folds to be similar to what you are experiencing in your uterus. Swelling of the vocal folds is not a good thing—if the “cover,” or top layer, of the vocal fold tissue cannot “slip” off the body of the fold to vibrate, you can’t phonate properly. This swelling can come from edema (water retention), or from the dilation of your blood vessels. Either way, swelling is tough on the voice! Top notes become higher to manage and you may feel pain or general discomfort.

What to do? Keep a diary of your menstrual cycle and your vocal symptoms. You may be able to “plot” good and bad days this way and avoid planning a recital on one of the bad days, such as one of the days before your period. Don’t push high notes during PMS times (and let your teacher know what is going on). Avoid singing if you have pain or discomfort. (Prolonged swelling or other vocal issues need to be addressed by a qualified health professional.)

Pregnancy: Many challenges and rewards

The joys of impending motherhood far outweigh the often-difficult adjustments your body and mind need to make during these months of preparation.

What happens when you are expecting? Your blood volume increases by about 30 percent, causing tissues to swell. Weight gain and the baby can put pressure on your stomach and cause gastric reflux. All the abdominal muscles, as well as the fascia (the lining around the muscles), are stretched. This can make breath support more challenging, and you can get winded as the growing baby makes full excursion of the diaphragm more difficult.

One nice thing is that during pregnancy, estrogens and progesterones both increase to high levels, which can make tissues moist—not a bad thing for the vocal folds. Sometimes androgens (male hormones) increase as well, however, which can deepen and increase the fullness in your voice, take away some high notes, and lower the fundamental of your speaking voice.

Other changes can include breathiness, hoarseness, muffled voice, vocal fatigue, and a compensatory need for more vocal effort—meaning a pregnant singer may tense her neck, throat, or jaw muscles in an effort to “make things right.” The vocal folds become thicker and heavier from excess fluid. The medical term for these troubles is Laryngopathia gravidarium, meaning the “laryngeal pathology of pregnancy.”

What to do? Be aware that the baby will interfere with your abdominal breathing—the sense of breath low, down, and in front. To compensate, focus the effort of breath support at two other places in your body—the ribs and the back. Go for more thoracic-intercostal stretch (at your sides) as well as your lower back.

Watch for alignment issues: the baby shifts your center of gravity and you might develop bad habits trying to compensate. The best plan is to maintain an “athletic” posture—not only during singing, but throughout your busy day. Keep your knees slightly bent, maintaining a strong base of support from legs that form a pyramid-type base. Keep your shoulders back but not rigid, your sternum elevated, and your neck back rather than jutting out. You can sit down while practicing or during a lesson—as long as you maintain good body alignment.

Bending down can become very difficult, especially towards the end—make sure you bend at the knees and squat to pick things up. Also, avoid bearing down—locking at the larynx—when bending down. Better to sigh the air out than build up sub-glottal pressure.

Labor: Like no other experience in the world

The moment you have been waiting for is here! Is there any way to take care of your voice even during labor, and during the postpartum time that follows?

It is imperative to avoid holding your breath, “bearing down,” or any kind of buildup of sub-glottal pressure during contractions or during the pushing phase of labor. Changes in breathing are a natural response to pain or
fear, but damming the breath can make you more tense overall and end up damaging the vocal folds.

What to do? Believe it or not, sing! Let go of any “grabbing” or focus of tension at the larynx, and find the deepest, breathiest, “chestiest” place your voice can go—it will feel and sound like a low moan. This is wonderful. It will keep the larynx free of tension and calm your breathing patterns. The “labor voice” will help you find muscular strength lower in your body (where you surely will be needing it) and help you avoid any lockup at the larynx.

After the baby arrives

Congratulations! During postpartum, you no doubt are flooded with rushes of emotion and the adjustments to your body. You are more tired than normal and find that the spare moments in your day disappear. Be careful that even though you are tired, you speak on the breath and remain supported, so as not to become hoarse. Keep as hydrated as possible.

It may feel very different trying to sing after the baby is born, but everything else is different, too. You may end up being hoarse from labor no matter how careful you tried to be. Rest, and sing when you feel no discomfort or struggle.

Get back into vocal shape as soon as possible—especially for the sake of your abdominals—by doing abdominal crunches, Tae Bo, Pilates, or whatever regime you like. Work back into singing gradually. Use the gentlest and mildest exercises you can in the beginning: silent breath exercises, hissing, humming, ng, or a soft portamento on [u] in a simple descending 5-4-3-2-1 pattern. Resume your study when you feel ready, but I would not advise doing so before six weeks postpartum.

Lactation: Your milk—the greatest gift you can give your new baby

Breast milk is brain food. The brain of a newborn is not fully developed, and the amino acids and fats in human milk are perfectly suited to the human brain. Breastfeeding gives a baby a smart brain, and it makes for a healthy body and a calm, secure spirit.

Interestingly, the state of lactation is similar hormonally not only to the PMS state, but to menopause: low levels of estrogen and progesterone. Voice problems similar to those that occur during the PMS and menopausal states can occur during lactation—voice breaks, breathiness, weakness, register transition problems, and lack of flexibility. These changes subside when the baby is weaned. None of these conditions should inhibit breastfeeding.

What to do? Not all women experience voice changes during lactation, but if you do, realize that this too shall pass. You will never be the same again in any way, in any part of your body, including your vocal instrument. So use it to your advantage. I spent many blissful hours singing to my babies while they were nursing. I sang everything from lullabies, to nursery rhymes, to hymns, to made-up songs, to sung prayers. Your voice is a gift to your children as much as it is to any audience.

Menopause: Coming to a singer near you

My voice is so different now that I am perimenopausal. I have had my hormone levels checked and they are fluctuating all over the place. In a few years I will be done with the reproductive phase of my life.

What has been going on? I found that because my estrogen and progesterone levels are in flux, I have some symptoms of androgen dominance. This means the small amount of male hormone all females have is in greater proportion to the lessening amount of female hormones. For me, the worst problem is managing the blending and shifting of the registers. I have also found my voice has “darkened” and my lower range has increased dramatically. My super high notes are not so super anymore.

The range of menopausal symptoms in singers is varied. Interestingly, because the laryngeal tissue is identical to vaginal tissue, “when one is dry, the other is dry” (to quote Dr. Jean Abitbol). Low estrogen levels can lead to vaginal atrophy (muscle wasting), which unfortunately is also a menopausal condition of the larynx. Vocal fold tissues become thinner, drier, more delicate, shrunken, and weaker. Singers may experience a lowering of the fundamental speaking frequency, edema, vocal fold thickening, dry voice, loss of the upper range, more obvious register breaks or imbalances, bowing of the vocal folds, and increased compensatory laryngeal muscular tensions. Not every singer will experience a dramatic change as she ages, but some change is likely. We develop a different instrument and now we must learn to use it.

What to do? The best defense against the changes of aging is to stay vocally fit. Do not give up because you become frustrated with the changes in your voice. Maintain good technique and practice daily. Regular singing can help prevent vocal atrophy. David Jones has a wonderful article on exercises for menopausal voices on his website, www.voiceteacher.com.

Being a singer has been the joy of my life, and being a mother has been the joy of my life. Singing can and should remain a joy through all the stages of womanhood, no matter what challenges and changes face singing mothers.

Endnotes

Abitbol, J, et. al. “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.” J Voice 3 (1989): 157-162.

Bernstein, T. “Is it the opera house or is it just me? Menopause, which can mean disaster for a diva at her peak, is opera’s last taboo.” La Scena Musicale 4 (2000) www.scena.org/lsm/sm6-4/menopause-en.html (accessed 2/15/04). [Editor’s Note: Reprinted in Classical Singer, 3/05. See online archives at www.classicalsinger.com.]

Davis, CB, Davis, ML. “The effects of Premenstrual Syndrome (PMS) on the female singer.” 4 (1993): 337-351.

Emerich, KA. “Pregnancy and the voice.” www.operamom.com/voiceandpregnancy.html (accessed 2/15/04).

Jahn, A. “Pregnancy: singing your way through.” Reprint from Classical Singer magazine 12/99. www.operamom.com/singingthroughpregnancy.com (accessed 10/15/02).

Jones, D. “Vocalizing through menopause: regaining lost function.” www.voiceteacher.com/menopause.html (accessed 3/3/2004). [Editor’s Note: Reprinted in Classical Singer, 3/05. See online archives at www.classicalsinger.com.]

Lã, F. “The menstrual cycle and the singing voice.” University of Sheffield Music Department. www.shef.ac.uk/janedavidson/menstrualcycle.html (accessed 6/15/04).

Newman, SR. “Preliminary report on hormone receptors in the human vocal fold.” J Voice 1 (2000): 72-81.

Sataloff, Robert T. Vocal Health and Pedagogy. Chapter 14 “Endocrine Dysfunction.” San Diego: Singular Publishing Group, 1998.

Theresa Rodriguez

Theresa Rodriguez received her master of music with distinction in voice pedagogy and performance from Westminster Choir College at Rider University in Princeton, NJ. She is currently a member of the voice faculty at the Community School of Music and the Arts at the Goggleworks in Reading, PA. She recently published a book of poetry entitled “Jesus and Eros: Sonnets, Poems and Songs,” which is available on Amazon.