Finding Your Voice Through Menopause: A Journey of Physical and Emotional Transformation

Changes in the Voice and Pelvic Floor are Related during Menopause

Menopause is an incredibly transformative phase in a woman’s life. But it doesn’t have to mark the “beginning of the end of life.” On the contrary, it can signal the beginning of an era of freedom. Menopause is also where women often end up spending the majority of their adult life: Free from periods, dealing with period products, or anything else that would tether you to a bathroom or drugstore and/or limit your activities or what clothes you wears, due to pain or flow or both.

Menopause is also a time where women’s health has historically been entirely dismissed and overlooked. During the 20^th century, women’s life expectancy was never long enough to prioritize focusing on menopause healthcare, much less research. Combine that with the well documented evidence of medical gaslighting and medical misogyny in women’s health, and you have a recipe for disastrous public health outcomes for women. However, thankfully that is rapidly changing and as pelvic floor practitioners, we have a big role to fill in menopause management.

While there are many symptoms of perimenopause and menopause, one of the more overlooked ones is the connection between hormonal changes, the voice, and the pelvic floor. We need to start to frame menopause as starting with conservative treatment in pelvic health and rehab first, before we automatically assume that hormone therapy (now known as HT instead of HRT, or hormone replacement therapy) is the only way to manage menopause. Understanding the connections between the voice and pelvic health can empower women going through menopause – to claim the power of their voice through menopause, instead of losing it.

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The Voice as a Reflection of Hormonal Shifts

A 2024 study discusses how hormonal changes during menopause (e.g., decreased estrogen levels) affect vocal cords and voice quality. Symptoms women can experience include lowered pitch, reduced vocal endurance, vocal fatigue, dryness, and hoarseness. The authors state, “the human voice is very sensitive to endocrine changes, with various endocrine changes affecting the voice throughout the normal human life cycle.” Take puberty for example, when the presence of testosterone changes the dimensions of the male vocal tract. The vocal folds become thicker and longer, the larynx size increases, which changes the “fundamental frequency of the voice.” By contrast, premenstrual voice changes have also been noted, which is known as dysphonia premenstrualis and is characterized by a loss of ability to achieve high notes, as well as vocal fatigue and reduced vocal range. Some of these changes are driven by inflammation, muscosal dryness, and decreased muscoal secretions caused by progesterone. Other researchers have noted that cervical and laryngeal smears, taken during the premenstrual period phase consistent with progesterone peak, were indistinguishable. 

Likewise, women going through pregnancy, and specific to the menopause discussion, experience unique voice changes as well. Vocal abnormalities noted in the literature include vocal fold thickening, lowered vocal pitch, vocal fatigue, reduced vocal range, and failure to reach higher notes. Though anecdotally I have also seen women struggle with mid-range notes rather than high range notes in clinical practice, which underscores the importance of evaluating each patient case-by-case instead of making broad assumptions about voice and pelvic health during perimenopause and menopause.

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Hormones, Menopause, and the Voice to Pelvic Floor Connection

Of additional concern is the change that HT can have on the vocal folds, which overall can be positive. HT can improve glandular secretions above and below the vocal folks, enhance mucosal viscosity, increase pitch range, capillary permeability, and overall better tissue oxygenation. Estrogen is also a well-known inflammatory mediator, which can help protect and prevent damage to the vocal folds. Additionally, sarcopenia is known to impact vocal fold shape, which could lead to vocal fold bowing, vocalis atrophy, and subsequent glottal fold closure impairment.

The shared connective tissue between the larynx and the pelvic floor and diaphragm, presents an unmistakable link when it comes to managing pressure in order to generate both sustainable sound and continence. The proof of the impact that the voice has on the pelvic floor and diaphragm is well supported in the literature, and in the clinic, pelvic health practitioners can be trained in and use musculoskeletal ultrasound imaging to measure and create positive change in pressure management. This leads to improved outcomes with vocal, respiratory diaphragm, core, and pelvic floor strength, range (pitch for the voice and motion for the pelvic floor), endurance, coordination, and modulation.

So how many women experience voice changes during menopause? A study of 107 postmenopausal women, published in Menopause, found 46% had voice changes and 33% found those changes to negatively impact quality of life and caused discomfort. Not surprisingly, in a study published in Clinical Linguistics and Phonetics, researchers also reported respiratory function decline during menopause. And in a survey of perimenopausal women in the UK, women reported a lack of vocal volume, power, flexibility, and also a reduction in pitch, leading to a lack of confidence, and a perceived loss of status in the workplace.

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The Voice to Pelvic Floor Connection as Both Physical and Emotional Transformation

The Voice to Pelvic Floor (V2PF) method was developed as a systems-based evaluation in order to provide trauma-informed and psych-informed pelvic healthcare. The V2PF approach investigates the interdependence of three diaphragms:

• The orofacial/cervico-laryngeal diaphragm
• The respiratory diaphragm
• The pelvic diaphragm

The purpose of a V2PF approach is to provide a deeper understanding of polyvagal theory, anatomy and physiology, neuropsychology, trauma-informed evidence-base, as well as a deeper dive sociocultural issues that impact women’s safety, efficacy, and inclusion in the workplace. In this way, the V2PF method allows pelvic health practitioners to function as primary care providers in the pelvic, orthopedic, and lifestyle medicine health space across the lifespan.

Since 100% of women experience menopause, and men go through their own experience with hormone shifts, everyone can benefit from the V2PF approach.

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Practical Tools for Navigating Voice Changes during Menopause

Menopause brings changes that can affect both the voice and the pelvic floor, but proactive care can help manage these transitions effectively. Below are actionable steps to support vocal and pelvic health during this stage of life:

• Hydration: Proper hydration is crucial for maintaining the health of tissues in both the vocal cords and the pelvic floor. Aim to approximately ½ of your body weight in ounces each day and consider using a humidifier to keep your environment moist, which supports your voice.
• Breathing Exercises: Practice diaphragmatic breathing to improve coordination between the diaphragm and pelvic floor. This type of breathing reduces tension, supports vocal resonance, and enhances overall relaxation. More advanced breathing concepts can be found on my YouTube Channel under the Master these First Medical Therapeutic Yoga Breathwork Playlist.
• Gentle Vocal Warm-ups: Maintain vocal cord flexibility and strength with exercises like lip trills, humming, and soft sirens. These gentle practices can prevent vocal fatigue and support vocal clarity.
• Pelvic Health Exercises: Incorporate practices such as pelvic floor relaxation techniques and alignment exercises. These can help alleviate tension, improve circulation, and promote overall pelvic stability.
• Mindfulness and Relaxation: Menopause can bring heightened stress, which often manifests as tension in the body, including the voice and pelvic floor. Regular mindfulness practices, such as meditation or yoga, can help you stay grounded and alleviate this tension.
• Subscribe to my Free YouTube Voice to Pelvic Floor Channel

By implementing these tools, you can take proactive steps to maintain your physical and emotional well-being.

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Seeking Support and Advocacy

Navigating the challenges of menopause is easier with the right support. Here’s how you can empower yourself during this transition:

• Seek Trauma-Informed Practitioners: Work with healthcare professionals who understand the multifaceted impact of menopause. Trauma-informed care ensures that your experiences are validated and that treatment plans address both physical and emotional aspects.
• Address Physical and Emotional Symptoms: Don’t ignore the connection between your body and mind. Look for practitioners who integrate holistic approaches, such as pelvic health specialists or vocal coaches familiar with menopause-related changes.
• Advocate for Yourself in Medical Settings: If you encounter dismissive or gaslighting behavior, remember your experiences are valid. Be prepared to ask questions, request second opinions, or bring a trusted advocate to appointments. It can also help to keep a journal of symptoms to share with your healthcare provider.

With the right support and advocacy, you can navigate this phase with confidence and resilience.

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Conclusion

Menopause is a transformative phase of life that calls for a deeper understanding of the voice-pelvic floor connection. By recognizing and addressing the changes in these areas, you can embrace menopause as a time of growth and empowerment. Your voice, both literal and metaphorical, can serve as a powerful symbol of this transformation.

Have you experienced changes in your voice or pelvic health during menopause? Share your story or questions in the comments—we’d love to hear from you. For more resources, workshops, or consultations on pelvic health and trauma-informed care, visit www.garnerpelvichealth.com and sign up for our free newsletter or contact us directly. First consults are free. Let’s navigate this journey together!

Are you a healthcare provider or person who wants to learn or benefit from the V2PF Method?

Start here:

• If online, on-demand virtual learning fits you best, Enroll here
• If you like to have some live learning in a hybrid model (combined with online learning),  Enroll here
• Are you a person wanting to benefit from Voice to Pelvic Floor evaluation and treatment, sign up for a free consult here.

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Sources

1. Afsah, O. Effects of hormonal changes on the human voice: a review. Egypt J Otolaryngol 40, 22 (2024).
2. Abitbol J, Abitbol P, Abitbol B. Sex hormones and the female voice. J Voice. 1999 Sep;13(3):424-46.
3. D’haeseleer E, Depypere H, Van Lierde K, (2013) Comparison of speaking fundamental frequency between premenopausal women and postmenopausal women with and without hormone therapy. Folia Phoniatr Logop 65:78–83
4. McCarthy, M., Raval, A.P. The peri-menopause in a woman’s life: a systemic inflammatory phase that enables later neurodegenerative disease. J Neuroinflammation 17, 317 (2020)
5. Bensoussan T, et al. Voice as a predictor of health during menopause. Presented at: Annual Meeting of The Menopause Society; Sept. 10-14, 2024; Chicago.
6. Schneider B, van Trotsenburg M, Hanke G, Bigenzahn W, Huber J. Voice impairment and menopause. Menopause. 2004 Mar-Apr;11(2):151-8.
7. Awan, S. N. (2006). The aging female voice: Acoustic and respiratory data. Clinical Linguistics & Phonetics, 20(2–3), 171–180. https://doi-org.elon.idm.oclc.org/10.1080/02699200400026918
8. https://www.nursinginpractice.com/clinical/womens-health/menopause-confidence-loss-and-the-voice/?utm_source=chatgpt.com
9. https://hermanwallace.com/blog/trauma-and-the-voice-to-pelvic-floor-connection