Premenstrual Vocal Syndrome

Updated: Aug 19, 2021


Many moons ago, opera houses would schedule performances around their prima

donnas’ grace days. That’s right, great divas of old didn’t have to go on stage when

they had their periods! This practice existed up until the early 20th century in some

European countries. Nowadays with limited arts funding and an intense climate of “time

is money”, modern singers are no longer awarded this luxury. But it begs the question,

do our hormones have such an effect on the voice that we should consider avoiding

singing at “that” time of the month?


Scholars started researching the effects of hormones on the voice as early as the mid-

20th century, and by the 1980s a solid body of literature had started to amass. So, it

makes perfect sense that you may have noticed some differences in your voice when

you are menstruating. In particular, many singers report that accessing their high notes

is a little harder than usual, and that there is a breathier or huskier quality to their sound,

which is sometimes accompanied by a feeling of hoarseness.


However, much like the classic symptoms of Premenstrual Syndrome (PMS) such as

bloating and cramping, there is a wide spectrum of severity. Some singers may notice

substantial voice difficulties, and others may experience no symptoms whatsoever.


 

The uterus-larynx connection


What may be surprising is the connection between the uterus and the larynx. Not only

are there structural similarities between the two organs (the term “cervix” even comes

from the Latin word “neck”), but the cells of the vocal fold tissue and the uterine cervix

also have a similar composition and even more amazingly, hormone receptors are also

found in the vocal fold cells. This means that hormones like progesterone, estrogen

and testosterone are found in both sets of cells and can be monitored throughout the

menstrual cycle, so by examining vocal fold cells you could predict at what point someone would be in their menstrual cycle!


Art by Luisa Alexandre



What’s going on with our hormones?


Most people who menstruate have on average a 28-day cycle, and during this time, the sex hormones move in a fairly predictable pattern. This shift in hormones has an affect on our entire body, including our voice, something we may be hyper-aware of as singers. In the middle of the cycle, around day 14, just before and during ovulation, we see a surge in estrogen. It is during this time that your voice will be the most cooperative, particularly when it comes to ease of high notes and the flexibility required to sing coloratura.


However, post-ovulation, estrogen starts to drop, allowing progesterone to become a little more dominant in the hormone mix than usual. One of the hallmark symptoms of this is bloating and swelling, a familiar PMS sign. Your vocal folds also experience swelling, because the progesterone encourages the capillaries in your vocal folds to engorge with blood. This enlargement of the folds changes the vibratory characteristics of the voice. It also affects the lubrication of the folds and elasticity. The result is vocal folds that may be drier, less flexible and thicker than usual… not the easiest singing conditions!



Image: Pelvic Health Plus




How can this affect your voice?


Given the changes happening in your body during your period, you can expect that you will be working with an instrument that has slightly different considerations to what you are used to.


You may experience the following symptoms:


-Reflux of Gastroesophageal Reflux Disease (GERD)

A common PMS symptom is a worsening of acid reflux. This is a problem for many singers as the acid sitting against the folds can further exacerbate swelling and irritation already experienced by an increase in progesterone. This can be managed by lifestyle factors that reduce GERD symptoms, such as avoiding fun things like spicy food and alcohol, or there are reflux medications readily available over-the-counter from your local pharmacist.


-Vocal fatigue

You may find that during menstruation your voice will tire more quickly than usual. Your vocal folds are tiny muscles that are vibrating together as you sing; changes to the surface area due to swelling, as well as diminished lubrication make singing feel more effortful, particularly when the folds need to stretch long and thin for top notes.


-Change in vocal colour

The fluid retention you experience in your vocal folds may also affect the tone colour of your voice. It’s possible that your folds may not be drawn together as neatly as usual, resulting in an unfocused, breathy, or husky sound.


-Changes in resonance

Closely related to the possible change in vocal colour, many singers report feeling of nasal congestion during that time of the month. The stuffy nose is a result of, you guessed it, swelling and fluid retention! Much like singing when you have a cold, you may feel a very different resonant feedback to what you are used to, and you may even perceive a loss of resonance.


-Decreased agility and feeling like you need to clear your throat

Thicker folds means decreased agility and more difficulty singing in a wide dynamic range, especially when it comes to singing piano. You may also find with the natural lubrication of the folds being less watery than usual that there is a sticky, goopy feeling in your throat that you have an urge to clear.




Things to keep in mind



Even though it isn’t overtly dangerous or disadvantageous to sing whilst menstruating, there are a few things to consider when it comes to your vocal health during this time.


  • Vocal injury

The capillaries in your vocal folds are going to be slightly enlarged. As the folds vibrate with singing in this state, you are at a slightly increased risk of injury.


  • Be mindful with your pain management

Chances are if you are a singer who experiences menstrual cramps, you likely take pain medication. Non-steroidal anti-inflammatory drugs like Aspirin and Ibuprofen are best to be avoided when you need to sing. These medications are blood-thinners and can increase the risk of a vocal haemorrhage, especially when the capillaries are already enlarged.


  • Be mindful of not pushing

There’s a perfect storm brewing when it comes to pushing your voice- resist the urge! Given the swelling of the vocal folds, singing feels more effortful already, and you may try to counteract any breathiness you have with excess compression. You may even experience a double-whammy if you also are experiencing some nasal congestion and can’t feel your resonance as readily as usual. Be mindful that your voice may feel different or less powerful. It’s the time to let your technique carry you, not force!




Caring for your voice during your period



With the times of “grace days” far behind us, what happens when singing on your period is unavoidable? Don’t worry, you can still sing beautifully! You just may need to be a little gentler with yourself than usual.


  • Warm up slowly and lovingly

Whilst it isn’t recommended you warm up for any longer than 10-15 minutes, ensure you take your time warming up from zero, don’t jump into anything too strenuous. Semi-occluded vocal tract exercises (SOVTs) are a wonderful technique for this. This can include humming or straw phonation.


  • Only do the essentials

Where you can, try and scale back on any heavy vocal demands. This doesn’t just include performances, but also loud or lengthy social engagements. Forgo the loud bars at night, or hours of talking during the day; these will all tire you out prematurely if your vocal folds are already swollen and a bit unhappy.




Your time for self-care



Often, it’s presented to us that the time of our period is an inconvenience, or something that is disgusting or shameful. There is an expectation that you’re supposed to curse your period when it arrives, and that your time menstruating is supposed to be miserable. But listen to your body’s cues: is it telling you to spend some time going within? To rest? If so, why is this such a bad thing?


In many cultures around the world, the time a person is menstruating is when they are at their most intuitive and powerful. It’s understood that the menstrual cycle is just that; a cycle. People who menstruate have a different hormone signature for each of the 28 days. People assigned male at birth have a hormone pattern that lasts 24 hours before it resets. It’s not naturally easy for singers who menstruate to maintain a constant state of activity. If you menstruate, remind yourself that it’s completely ok if you feel a bit different each of these 28 days. This includes times when your body is asking you to rest.


Instead of thinking of your period as an inconvenience, start to see it as a sacred ritual, a time of renewal. This is you time, and a point in time where your self-care practice is particularly important.

Nurturing your body with gentle movement can be a great way to relieve muscle cramps and manage stress. Yoga is a wonderful tool in this regard. It also acts as a way of opening up the body before singing as part of a gentle warmup, if singing is unavoidable for you.


There is a lack of education around our bodies. It’s no coincidence that our society’s ideals of productivity and the 5 day work week line up with the 24 hour hormone pattern. As someone who menstruates living in a patriarchal and capitalist society, expecting to work at a certain, fixed physical level everyday causes stress on your body, which in turn can actually worsen your PMS symptoms.


In short, singing during your period is perfectly fine, and perhaps it’s a valuable learning opportunity. Listen to your body’s signals. In our fast-paced world, this is the perfect time to slow down. Enjoy this sacred time for yourself, and enjoy your body and voice in this special form.




Photo: Cliff Booth




Livia Brash is an Australian operatic soprano, the founder of Singing for Self-Care and cat mum living in Germany. www.liviabrash.com


 

Sources:


Levendoski EE, Leydon C, Thibeault SL. “Vocal Fold Epithelial Barrier in Health and Injury A Research Review”. J Speech Lang Hear Res. 2014 Oct; 57 (5)


Voelter Ch, Kleinsasser N, Joa P, et al. “Detection of hormone receptors in the human vocal fold”. Eur Arch Otorhinolaryngol. 2008; 265 (10)


Rios OAR, Duprat AC, Santos AR. “Immunohistochemical searching for estrogen and progesterone receptors in women vocal fold epithelia”. Rev. Bras. Otorrinolaringol. 2008 Aug; 74 (4)


J. Abitbol, J. deBrux, and G. Millot, “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, 1989 June; 3 (2)


C. Davis and M. Davis, “The Effects of Premenstrual Syndrome on the Female Singer” Journal of Voice. 1993 December; 7 (4)


Timothy Anderson, Dawn Anderson, and Robert T. Sataloff, “Endocrine Dysfunction.” Professional Voice: The Science and Art of Clinical Care (San Diego: Singular Publishing, 1997)


Sameep Kadakia, Dave Carlson, and Robert T. Sataloff. “The Effect of Hormones on the Voice.” Journal of Singing. 2014 May/June; 69 (5)


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