Key takeaways:
- Hormones matter for the voice: Falling estrogen and progesterone during menopause can cause hoarseness, vocal fatigue and instability, with major impact on singers, teachers, actors and other voice professionals.
- An overlooked women's health issue: Many women with vocal changes are dismissed or misdiagnosed, underscoring the need for stronger collaboration between gynecologists and voice specialists.
- Promising new solutions: From AI-powered voice biomarkers to hormone therapy and vocal fold injections, innovative approaches are emerging to detect and treat menopause-related voice changes.
TAMPA, Fla. (Sept. 10, 2025) – A new University of South Florida study published in Menopause highlights a largely overlooked health issue: voice changes that many women experience during menopause, often triggered by falling levels of estrogen and progesterone.
The groundbreaking paper, led by Yael Bensoussan, MD, director of the USF Health Voice Center , and Rupal Patel, professor at Northeastern University, explains that those most at risk of unwanted voice changes — including roughness, hoarseness and loss of vocal stability — are women who rely on their voices professionally, such as teachers, actors and especially singers.
"Voice production is a complex physiological process requiring the precise coordination of multiple systems: respiration, phonation, articulation and resonance," the authors wrote in the article, "Menopause and the voice: a narrative review of physiological changes, hormone therapy effects, and treatment options," which published online today.
Even minor disruptions can affect vocal quality, the paper found. Vocal folds rely on musculature, pliability and airflow, while tension and elasticity of the cords play a key role in sound production. "Hormonal fluctuations play a critical role in maintaining the structural integrity of laryngeal tissues," the authors wrote.
The team outlined a range of treatment options:
- Voice therapy to reduce strain.
- Hydration and steaming to address dryness of mucosal tissues.
- Hormone therapy in collaboration with gynecology.
- Bilateral vocal fold injections to restore clarity and volume.
They also highlight AI-powered voice biomarkers as a promising, noninvasive tool to detect subtle vocal changes linked to menopause.
"What needs to be done in the future is more research and more collaboration with gynecologists," Bensoussan said. "And hopefully there will be more awareness to refer patients with these symptoms to a voice specialist, rather than saying, 'Oh, it's normal, don't worry.' And we need more research to understand at what level does giving hormones help the voice – and who should we give them to?"
Bensoussan, an assistant professor in Otolaryngology at the Morsani College of Medicine, is also leading NIH-funded research to build a database of human voices analyzed with AI to identify potential disease biomarkers.
Her interest in menopause-related voice issues grew directly from her patients.
"I was seeing a lot of middle-aged women just around menopause age, and they were coming in with very specific symptoms of rough voices, and dry coughs," she said. "When we looked at their vocal cords with the little camera, we didn't see anything abnormal. As a surgeon, I like to see something I can fix or remove. But these women just had tired voices, and that's when I got really interested in the potential affect of hormones and what those do to change the voice."
She recalls one singer whose teacher could tell when she was menstruating because her voice sounded different.
"Often these women – like many in women's health – are dismissed and told 'Oh, it's reflux, oh it's laryngitis, oh it's nothing,'" Bensoussan said. "But a lot of these voice professionals are being dismissed because there's not enough understanding that hormones have a huge impact on the voice."
Another concern: testosterone therapy sometimes prescribed to menopausal women.
"Unfortunately, testosterone is a male hormone and one of the side effects is a 'more masculine' voice," she said. "And these women are not counseled for that. So, they get to my office and, I can tell within two seconds of speaking with them what's going on. I ask if they're on testosterone, and they say, 'Yes,' and it's really terrible for them. Many cry and say they were never told that it would affect their voice."
Her collaboration with Patel — who noticed her own voice changes during perimenopause — and Dallas gynecologist Cheryl Kinney, MD, helped crystallize the project. Bensoussan was invited to present at a Menopause Society event in Chicago, where the response was overwhelming.
"I think it's because they were surprised," she said. "They didn't understand or appreciate the effect of hormones on the voice."
Among their conclusions: AI voice biomarkers could be a game-changer for early detection, but awareness and cross-specialty collaboration remain critical.
