A recent study from USF Health, published in the journal Menopause on September 9, explores how menopause can affect women’s vocal tone and quality. The research was led by Yael Bensoussan, MD, MSc, inaugural director of the USF Health Voice Center at the Morsani College of Medicine, along with Rupal Patel, PhD, professor at Northeastern University.
The study focuses on women who use their voices professionally—such as teachers, actors, and singers—who may experience unwanted changes in their voice during menopause. These changes include roughness, hoarseness, and a loss of vocal stability. According to Dr. Bensoussan and her team, “Voice production is a complex physiological process requiring ‘the precise coordination of multiple systems: respiration, phonation, articulation and resonance.'”
They note that small disruptions in any part of this process can negatively impact vocal function. The balance of tension and elasticity in the vocal cords is crucial for maintaining vocal quality. The paper also states that “hormonal fluctuations play a critical role in maintaining the structural integrity of laryngeal tissues.”
Treatment options outlined in the paper include voice therapy with a trained therapist to help patients learn to vocalize with less effort; steaming and hydration to address dryness; systematic hormone therapy conducted with both laryngology and gynecology teams; and bilateral vocal fold injection augmentation to increase volume and clarity by injecting material into the vocal cords.
The researchers highlight artificial intelligence (AI) as a promising tool for detecting subtle changes in voice linked to hormonal fluctuations caused by menopause. AI-powered voice biomarkers could offer noninvasive monitoring methods.
Dr. Bensoussan emphasized future directions: “What needs to be done in the future is more research and more collaboration with gynecologists,” she 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?”
Her ongoing work involves creating a database of human voices from people with various health conditions using National Institutes of Health funding. This project uses AI analysis to determine if differences in voice can serve as biomarkers for disease.
Dr. Bensoussan noted that many middle-aged women she saw at the Voice Center had specific symptoms such as rough voices or dry coughs without visible abnormalities upon examination. She observed that some women professionals were dismissed or misdiagnosed due to limited understanding about hormonal effects on the voice.
She also discussed challenges faced by menopausal women treated with testosterone therapy: “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… Many cry and say they were never told that it would affect their voice.”
The idea for this study grew after conversations with colleagues who noticed similar issues among perimenopausal peers. An invitation from Dallas gynecologist Cheryl Kinney led Dr. Bensoussan to present her findings at a Menopause Society event in Chicago.
The study concludes that AI-powered tools could improve detection of menopause-related vocal changes while calling for increased awareness among healthcare providers regarding these symptoms.
“What needs to be done in the future is more research and more collaboration with gynecologists,” Dr. 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?”
