Effect of Hormonal Replacement Therapy on Voice

Journal of Voice – Article in Press

Abdul-Latif Hamdan, Georges Tabet, Ghina Fakhri, Doja Sarieddine, Rachel Braiche and Myhieddine Seoud

This research study assesses the impact of Hormonal Replacement Therapy on Voice. It also draws together previous research into this area which is extremely useful. Citing research by Abitbol (1999), ‘Post-Menopausal Vocal Syndrome’ refers to a decrease in oestrogen and progesterone during the menopause and the resultant symptoms such as a decreased range, loss of high notes, impact on timbre and an increase in vocal fatigue. The study cites Lindholm (1997) which found that professional voice users report the greatest number of symptoms and the changes observed by laryngeal videostroboscopy include oedema, thickened mucus, dilated varices and a thinning of the vocal folds with atrophic changes. These findings were supported acoustically by ‘a decrease in the speaking fundamental frequency (F0) and an increase in the perturbation parameters.’ (p1)

Lindholm et al (1997) examined the effect of HRT on the fundamental frequency and sound pressure level of 43 postmenopausal women. There appeared to be a decrease in fundamental frequency and sound pressure level than those who were not on treatment.

The study also cites further evidence by D’haesleer et al (2011) Which reported the mean speaking fundamental frequency (SFF) to be higher in women on HRT compared to those who did not receive treatment. They also conducted a second study a year later showing further benefits of HRT with an increase in vocal intensity.

This study also highlights the impact of HRT on women who experience surgically induced menopause. According to Carusso (2011) which also shows that HRT can prevent and treat ‘vocal fold dystrophic changes.’ This links to Firat et al (2009) who conducted a study on 32 surgically induced menopausal women and found a greater degree of voice stability amongst those on therapy. Oestrogen replacement, according to this study had the most positive effect.

What is interesting about this particular research study is that it also takes into account the Body Mass Index of the participants and it explores the possibility of fat as a major source of Oestrogen in post-menopausal women. At menopause ‘the drastic drop in sex hormones unmasks the potential role of fat as an alternative source of Oestrogen, which can mitigate the vocal symptoms and acoustic changes often experienced by menopausal women.’ (p1).

In this study 53 non-professional menopausal women were recruited. 34 were not HRT and 19 were. All subjects completed the Voice Handicap Index by Jacobson et al (1997). The results were as follows:

–          There was no statistical difference in the prevalence of any of the phonatory symptoms in menopausal women not on HRT compared with women on HRT. There was also no difference in the phonatory symptoms of those with low BMI compared to high BMI.

–          Menopausal women not on HRT had a significantly lower habitual pitch than those on HRT. The jitter however was significantly higher in those on HRT. This increase in jitter may be attributed to the marked increase in glandular secretions above and below the true vocal folds.



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