Menopause: The Journal of The North American Menopause Society Vol. 18, No. 3, pp. 267/272 DOI: 10.1097/gme.0b013e3181f3ee36 * 2011 by The North American Menopause Society The impact of menopause on vocal quality Evelien D’haeseleer, MSc, 1 Herman Depypere, MD, PhD, 2 Sofie Claeys, MD, PhD, 1 Floris L. Wuyts, PhD, 3 Sophia De Ley, MSc, 1 and Kristiane M. Van Lierde, PhD 1 Abstract Objective: The purpose of this study was to measure and describe the effect of menopause on vocal characteristics by comparing premenopausal and postmenopausal women (not taking hormone therapy [HT]). Methods: Thirty-eight postmenopausal women (mean age, 58 y) not taking HT participated in the study. The control group consisted of 34 premenopausal women (mean age, 48 y). To determine the vocal characteristics in both groups, objective (aerodynamic measurements, vocal range measurements, acoustic analysis, electroglottography, and a determination of the Dysphonia Severity Index) and subjective (perceptual evaluation, videostroboscopic evaluation, and Voice Handicap Index) assessment techniques were used. Results: Postmenopausal women showed a good overall vocal quality, with a Dysphonia Severity Index value of 3.3. Significant differences in aerodynamic parameters (vital capacity and phonation quotient), vocal range (lowest frequency), and acoustic parameters (fundamental frequency [F0] during reading, variation of F0, F0 tremor in- tensity index, and amplitude tremor intensity index) were found between the premenopausal and postmenopausal women. However, when controlling for age, only phonation quotient and F0 during reading were significantly lower in the group of postmenopausal women. For the perceptual evaluation, significant differences in grade of dysphonia, breathiness, and strained vocal quality were found. Conclusions: Postmenopausal women not taking HT had a good overall vocal quality. However, in comparison with premenopausal women, they showed a lower habitual F0 in continuous speech. Key Words: Menopause Y Vocal quality Y Vocal performance Y Larynx. D uring lifetime, the female larynx is very sensitive to sex hormone fluctuations. In middle-aged women, the menopausal transition is an important event that drastically changes the sex hormone balance. Menopause ends the reproductive period and is characterized by a permanent cessation of menstruation resulting from the loss of ovarian follicular activity. In menopause, levels of the female sex hormones estrogen and progesterone decrease so that the ratio of estrogen-progesterone to androgens changes and the influ- ence of androgens becomes more important in the female body. These hormone fluctuations are associated with many alterations of functional and organic well-being. For many women and especially for professional voice users, the main- tenance of an optimal vocal quality is important in their mid- dle ages. From that point of view, it is very important to know the precise impact of the menopausal transition on the larynx and on vocal quality. The prevalence of vocal complaints during menopause varies between 17% 1 and 77%. 2 This wide range is partly due to the different definitions of voice problems and the different methodologies (observational studyVquestionnaire) used in the studies. In the literature, the most reported acoustic change after menopause is lowering of the fundamental frequency (F0) in continuous speech 3,4 and in an isolated vowel. 5 However, some authors 6,7 did not detect significant differences in F0 in the acoustic analysis of an isolated vowel. Other reported acoustic changes in postmenopausal women are a decrease in voice intensity (sound pressure level), 5 decrease in vocal fre- quency range, 1 and changes in the variation of the F0 (vF0). Some researchers 1,8,9 have investigated the morphologic changes in the larynx caused by menopause. Abitbol et al 1 and Caruso et al 8 investigated the cytologic aspects of the vocal folds smears and found atrophy and dystrophy in postme- nopausal women not taking hormone therapy (HT). Observa- tions through laryngoscopy revealed different observations like viscous mucosa, 9 mucosal atrophy, 1 edema, 9 microvarices, 1 and loss of the white appearance of the mucosa. 9 However, until now, it is not totally clear if there is a change in the objective vocal quality characteristics after menopause. Most studies used acoustic analysis in combination with video- laryngoscopy or subjective voice evaluations to assess post- menopausal vocal quality. Studies evaluating the effect of menopause on vocal quality using an objective multiparameter voice approach haveVto the best of our knowledgeVnot yet Received April 27, 2010; revised and accepted July 19, 2010. From the Departments of 1 Otorhinolaryngology, Logopaedic, and Audio- logic Sciences and 2 Gynaecology, Ghent University, Ghent, Belgium; and 3 Department of Biomedical Physics, University of Antwerp, Antwerp, Belgium. Financial disclosure/conflicts of interest: None reported. Address correspondence to: Evelien D’haeseleer, MSc, Department of Otorhinolaryngology and Head and Neck Surgery, Speech and Language Pathology, GE 19, Ghent University, De Pintelaan 185, 2P1, 9000 Ghent, Belgium. E-mail: Evelien.Dhaeseleer@Ugent.be Menopause, Vol. 18, No. 3, 2011 267 Copyright © 2011 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.