Doc: My Voice Feels ‘Tight’ Just Before My Period!

Commissioned Illustration singing duo with doctor
Dr. Jahn discusses the impact of the menstrual cycle on singing as well as solutions for a less responsive voice just prior to a period

Dear Doctor Jahn

I notice that my voice gets a scratchy/fuzzy feeling a couple days before my period pretty much every cycle. My throat becomes tight, and I have a harder time bringing my voice into that forward, healthy placement. What would you recommend as a work around when this happens?

-Kerry

Dear Kerry,

Where to begin? In simple terms, the menstrual cycle involves the rise and fall of two hormones, estrogen and progesterone.

During the first two weeks of your cycle, estrogen predominates, culminating in ovulation.

During the third week, progesterone is dominant, which thickens and prepares the uterine wall in preparation for possible ovum implantation. And then the period begins.

While both hormones can cause some fluid retention, progesterone is much more active in this regard. For this reason, during your third ( pre-menstrual) week, the tissues of your body, including vocal folds and the vocal tract, may be more swollen and less flexible.

For some women, this is when shoes get tight and your rings don’t fit.

Singers often feel at this time that the voice is less responsive, less resonant, and the vocal range is reduced.

The degree of impairment varies greatly from one singer to the next and only you can tell (both by sound and proprioception) where you sit on that spectrum.

If you try to push through any premenstrual impairment by muscling your voice, you may feel tightness and even develop problems in the mix. These symptoms are due not so much to the swelling but to your attempts to compensate for it.

Solutions Just Prior to a Period

Solution options are many, and I will just list the main ones below – since detailed discussion is beyond the scope of this question-answer format.

1) Restrict singing engagements that week.

2) Consider the use of hormones, either conventional birth control pills, or long term implantable hormone-eluting devices (subcutaneous or IUDs) which reduce or eliminate hormonal fluctuations.

3) Strict salt restriction during your premenstrual week. Paradoxically, this is a time when many women crave salt, adding to the problem.

4) Modify repertoire, amplification use, etc. to avoid the need to muscle and strain.

5) Use of a mild diuretic for a week, if your general health status allows.

Just be careful to reduce the demands you make on your vocal tract during this time, and that way, you won’t acquire a secondary list of problems from over straining.

– Anthony F. Jahn, MD, FACS, FRCS(C)

This discussion is for general information and not to be construed as specific medical advice that you should obtain from your own physician.

Dr. Jahn is an internationally renowned otolaryngologist based in Manhattan with a sub-specialty interest in the professional voice. His practice includes classical and popular singers. He holds academic appointments at Mount Sinai School of Medicine and Westminster Choir College in Princeton, and is Medical Director at the Metropolitan Opera and Jazz at Lincoln Center. Dr. Jahn has published "The Singer's Guide to Complete Health" (Oxford University Press) - a comprehensive guidebook on a wide range of health issues that affect the voice.