Dear Doctor,

I recently noticed change in my voice as it is becoming hoarse. Now that I have begun my menopause, should I take it as the cause or is there need to seek medication.

Harriet

Dear Harriet,

Change of voice and hoarseness is indeed a symptom of menopause, which is often overlooked. Menstrual cycles occur due to balance of the 2 hormones, estrogen and progestrone. Around and after menopause, levels of estrogen reduce, which is responsible for the unique  feminine characters of a woman. Testosterone levels also rise unopposed. This makes the voice hoarse. There are associated other masculinizing features visible in menopausal women, like central obesity, growth of facial hair,e.t.c..

Apart from this, there is loss of muscle mass around the sound box or larynx. The supporting tissues also start to dry up and decay due to aging. This hampers efficient vibration of the vocal cords, needed to produce sound. These factors also contribute to the hoarseness of voice. Change in voice and a hoarse voice can even occur before actual menopause, as part of perimenopausal syndrome. One also has voice fatigue along with hoarseness. Many professional singers find it difficult to reach high notes after menopause. Those women in public service or teaching(jobs which require lot of talking), start feeling tired after talking much and find it difficult to put through the week.

However, a hoarse voice can be due  other reasons as well. A chronic infection of the sound box, tuberculosis of the larynx are conditions which can  cause an altered voice. But these conditions would have other features of infection like fever, loss of appetite and loss of weight, sweating, e.t.c. Any infection can be diagnosed by suitable investigations and is treatable by antibiotics. Tests  like complete blood count and, laryngoscopy(where the sound box is directly visualised) help to find any underlying abnormality in the sound box.   Laryngeal biopsy( Here a piece of tissue is taken from the larynx and examined to see any abnormality or even cancer) is very useful. Cancer of the sound box or surrounding structures can also cause a hoarse voice. Hormonal disorders like hypothyroidism, disorders of adrenal gland can cause a hoarse voice. Drugs like corticoids, anabolic steroids, can cause a hoarse voice as adverse effect.

If there is no fever, the appetite is good and no weight loss occurs, if, one is able to carry out all activities as before.  there is nothing to worry. A woman learns to accept the changed voice and live with it. Counseling, hormone replacement therapy and speech therapy help her to overcome this change in life.

If there is any doubt about any underlying disorder, one can get examined by a doctor, do all the investigations asked for and take suitable treatment

Dr. Rachna Pande Internist

E-mail- rachna212002@yahoo.co.uk