April 12, 2025 • 31 mins
Karen unpacks the surprising connection between hormones and the human voice—especially for singers. Drawing from her dual background in opera and medicine, she explains how hormonal shifts throughout the menstrual cycle can impact vocal quality, flexibility, and range.
Visit our website itchyandbitchy.com to read blog posts on the many topics we have covered on the show.
Visit our website itchyandbitchy.com to read blog posts on the many topics we have covered on the show.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
The content of this podcast is provided for general informational
purposes only and is not intended as nor should it
be considered, a substitute for professional medical advice. Hello everyone,
(00:22):
This is Karen Nickel, family nurse practitioner, and this is
Itchy and Bitchy, a podcast that provides answers to your
many unanswered health questions. After the last episode that was
aired on March twenty ninth, twenty twenty five, in which
I spoke about my friend who did research to advocate
for her healthcare, it was brought to my attention by
(00:44):
my husband and a faithful listener that it would have
been helpful to hear how to do reliable research. They
are absolutely right. I definitely missed the mark on that one.
First of all, I should have mentioned that my friend
I talked about in that episode has experience in the
medical field, so she knows how to find reliable health info. Also,
(01:07):
here are a couple of research tips. In general, you'll
find good health information on websites that are run by
federal government agencies. These are sites that end in dot gov,
dot gov, medical schools, or large medical facilities, for example
Cleveland Clinic Health Library or Mayo clinic diseases and conditions.
(01:32):
Large professional or nonprofit organizations are also excellent resources, for example,
the American College of Cardiology, American Heart Association, or American
Cancer Society. Another site that provides evidence based information that
is very user friendly is health Line healthline at healthline
(01:52):
dot com. Do not trust information on a site if
they don't use up to date research on the subject,
or if they're promising some unbelievable, too good to be
true cure for a disease or problem, or if they
have lots of ads, or if they're making a sales pitch,
or if their writing is very dramatic and emotional. My apologies,
(02:17):
and now on to today's episode. As many of you know,
for the first twenty years of my adult life, I
made my living as an opera singer. Then I spent
twenty two years practicing medicine as a nurse practitioner, and
during my years in family practice, I became what many
people would call an expert in hormone balance and hormone replacement.
(02:40):
So it wasn't until this second part of my life,
the medical part, that I made the connection that hormones
really affect our singing voice. What a revelation that was
I should have figured that out earlier. I just gave
a lecture to graduate students who are at the University
of Tennessee in the opera program, and I titled it
(03:02):
Hormones and high Notes. I know that not all of
my listeners are professional singers, but I thought you might
like to know how our hormones affect our voice production.
We need to start by understanding what is going on
with the hormones when they're cycling, and we need to
know something about how hormones are supposed to cycle. I
(03:26):
will be referring to cycle days, so it's important to
know that cycle day one is the first day of
minstrel flow. Knowing how this whole thing works will help
you understand the job of female hormones and how they
are supposed to be balanced. Let's start with the fillicular phase.
During the follicular phase of the cycle, which is the
(03:46):
first half of the cycle, several small sacks or follicles
we call them form in the ovary. A dominant follicle
forms that's bigger than all the other follicles, and an
a matures inside it. All the other follicles shrink and
eventually disappear during this phase. Estrogen is the dominant hormone,
(04:10):
and if hormones are well balanced, it is in the
second week of this follicular phase when women tend to
feel their best. Women will often say this is when
I feel like my normal self, happy, healthy, well adjusted,
and imbalance. Then we move on to the ovulation phase.
On a round cycle, day fifteen, a pituitary hormone called
(04:34):
lutinizing hormone causes the dominant follicle to release that egg.
It takes anywhere from one to two days for the
egg to leave the follicle. During this time, some people
have ovulatory pain, which we call Mittelschmertz, which is German
for middle pain. The last half of the monthly cycle
(04:55):
is the luteal phase, which lasts for about fourteen days.
After the egg has left the follicle, a mini organ
called the corpus lutium starts to form from the site
of ovulation. Your corpus lutium produces progesterone. Making progesterone is
the corpus lutium's most important job. Progesterone becomes a dominant
(05:20):
hormone during this phase, or it's supposed to be anyway,
and if an imbalance occurs of wimpy progesterone levels or
two high estrogen levels are both, women tend to feel
terrible and often refer to this as hell week or
two weeks of hell. This is when we can see
some significant vocal changes, which I'll talk about a little later.
(05:44):
During this phase, some of you may experience fatigue and
feel quite weepy and emotional. You may also have severe fatigue,
sudden bounts of weakness or feeling like you're going to
pass out. Breast swelling and tenderness, and craving junk food
can also occur. Anxiety and panic attacks, along with extreme irritability,
(06:07):
can also be present. Research has shown that around seventy
five to eighty percent of reproductive age women have these
kinds of symptoms during the luteal phase. So you are
not in the minority. You are in the majority if
you're experiencing these symptoms. When someone isn't having a regular cycle,
(06:30):
they're not having regular periods like those people who have
PCOS polycistic ovarian syndrome, the person doesn't typically ovulate. So
guess what. No ovulation, no corpus lutium forms, and no
progesterone is secreted, and even those women who are ovulating
may develop a corpus lutium that isn't very good at
(06:53):
secreting progesterone. The levels of progesterone are low, while at
the same time are over are still chunking out plenty
of estrogen, and in addition to the ovaries, we have
other estrogen sources. Our fat cells and our adrenal glands
are also making estrogen. The balance of progesterone and estrogen
(07:17):
is important. When they aren't balanced, meaning progesterone is too
low and estrogen is too high, we can develop something
called estrogen dominance, a hormonal imbalance that can affect singing.
All hormones, including sex hormones, thyroid hormones, adrenal hormones, and
insulin regulate every cell in our body. Our cells have
(07:41):
receptors on them for each hormone, and when a hormone
attaches to that cellular receptor, it changes the behavior or
the metabolism of the cell. Receptors for sex hormones have
been found on the vocal folds, which we also call
vocal chords, suggesting a link between hormone levels and vocal
(08:05):
fold function. Which can cause changes in voice production. A
twenty seventeen study investigated the quality of women's voices in
different phases of the cycle. They compared those who have
natural periods periods that aren't influenced by outside hormones, to
those who have the kind of hormonal contraception that gives
(08:27):
you the same amount of hormone daily. In this study,
they collected voice samples of forty four women who had
natural cycles. The samples were collected during two phases, the
late follicular phase, this is the second week in the
cycle when women typically feel good, and the luteal phase,
(08:48):
the time in the cycle when PMS often occurs. They
also collected samples from twenty women who were hormonal contraceptive users.
The samples were taken during the sixth through the twelfth
day of the month and the sixteenth through the twenty
eighth day of the month. Results showed that voices of
(09:08):
naturally cycling women had a higher minimum pitch in the
late follicular phase that first part of the cycle compared
with other phases. So if that's the case, singing high
notes would be easier during this timeframe. Interestingly, as I
explained earlier, this is also the week of the month
(09:30):
during which women will often say that they feel like
their normal self, happy, healthy, well adjusted, and imbalance. It
was also noted in the study that during the late
follicular phase there was an increase in mucus in the
laryngeal mucosa and increased mucus production on the vocal folds,
compared to the luteal phase, during which there was a
(09:51):
drying of the laryngeal mucosa. These changes in the moistness
of the vocal folds can also impact vocal pas. The
amount of health and medicine research done on women compared
to men is really sort of pathetic, But someone has
bothered to do research on the and I'm doing air
(10:13):
quotes here attractiveness of the female voice. They measured the
attractiveness of the female voice throughout the menstrual cycle. Not
sure who dreamed up that study, but it is true
that research has revealed that attractiveness ratings of women's voices
varied across the menstrual cycle. So sometimes you may have
(10:36):
a very attractive voice and sometimes you have a screeching,
horrible voice. It's usually not that dramatic anyway. Those who
were rating the voices found that voices recorded in the
fertile phase, that late fidleicular phase the good week were
found to be most attractive, and lowest ratings were given
(10:59):
for voices recorded in the minstreal phase or the luteal phase,
the PMS phase. The researchers theorize that the female voice
becomes more attractive during the ovulatory phase as nature's way
of increasing the chances that mating will occur during this time.
(11:20):
You have probably noted that during the luteal phase, the
last half of the cycle, I talked about two seemingly
different things, PMS symptoms and unfavorable vocal changes, but they
can certainly be and most likely are related. One of
the many symptoms that can occur during this phase in
(11:40):
the cycle, the luteal phase the PMS phase is water retention.
When we retain fluid in our body related to hormone changes.
It typically impacts every part of our body, including our
vocal folds or vocal chords, which can make them thicker,
(12:01):
which of course can impact our singing. Thick vocal chords
are harder to move, which makes it harder to sing.
I can tell you personally this phenomenon is called dysphonia
pre mins dualis. I love this term, dysphonia pre mins dualis.
It sounds so wonderful and it isn't anyway. It literally
(12:26):
means pre minstrual abnormal voice when the voice can be
described as hoarse, rough, raspy, strained, weak, breathy, or gravelly.
According to a twenty sixteen study, the most common symptoms
of dysphonia mins jealis. Can you tell I like saying
that our difficulties singing high notes? Decreased vocal flexibility, huskiness, fuzziness, breathiness,
(12:52):
decreased volume, difficulty bridging pissagos and pisagio is a break
between the lower and high higher areas of the voice,
So we have difficulty bridging those two areas and intonation problems.
We'd end up with pitch problems. Not too many problems, really,
(13:12):
just a fairly long list. I remember very well struggling
through these issues when I was singing professionally. Dysphonia goes
hand in hand with PMS pre minstrual syndrome, and PMS
is typically caused by estrogen dominance. So why we get
(13:32):
estrogen dominance and what do we do about it? Is
up next after this break, so please stay with me.
(13:55):
What puts us at increased risk for developing estrogen dominance
having an ovulatory cycles. This is when we don't ovulate
during a cycle. Again, after we ovulate, a mini organ
called the corpus lutium forms at the site of ovulation,
and that mini organ secretes progesterone. So if you do
(14:17):
not ovulate, you do not make progesterone this month. This
commonly happens in women with PCs and perimenopausal women. Excess
body fat our fat cells produce estrogen, so the more
fat cells we have, the more estrogen we produce. Chronic
(14:37):
stress this causes increased cortisol secretion from the adrenal gland,
which leads to hormone imbalances. A diet low in fiber,
high in refined carbohydrates, and low in high quality nutritious
foods like fresh fruits, fresh vegetables, and good fats from
foods like nuts and avocados. This will set them stage
(15:00):
for estrogen progesterone imbalance. Poor immune function. Supporting your immune
system is very important for this and for so many
other reasons. We've talked about this endlessly on this podcast.
Environmental agents like mineral oils or petroleum products that can
act like estrogen in our body. These are called zeno estrogens.
(15:23):
Using skin care products or makeup that contain mineral oil,
or drinking out of plastic containers or heating up food
in plastic containers allows zeno estrogens to enter your body.
Estrogen and progestin containing birth control options can cause estrogen dominance,
(15:43):
but you won't have the up and down female hormones,
which I'll discuss later. Some of the symptoms and there
are a lot of estrogen dominance and I'm going to
go try to go through them quickly. Irritability, weight gain,
especially around the hips, and waste, difficulty losing weight, floating,
fluid retention, brain fog, anxiety, blue mood. It continues here
(16:06):
for sleep patterns, mostly trouble staying asleep, fatigue or exhaustion,
decrease in physical stamina, hair loss, skin changes including acne,
quickly aging skin and or dry skin, low motivation or apathy,
low sex drive. For those who are still having natural periods,
(16:28):
you can have additional estrogen dominant symptoms that include heavy periods,
irregular bleeding, increase, cramping, longer period flow. You can also
have worsening PMS, which can include mood swings and fatigue
increase breast pain. You can feel good only one week
of the month, the week that we talked about earlier worsening,
(16:50):
ovulatory pain, worsening, or new migraines. In some of the
disease processes versus symptoms, these are disease processes, not Symptoms
that can occur because of estrogen dominants include ovarian cysts,
uterine fibroids, fibrocystic breast disease, endometriosis, and infertility. These diseases
(17:12):
can develop when someone is estrogen dominant because estradiol, the
estrogen that comes from our ovaries, and estrone, the estrogen
that is produced by our fat cells, are stimulatory. They
stimulate the growth of cells in the female sex organs,
and progesterone slows the growth of cells in the female
sex organs. So when estrogen levels are high and progesterone
(17:36):
levels are low, we get overgrowth of tissues, which can
present as cysts, fibroids, and thickened lining of the uterus.
There are conventional treatment methods used to address the symptoms
that develop due to estrogen dominance. For acne, we use
topical prescriptions like retine and benzicline. We also use hormonal
(17:59):
content receptives and acutane for bloating. Prescription water pills called
diuretics are often used for mood changes. Antidepressants and cognitive
behavioral therapy are often recommended. For hot flashes. Sometimes hormonal
contraceptives are used, whether or not you need birth control. However,
(18:20):
sometimes people get hot flashes when they use birth control.
Hormonal birth control. For sleep disturbances, Prescription sleep meds, including
ambient sedative antidepressants and benzotiazepines like xanax are often prescribed.
For headaches, prescriptions like imitrex, beta blockers, tricyclic antidepressants, botox injections,
(18:44):
and CGERP injectibles are used. And for sex drive, Viagra
can be prescribed. Yes, it can be prescribed for women.
There are other ways to reverse or prevent estrogen dominance
other than the prescription options I just listed. Most of
these recommendations are also made for general wellness. Increasing exercise
(19:06):
promotes hormone balance and reduces body fat. Eat nutritious foods
like fresh fruits and vegetables and good fats also increase
your fiber in your diet. Adequate fiber in your diet
allows for improved elimination of stool. Estrogen is excreted by
the bowel. If stool remains in the bowel, estrogen will
(19:30):
be reabsorbed into the body. Reduce stress. I know this
is not an easy task, but if you have stress
in your life, and I'm not sure I know anyone
who doesn't have stress, it is so important to find
your way of managing it. Avoid use of mineral oils
and petroleum products in your hair care and skin care
(19:51):
because they act like estrogens in your body. I discussed
this earlier. They are called zeno estrogens. Zeno Estrogens can
also be leached into your food if you heat it
in plastic containers in the microwave. This can also happen
when light filters through clear plastic water bottles, so use
a stainless steel water bottle instead and fill it with
(20:13):
filtered water. Consider adding over the counter supplements like dim
diendyl methane or milk thistle, which aids in hormone balance
by supporting the body's metabolism of excess estrogen. And I'll
talk about some options later. Detoxify the liver. The liver
is our bodies filter and filters out excess estrogen, so
(20:35):
keep this organ healthy by limiting alcohol and avoiding high
fat foods. Milk thistle caps can aid supporting a healthy
liver and clears estrogen from the liver. However, if you
have grass allergies or hay fever, this may not be
the best option for you. DIM would be a better
choice for you. Consider starting a balanced bioidentical hormone regimen
(20:59):
that includes per gesterone and bioidentical hormones or hormones that
are identical to what your body produces. Progesterone helps the
body release extra fluid, so it balances the water retention
that estrogen can cause. Progesterone typically requires a prescription, but
there are progesterone creams that can be purchased over the counter. However,
(21:21):
it is best to have a provider knowledgeable in progesterone
dosing guide you in the use of this product, whether
it's prescription or over the counter. In order to address
estrogen dominance, it can be helpful to begin a supplement
that improves our estrogen metabolism, meaning that it helps clear
extra estrogen from your body. There are a couple of option,
(21:44):
but let's just start by talking about DIM diendyl methane.
This is a phytochemical, a plant based chemical that comes
from cruciferous vegetables like broccoli or cabbage. Brands like Life Extension,
Nature's Way Source, No naturals and pure encapsulations have good
DIM products, and some of those products also have additional
(22:07):
ingredients to aid absorption. There are also liquid forms of DIM.
If you have troubled taking pills or you want to
start at a lower dose and work up to the
recommended dosing, you will commonly see indul three carbonyl combined
with DIM supplements. Indul three carbonyl is a phytochemical also
(22:32):
found in cruciferous vegetables such as cabbage. It shows great
potential in preventing cancer, especially hormone related cancers such as
breast and prostate. Abbreviated as I three C, it is
now available as a supplement. I three C is popular
both as an antioxidant and as a cancer fighter. Research
(22:57):
on I three C dates back to the nineteen sixties,
when it was investigated for its actions against chemical carcinogens.
Since that time, researchers have been able to show that
I three C has powerful and diverse ways of stopping cancer.
It is a precursor to DIM, meaning that once in
(23:19):
the gut, indul three carbonyl breaks down and forms DIM
vite immune that's vit immune. Brand Supplement is an example
of indul three carbonyl combined with DIM. The dosing is
two caps one s daily. Milk thistle is another option
to help with estrogen metabolism. One advantage of using milk
(23:43):
thistle versus DIM is that most milk thistle products are
single ingredient products, so if you don't want to have
a combination product one that has a lot of things
in it, this can be a good choice. Again, I
do not recommend this option to anyone who has grass
allergies or hay fever. If you have this type of allergy,
(24:04):
it's best to stick with DIM for estrogen metabolism. Companies
like Life Extension and Puritan's Pride have reliable milk thistle products.
Recommended milk thistle dosing is usually around two hundred and
fifty milligrams twice a day, and the milligrams per cap
really varies from brand to brand, so follow the directions
(24:24):
on the bottle. It's usually one cap twice daily for
most products. Men can have too much estrogen too. How
the heck does that happen Well, many of the same
ways it happens in women. Diet. Our diet has a
direct effect on estrogen production in the body. So eating
a diet high in refined carbs triggers excess fat storage
(24:46):
and fat cells secrete estrone, one form of estrogen. Estrogen
tells our body to store more fat, so the estrogen
secreting fat cells just create more estrogen secreting fat cells.
When we have chronic stress, our body secretes cortisol from
our adrenal glands, and when cortisol levels are up, testosterone
(25:08):
levels go down in men and estrogen levels soar again.
Mindful stress management is so important. Zeno estrogens are also
problematic for men since they act like estrogen in our body,
and I've reviewed with you how to avoid zeno estrogens
earlier in the episode. And symptoms of estrogen dominance and
(25:31):
men are often very similar to those that women have.
The irritability weight gain for them, especially around the waste, difficulty,
losing weight, bloating, fluid retention, brain fog, anxiety, blue mood,
poor sleep patterns, fatigue, decrease in physical stamina, hair loss,
skin changes, low motivation, apathy, low sex drive. This can
(25:54):
all happen when men have estrogen dominance. Men can see
changes in their vocal products if they're dealing with estrogen dominance.
They won't usually happen in a cyclic way, but it
could change day to day depending on what's happening in
that person's life. So we can do the same kinds
of things to eliminate estrogen dominance in men. Reduce or
(26:18):
eliminate refined carbohydrates. Work to reduce fat by increasing exercise
and changing diet. Implement mindful stress reduction techniques, avoid zeno estrogens,
Start a supplement that aids estrogen metabolism, like dim or
milk thistle. And back to women in that twenty seventeen
(26:38):
study I talked about earlier. In contrast to the women
in the study with a natural cycle, there were no
voice changes across the cycle. In hormonal contraceptive users, hormonal
birth control can help with symptoms we can have with
our body's own fluctuating hormones during our monthly cycle. Hormonal
(26:59):
birth control shuts down ovulation from the ovaries. That's the
whole point, and in doing so, you do not produce
any of your own hormones. That being said, some estrogen
and testosterone can be produced by your dream lands, but
that doesn't happen in a cyclic way. A literature view
in a twenty sixteen Journal of Voice article was done
(27:22):
on the effects of hormonal contraception on the voice. A
total of twenty four articles were available for review, and
back when I was singing professionally, contraception was believed to
affect the voice negatively, and it often did have a
negative impact. Because the estrogen doses at that time in
(27:43):
birth control was so high, we didn't have low dose options.
Recent studies using low dose oral contraceptive pills show that
they stabilize the voice. It was noted that vocal stabilization
occurred only during sustained vowel production. There appeared to be
(28:04):
no benefit seen in regular patterned speech. Because of this
sustained vowel production benefit, Singers may be the only population
that have increased vocal stability as a result of taking
hormonal contraceptives. The only type of birth control that has
been studied are oral contraceptives that contain both ethanol estradil
(28:28):
and progestine, which is a synthetic form of progesterone. Other
forms of hormonal contraception have not been evaluated for effects
on the voice. I had many patients who couldn't tolerate
hormonal contraception due to side effects, so that may not
be an option for you if you are a singer
and wanting to have a more stable voice. Here's the
(28:50):
bottom line. If you are having regular periods without significant
PMS or dysphonia pre minstalis, or if you are on
hormonal contract and you have no medication side effects and
no vocal problems, or you are a man who has
no estrogen dominant symptoms or vocal issues, y'all are good
(29:11):
to go. Keep doing what you're doing. Singers find ways
to deal with vocal changes that occur pre menstally, mainly
by solidifying an excellent vocal technique through voice lessons and
lots of practice. Singers do whatever they can to address
the problem, because when you have to sing, you have
(29:32):
to sing. So I figured it out, and countless other
singers have found a way to do their best singing
in spite of hormonal changes. So if you are having
estrogen dominant symptoms, especially if those symptoms include vocal problems
and or pre menstrual symptoms, and the symptoms are impacting
(29:53):
how you function in your daily life or how you
function as a singer. Consider making the lifestyle changes I
reviewed and starting a supplement that helps with estrogen metabolism
to balance your own hormones and correct estrogen dominance. Thank
you all for listening. Wherever you listen to this podcast,
(30:15):
please leave a review and rate the podcast. Your reviews
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and leave comments or questions for me. Our website is
(30:37):
Itchybitch dot com, where there are blogs with some of
our subjects available for you to read. On our Facebook
page and website, we have the information about how to
schedule an appointment with me so we can chat about
how my paramid and Pause course can help you if
you are going through this phase in life. As always,
thanks to Forrest Winzl, our producer and composer of our
(30:58):
theme music and person who does all the behind the
scenes work to make this podcast possible. Thank you for
us everyone, remember your health is in your hands.
The content of this podcast is provided for general informational
purposes only and is not intended as nor should it
be considered, a substitute for professional medical advice. Hello everyone,
(00:22):
This is Karen Nickel, family nurse practitioner, and this is
Itchy and Bitchy, a podcast that provides answers to your
many unanswered health questions. After the last episode that was
aired on March twenty ninth, twenty twenty five, in which
I spoke about my friend who did research to advocate
for her healthcare, it was brought to my attention by
(00:44):
my husband and a faithful listener that it would have
been helpful to hear how to do reliable research. They
are absolutely right. I definitely missed the mark on that one.
First of all, I should have mentioned that my friend
I talked about in that episode has experience in the
medical field, so she knows how to find reliable health info. Also,
(01:07):
here are a couple of research tips. In general, you'll
find good health information on websites that are run by
federal government agencies. These are sites that end in dot gov,
dot gov, medical schools, or large medical facilities, for example
Cleveland Clinic Health Library or Mayo clinic diseases and conditions.
(01:32):
Large professional or nonprofit organizations are also excellent resources, for example,
the American College of Cardiology, American Heart Association, or American
Cancer Society. Another site that provides evidence based information that
is very user friendly is health Line healthline at healthline
(01:52):
dot com. Do not trust information on a site if
they don't use up to date research on the subject,
or if they're promising some unbelievable, too good to be
true cure for a disease or problem, or if they
have lots of ads, or if they're making a sales pitch,
or if their writing is very dramatic and emotional. My apologies,
(02:17):
and now on to today's episode. As many of you know,
for the first twenty years of my adult life, I
made my living as an opera singer. Then I spent
twenty two years practicing medicine as a nurse practitioner, and
during my years in family practice, I became what many
people would call an expert in hormone balance and hormone replacement.
(02:40):
So it wasn't until this second part of my life,
the medical part, that I made the connection that hormones
really affect our singing voice. What a revelation that was
I should have figured that out earlier. I just gave
a lecture to graduate students who are at the University
of Tennessee in the opera program, and I titled it
(03:02):
Hormones and high Notes. I know that not all of
my listeners are professional singers, but I thought you might
like to know how our hormones affect our voice production.
We need to start by understanding what is going on
with the hormones when they're cycling, and we need to
know something about how hormones are supposed to cycle. I
(03:26):
will be referring to cycle days, so it's important to
know that cycle day one is the first day of
minstrel flow. Knowing how this whole thing works will help
you understand the job of female hormones and how they
are supposed to be balanced. Let's start with the fillicular phase.
During the follicular phase of the cycle, which is the
(03:46):
first half of the cycle, several small sacks or follicles
we call them form in the ovary. A dominant follicle
forms that's bigger than all the other follicles, and an
a matures inside it. All the other follicles shrink and
eventually disappear during this phase. Estrogen is the dominant hormone,
(04:10):
and if hormones are well balanced, it is in the
second week of this follicular phase when women tend to
feel their best. Women will often say this is when
I feel like my normal self, happy, healthy, well adjusted,
and imbalance. Then we move on to the ovulation phase.
On a round cycle, day fifteen, a pituitary hormone called
(04:34):
lutinizing hormone causes the dominant follicle to release that egg.
It takes anywhere from one to two days for the
egg to leave the follicle. During this time, some people
have ovulatory pain, which we call Mittelschmertz, which is German
for middle pain. The last half of the monthly cycle
(04:55):
is the luteal phase, which lasts for about fourteen days.
After the egg has left the follicle, a mini organ
called the corpus lutium starts to form from the site
of ovulation. Your corpus lutium produces progesterone. Making progesterone is
the corpus lutium's most important job. Progesterone becomes a dominant
(05:20):
hormone during this phase, or it's supposed to be anyway,
and if an imbalance occurs of wimpy progesterone levels or
two high estrogen levels are both, women tend to feel
terrible and often refer to this as hell week or
two weeks of hell. This is when we can see
some significant vocal changes, which I'll talk about a little later.
(05:44):
During this phase, some of you may experience fatigue and
feel quite weepy and emotional. You may also have severe fatigue,
sudden bounts of weakness or feeling like you're going to
pass out. Breast swelling and tenderness, and craving junk food
can also occur. Anxiety and panic attacks, along with extreme irritability,
(06:07):
can also be present. Research has shown that around seventy
five to eighty percent of reproductive age women have these
kinds of symptoms during the luteal phase. So you are
not in the minority. You are in the majority if
you're experiencing these symptoms. When someone isn't having a regular cycle,
(06:30):
they're not having regular periods like those people who have
PCOS polycistic ovarian syndrome, the person doesn't typically ovulate. So
guess what. No ovulation, no corpus lutium forms, and no
progesterone is secreted, and even those women who are ovulating
may develop a corpus lutium that isn't very good at
(06:53):
secreting progesterone. The levels of progesterone are low, while at
the same time are over are still chunking out plenty
of estrogen, and in addition to the ovaries, we have
other estrogen sources. Our fat cells and our adrenal glands
are also making estrogen. The balance of progesterone and estrogen
(07:17):
is important. When they aren't balanced, meaning progesterone is too
low and estrogen is too high, we can develop something
called estrogen dominance, a hormonal imbalance that can affect singing.
All hormones, including sex hormones, thyroid hormones, adrenal hormones, and
insulin regulate every cell in our body. Our cells have
(07:41):
receptors on them for each hormone, and when a hormone
attaches to that cellular receptor, it changes the behavior or
the metabolism of the cell. Receptors for sex hormones have
been found on the vocal folds, which we also call
vocal chords, suggesting a link between hormone levels and vocal
(08:05):
fold function. Which can cause changes in voice production. A
twenty seventeen study investigated the quality of women's voices in
different phases of the cycle. They compared those who have
natural periods periods that aren't influenced by outside hormones, to
those who have the kind of hormonal contraception that gives
(08:27):
you the same amount of hormone daily. In this study,
they collected voice samples of forty four women who had
natural cycles. The samples were collected during two phases, the
late follicular phase, this is the second week in the
cycle when women typically feel good, and the luteal phase,
(08:48):
the time in the cycle when PMS often occurs. They
also collected samples from twenty women who were hormonal contraceptive users.
The samples were taken during the sixth through the twelfth
day of the month and the sixteenth through the twenty
eighth day of the month. Results showed that voices of
(09:08):
naturally cycling women had a higher minimum pitch in the
late follicular phase that first part of the cycle compared
with other phases. So if that's the case, singing high
notes would be easier during this timeframe. Interestingly, as I
explained earlier, this is also the week of the month
(09:30):
during which women will often say that they feel like
their normal self, happy, healthy, well adjusted, and imbalance. It
was also noted in the study that during the late
follicular phase there was an increase in mucus in the
laryngeal mucosa and increased mucus production on the vocal folds,
compared to the luteal phase, during which there was a
(09:51):
drying of the laryngeal mucosa. These changes in the moistness
of the vocal folds can also impact vocal pas. The
amount of health and medicine research done on women compared
to men is really sort of pathetic, But someone has
bothered to do research on the and I'm doing air
(10:13):
quotes here attractiveness of the female voice. They measured the
attractiveness of the female voice throughout the menstrual cycle. Not
sure who dreamed up that study, but it is true
that research has revealed that attractiveness ratings of women's voices
varied across the menstrual cycle. So sometimes you may have
(10:36):
a very attractive voice and sometimes you have a screeching,
horrible voice. It's usually not that dramatic anyway. Those who
were rating the voices found that voices recorded in the
fertile phase, that late fidleicular phase the good week were
found to be most attractive, and lowest ratings were given
(10:59):
for voices recorded in the minstreal phase or the luteal phase,
the PMS phase. The researchers theorize that the female voice
becomes more attractive during the ovulatory phase as nature's way
of increasing the chances that mating will occur during this time.
(11:20):
You have probably noted that during the luteal phase, the
last half of the cycle, I talked about two seemingly
different things, PMS symptoms and unfavorable vocal changes, but they
can certainly be and most likely are related. One of
the many symptoms that can occur during this phase in
(11:40):
the cycle, the luteal phase the PMS phase is water retention.
When we retain fluid in our body related to hormone changes.
It typically impacts every part of our body, including our
vocal folds or vocal chords, which can make them thicker,
(12:01):
which of course can impact our singing. Thick vocal chords
are harder to move, which makes it harder to sing.
I can tell you personally this phenomenon is called dysphonia
pre mins dualis. I love this term, dysphonia pre mins dualis.
It sounds so wonderful and it isn't anyway. It literally
(12:26):
means pre minstrual abnormal voice when the voice can be
described as hoarse, rough, raspy, strained, weak, breathy, or gravelly.
According to a twenty sixteen study, the most common symptoms
of dysphonia mins jealis. Can you tell I like saying
that our difficulties singing high notes? Decreased vocal flexibility, huskiness, fuzziness, breathiness,
(12:52):
decreased volume, difficulty bridging pissagos and pisagio is a break
between the lower and high higher areas of the voice,
So we have difficulty bridging those two areas and intonation problems.
We'd end up with pitch problems. Not too many problems, really,
(13:12):
just a fairly long list. I remember very well struggling
through these issues when I was singing professionally. Dysphonia goes
hand in hand with PMS pre minstrual syndrome, and PMS
is typically caused by estrogen dominance. So why we get
(13:32):
estrogen dominance and what do we do about it? Is
up next after this break, so please stay with me.
(13:55):
What puts us at increased risk for developing estrogen dominance
having an ovulatory cycles. This is when we don't ovulate
during a cycle. Again, after we ovulate, a mini organ
called the corpus lutium forms at the site of ovulation,
and that mini organ secretes progesterone. So if you do
(14:17):
not ovulate, you do not make progesterone this month. This
commonly happens in women with PCs and perimenopausal women. Excess
body fat our fat cells produce estrogen, so the more
fat cells we have, the more estrogen we produce. Chronic
(14:37):
stress this causes increased cortisol secretion from the adrenal gland,
which leads to hormone imbalances. A diet low in fiber,
high in refined carbohydrates, and low in high quality nutritious
foods like fresh fruits, fresh vegetables, and good fats from
foods like nuts and avocados. This will set them stage
(15:00):
for estrogen progesterone imbalance. Poor immune function. Supporting your immune
system is very important for this and for so many
other reasons. We've talked about this endlessly on this podcast.
Environmental agents like mineral oils or petroleum products that can
act like estrogen in our body. These are called zeno estrogens.
(15:23):
Using skin care products or makeup that contain mineral oil,
or drinking out of plastic containers or heating up food
in plastic containers allows zeno estrogens to enter your body.
Estrogen and progestin containing birth control options can cause estrogen dominance,
(15:43):
but you won't have the up and down female hormones,
which I'll discuss later. Some of the symptoms and there
are a lot of estrogen dominance and I'm going to
go try to go through them quickly. Irritability, weight gain,
especially around the hips, and waste, difficulty losing weight, floating,
fluid retention, brain fog, anxiety, blue mood. It continues here
(16:06):
for sleep patterns, mostly trouble staying asleep, fatigue or exhaustion,
decrease in physical stamina, hair loss, skin changes including acne,
quickly aging skin and or dry skin, low motivation or apathy,
low sex drive. For those who are still having natural periods,
(16:28):
you can have additional estrogen dominant symptoms that include heavy periods,
irregular bleeding, increase, cramping, longer period flow. You can also
have worsening PMS, which can include mood swings and fatigue
increase breast pain. You can feel good only one week
of the month, the week that we talked about earlier worsening,
(16:50):
ovulatory pain, worsening, or new migraines. In some of the
disease processes versus symptoms, these are disease processes, not Symptoms
that can occur because of estrogen dominants include ovarian cysts,
uterine fibroids, fibrocystic breast disease, endometriosis, and infertility. These diseases
(17:12):
can develop when someone is estrogen dominant because estradiol, the
estrogen that comes from our ovaries, and estrone, the estrogen
that is produced by our fat cells, are stimulatory. They
stimulate the growth of cells in the female sex organs,
and progesterone slows the growth of cells in the female
sex organs. So when estrogen levels are high and progesterone
(17:36):
levels are low, we get overgrowth of tissues, which can
present as cysts, fibroids, and thickened lining of the uterus.
There are conventional treatment methods used to address the symptoms
that develop due to estrogen dominance. For acne, we use
topical prescriptions like retine and benzicline. We also use hormonal
(17:59):
content receptives and acutane for bloating. Prescription water pills called
diuretics are often used for mood changes. Antidepressants and cognitive
behavioral therapy are often recommended. For hot flashes. Sometimes hormonal
contraceptives are used, whether or not you need birth control. However,
(18:20):
sometimes people get hot flashes when they use birth control.
Hormonal birth control. For sleep disturbances, Prescription sleep meds, including
ambient sedative antidepressants and benzotiazepines like xanax are often prescribed.
For headaches, prescriptions like imitrex, beta blockers, tricyclic antidepressants, botox injections,
(18:44):
and CGERP injectibles are used. And for sex drive, Viagra
can be prescribed. Yes, it can be prescribed for women.
There are other ways to reverse or prevent estrogen dominance
other than the prescription options I just listed. Most of
these recommendations are also made for general wellness. Increasing exercise
(19:06):
promotes hormone balance and reduces body fat. Eat nutritious foods
like fresh fruits and vegetables and good fats also increase
your fiber in your diet. Adequate fiber in your diet
allows for improved elimination of stool. Estrogen is excreted by
the bowel. If stool remains in the bowel, estrogen will
(19:30):
be reabsorbed into the body. Reduce stress. I know this
is not an easy task, but if you have stress
in your life, and I'm not sure I know anyone
who doesn't have stress, it is so important to find
your way of managing it. Avoid use of mineral oils
and petroleum products in your hair care and skin care
(19:51):
because they act like estrogens in your body. I discussed
this earlier. They are called zeno estrogens. Zeno Estrogens can
also be leached into your food if you heat it
in plastic containers in the microwave. This can also happen
when light filters through clear plastic water bottles, so use
a stainless steel water bottle instead and fill it with
(20:13):
filtered water. Consider adding over the counter supplements like dim
diendyl methane or milk thistle, which aids in hormone balance
by supporting the body's metabolism of excess estrogen. And I'll
talk about some options later. Detoxify the liver. The liver
is our bodies filter and filters out excess estrogen, so
(20:35):
keep this organ healthy by limiting alcohol and avoiding high
fat foods. Milk thistle caps can aid supporting a healthy
liver and clears estrogen from the liver. However, if you
have grass allergies or hay fever, this may not be
the best option for you. DIM would be a better
choice for you. Consider starting a balanced bioidentical hormone regimen
(20:59):
that includes per gesterone and bioidentical hormones or hormones that
are identical to what your body produces. Progesterone helps the
body release extra fluid, so it balances the water retention
that estrogen can cause. Progesterone typically requires a prescription, but
there are progesterone creams that can be purchased over the counter. However,
(21:21):
it is best to have a provider knowledgeable in progesterone
dosing guide you in the use of this product, whether
it's prescription or over the counter. In order to address
estrogen dominance, it can be helpful to begin a supplement
that improves our estrogen metabolism, meaning that it helps clear
extra estrogen from your body. There are a couple of option,
(21:44):
but let's just start by talking about DIM diendyl methane.
This is a phytochemical, a plant based chemical that comes
from cruciferous vegetables like broccoli or cabbage. Brands like Life Extension,
Nature's Way Source, No naturals and pure encapsulations have good
DIM products, and some of those products also have additional
(22:07):
ingredients to aid absorption. There are also liquid forms of DIM.
If you have troubled taking pills or you want to
start at a lower dose and work up to the
recommended dosing, you will commonly see indul three carbonyl combined
with DIM supplements. Indul three carbonyl is a phytochemical also
(22:32):
found in cruciferous vegetables such as cabbage. It shows great
potential in preventing cancer, especially hormone related cancers such as
breast and prostate. Abbreviated as I three C, it is
now available as a supplement. I three C is popular
both as an antioxidant and as a cancer fighter. Research
(22:57):
on I three C dates back to the nineteen sixties,
when it was investigated for its actions against chemical carcinogens.
Since that time, researchers have been able to show that
I three C has powerful and diverse ways of stopping cancer.
It is a precursor to DIM, meaning that once in
(23:19):
the gut, indul three carbonyl breaks down and forms DIM
vite immune that's vit immune. Brand Supplement is an example
of indul three carbonyl combined with DIM. The dosing is
two caps one s daily. Milk thistle is another option
to help with estrogen metabolism. One advantage of using milk
(23:43):
thistle versus DIM is that most milk thistle products are
single ingredient products, so if you don't want to have
a combination product one that has a lot of things
in it, this can be a good choice. Again, I
do not recommend this option to anyone who has grass
allergies or hay fever. If you have this type of allergy,
(24:04):
it's best to stick with DIM for estrogen metabolism. Companies
like Life Extension and Puritan's Pride have reliable milk thistle products.
Recommended milk thistle dosing is usually around two hundred and
fifty milligrams twice a day, and the milligrams per cap
really varies from brand to brand, so follow the directions
(24:24):
on the bottle. It's usually one cap twice daily for
most products. Men can have too much estrogen too. How
the heck does that happen Well, many of the same
ways it happens in women. Diet. Our diet has a
direct effect on estrogen production in the body. So eating
a diet high in refined carbs triggers excess fat storage
(24:46):
and fat cells secrete estrone, one form of estrogen. Estrogen
tells our body to store more fat, so the estrogen
secreting fat cells just create more estrogen secreting fat cells.
When we have chronic stress, our body secretes cortisol from
our adrenal glands, and when cortisol levels are up, testosterone
(25:08):
levels go down in men and estrogen levels soar again.
Mindful stress management is so important. Zeno estrogens are also
problematic for men since they act like estrogen in our body,
and I've reviewed with you how to avoid zeno estrogens
earlier in the episode. And symptoms of estrogen dominance and
(25:31):
men are often very similar to those that women have.
The irritability weight gain for them, especially around the waste, difficulty,
losing weight, bloating, fluid retention, brain fog, anxiety, blue mood,
poor sleep patterns, fatigue, decrease in physical stamina, hair loss,
skin changes, low motivation, apathy, low sex drive. This can
(25:54):
all happen when men have estrogen dominance. Men can see
changes in their vocal products if they're dealing with estrogen dominance.
They won't usually happen in a cyclic way, but it
could change day to day depending on what's happening in
that person's life. So we can do the same kinds
of things to eliminate estrogen dominance in men. Reduce or
(26:18):
eliminate refined carbohydrates. Work to reduce fat by increasing exercise
and changing diet. Implement mindful stress reduction techniques, avoid zeno estrogens,
Start a supplement that aids estrogen metabolism, like dim or
milk thistle. And back to women in that twenty seventeen
(26:38):
study I talked about earlier. In contrast to the women
in the study with a natural cycle, there were no
voice changes across the cycle. In hormonal contraceptive users, hormonal
birth control can help with symptoms we can have with
our body's own fluctuating hormones during our monthly cycle. Hormonal
(26:59):
birth control shuts down ovulation from the ovaries. That's the
whole point, and in doing so, you do not produce
any of your own hormones. That being said, some estrogen
and testosterone can be produced by your dream lands, but
that doesn't happen in a cyclic way. A literature view
in a twenty sixteen Journal of Voice article was done
(27:22):
on the effects of hormonal contraception on the voice. A
total of twenty four articles were available for review, and
back when I was singing professionally, contraception was believed to
affect the voice negatively, and it often did have a
negative impact. Because the estrogen doses at that time in
(27:43):
birth control was so high, we didn't have low dose options.
Recent studies using low dose oral contraceptive pills show that
they stabilize the voice. It was noted that vocal stabilization
occurred only during sustained vowel production. There appeared to be
(28:04):
no benefit seen in regular patterned speech. Because of this
sustained vowel production benefit, Singers may be the only population
that have increased vocal stability as a result of taking
hormonal contraceptives. The only type of birth control that has
been studied are oral contraceptives that contain both ethanol estradil
(28:28):
and progestine, which is a synthetic form of progesterone. Other
forms of hormonal contraception have not been evaluated for effects
on the voice. I had many patients who couldn't tolerate
hormonal contraception due to side effects, so that may not
be an option for you if you are a singer
and wanting to have a more stable voice. Here's the
(28:50):
bottom line. If you are having regular periods without significant
PMS or dysphonia pre minstalis, or if you are on
hormonal contract and you have no medication side effects and
no vocal problems, or you are a man who has
no estrogen dominant symptoms or vocal issues, y'all are good
(29:11):
to go. Keep doing what you're doing. Singers find ways
to deal with vocal changes that occur pre menstally, mainly
by solidifying an excellent vocal technique through voice lessons and
lots of practice. Singers do whatever they can to address
the problem, because when you have to sing, you have
(29:32):
to sing. So I figured it out, and countless other
singers have found a way to do their best singing
in spite of hormonal changes. So if you are having
estrogen dominant symptoms, especially if those symptoms include vocal problems
and or pre menstrual symptoms, and the symptoms are impacting
(29:53):
how you function in your daily life or how you
function as a singer. Consider making the lifestyle changes I
reviewed and starting a supplement that helps with estrogen metabolism
to balance your own hormones and correct estrogen dominance. Thank
you all for listening. Wherever you listen to this podcast,
(30:15):
please leave a review and rate the podcast. Your reviews
and ratings really do matter. Also, make sure you follow
the show so that it will be automatically downloaded. That
matters too. I encourage you to visit our Facebook page
i NB Podcast, where you can give us a like
and leave comments or questions for me. Our website is
(30:37):
Itchybitch dot com, where there are blogs with some of
our subjects available for you to read. On our Facebook
page and website, we have the information about how to
schedule an appointment with me so we can chat about
how my paramid and Pause course can help you if
you are going through this phase in life. As always,
thanks to Forrest Winzl, our producer and composer of our
(30:58):
theme music and person who does all the behind the
scenes work to make this podcast possible. Thank you for
us everyone, remember your health is in your hands.
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