The Influence of the Menstrual Cycle and the Oral Contraceptive Pill on the Female
Filipa Lã1, Jane Davidson1, William Ledger2, David Howard3 & Georgina Jones4
Affiliation: Universities of Sheffield and York. Music Department, University of Sheffield1; Academic Unit of Reproductive and DevelopmentalMedicine, University of Sheffield2; Electronics Department, University of York3, Institute ofGeneral Practice & Primary Care4, U.K.
Address: Music DepartmentUniversity of Sheffield38 Taptonville RoadSheffield, S10 5 BRU.K.
Phone number: (0044) 7752 895 886Email: firstname.lastname@example.org
Aims and objectives
Previous studies have provided evidence for the connection between sex hormonal variations
and voice quality; however, the extent and type of this relationship still raises some controversy,
especially with regard to the singing voice. The current investigation aims to: (i) provide
consistent information about the effects of the hormonal variations during a natural menstrual
cycle on the quality of the trained singing voice in a population of healthy singers; (ii) investigate
whether the use of an OCP has an effect on the quality of the trained singing voice in a
The oral contraceptive pill (OCP) is one of the most common and effective contraceptive
methods used all over the world. However, research concerning the effects of OCP use on the
singing voice is too scant to allow firm conclusions. On the one hand, early studies done by
Zilstorff (1965), Brodnitz (1971), and Dordain (1972) have shown that the use of an OCP causes
temporarily voice masculinisation due to its androgenic derived progestogen. Therefore, during
the later 1960s and 1970s, OCPs were regarded as a dangerous drug for professional voice
users, and those who were taking an OCP were advised to do regular phoniatric examinations.
On the other hand, authors such as Isenberg, Brown and Rothman (1983), Wendler (1995), and
Amir and his associates (2002) showed that there were no alterations in the acoustical
characteristics of the voice or in the quality of the voice of OCP users. In the 1980s, as a
consequence of the pharmacological evolution of the OCP, in which hormonal dosages were
decreased and non-androgenic progestogens were used, there was a reduction of complaints of
vocal changes. No evidence of voice virilisation as a side effect of the intake of more modern
OCPs could be found. These findings lead us to believe that the use of an OCP with
antiandrogenic properties can be prescribed to singers without expecting vocal changes as a side
effect. Moreover, the use of Yasmin might benefit singers by dampening variations in sex
hormonal concentrations during the menstrual cycle, which might be the cause of vocal
To test the above mentioned hypothesis, two major assessments were done: (i) a preliminary
questionnaire assessing the singer’s perception of vocal changes associated with specific
phases of the menstrual cycle and during the intake of an oral contraceptive pill; (ii) a double
blind randomized placebo controlled trial involving 10 healthy operatic singers who took a
placebo and a third generation oral contraceptive pill, Yasmin, each during three consecutive
The preliminary questionnaire was piloted on a professional singer and singing teacher (J.D.)
and later distributed to advanced singing students, studying at several music colleges in the U.K.
The questionnaire involved several multiple choice questions, which included general
information about the participant, and specific questions about the singer’s perception of the
quality of the voice during a natural and an OCP menstrual cycles. A total of 102 questionnaires
were returned. Respondents were aged between 18 and 39 years old; 85 singers (83.3%)
complaint about vocal changes across the menstrual cycle. The most reported symptom was
vocal fatigue, reported by 59 singers (57.8%), and menstruation was most associated with vocal
changes, reported by 63 singers (64.5%). In a scale between 1 – not affected to 5 – very much
affected, 39 singers (38.6%) felt that vocal changes across the menstrual cycle considerably
affect their performances. OCP use did not show a negative effect on singer’s voice. In fact,
singers who were or have been OCP users reported less vocally affected across the menstrual
cycle than singers who were not using an OCP [z = -2.309; p = 0.021], feeling more comfortable
The double blind randomized controlled placebo trial involved 10 singers (mean age = 23.10
years; SD = 2.18 years; range 21-27 years), final students and postgraduate students at three
different music schools in the U.K., GSMD, RCM and Music Department of Sheffield University.
Each participant was asked to take three months of active Yasmin and three months of matched
placebo, without a washing period. Neither the participants or the researchers knew which arm
of the study would come first. The randomization was done at the Pharmacy Department of the
University of Sheffield, who labelled three identical packs of Yasmin and matched placebo. A
total of six audio recordings and 6 blood samples were done for each participant, at three
different stages of the menstrual cycle, for both natural and Yasmin use cycles: menstruation,
and follicular and luteal phases. Each participant was therefore tested taking and not taking
Yasmin. All participants were asked to read a standard text, to sing specific technical exercises,
to ensure that they had warmed-up their voice before starting recording the repertoire, and to
sing two contrasting songs of the singer’s choice: a Lied, and an Operatic aria, listening to the
respective piano accompaniment on one head phone. All recordings were done in a sound proof
room at the music school where the participants were studying, using a stereo digital audio tape-
recorder (DAT) and a portable electrolaryngograph connected to a portable oscilloscope.
Acoustical parameters such as irregularity in the amplitude and frequency of vibration of the
vocal folds (CAx and CFx, respectively) and closed quotient (CQ) were compared, and sex
hormonal concentrations measured for each recording session.
Results and discussion
The results of this study suggest that, when not using Yasmin, menstruation and follicular
phases of the menstrual cycle show higher vocal irregularity, and follicular phase shows higher
values of closed quotient, for both Lied and operatic aria, when compared with Yasmin use.
Possible explanations for these results might be related to the fact that when not using Yasmin,
rapid variations in concentrations of sex hormones, more evident for menstruation and follicular
phases of the menstrual cycle, interfere with the laryngeal neurocontrol, and therefore contribute
to an increase in the irregularity of vibration of the vocal folds. Additionally, the increase in
concentration of oestrogens during the follicular phase of a natural menstrual cycle, might be
responsible for a proliferation of the cells of the laryngeal mucosa, which increases the mass of
the mucosal tissue. This results in a longer contact of the mucosa of the vocal folds during each
vibratory cycle, and thus higher CQ values during this phase of the menstrual cycle when not
In conclusion, the psychological, physiological and perceptual aspects of the performance of
highly trained singers might be improved when using Yasmin.
This study is a new departure in research into the interface between voice and endocrinology.
The authors would like to acknowledge the participants and the Heads of the Vocal Studies
of the Music Colleges involved in this study, the Department of Clinical Chemistry and the
Pharmacy Services Directorate at the Royal Hallamshire Hospital, and finally the Schering
Health Care, Ltd. U.K. and Fundação para a Ciência e a Tecnologia, Portugal for their financial
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