Photo of Kaleigh Gamaché’s healthy vocal folds used with her permission

Vindhya Khare, D.M.A.
Coordinator of Vocal Studies
Florida International University, Miami

Could your hormonal intrauterine device (IUD) have the potential to change your voice? The answer is, yes. It’s important to understand that there are two types of IUDs: non-hormonal and hormonal. Non-hormonal IUDs, such as Paragard, are wound with copper wire. The continuous release of copper in the uterus is toxic to sperm. Hormonal IUDs include Mirena, Liletta, Skyla, and the latest – Kyleena, which was just recently made available in 2016. Some women choose an IUD over oral contraception because of the convenience of no daily pill to remember.

So, what hormone are we talking about and why does it matter? We’re talking about synthetic progesterone, called progestin or progestogen, and this is significant because sex hormones have a direct impact on the singing voice. Oral contraceptives, commonly called “the pill”, usually contain a combination of synthetic estrogen and progesterone, but hormonal IUDs only contain progestin. A simple Google search will reveal the various hormonal IUDs available and their benefits, such as not having to worry about risks associated with estrogen. (Estrogen facts and myths are an epic topic for future discussion). Your internet search will also lead to numerous blogs touting both the wonderful convenience as well as horrible side-effects of an IUD, Mirena in particular. However, let’s talk about how hormonal IUDs work and what this has to do with the voice. How can a hormonal IUD possibly change a woman’s singing voice?

The small plastic T-shaped IUD is inserted by a doctor into the uterus and removed 3 years later, or 5 years later if it’s Mirena. Once the IUD is inserted into the uterus, the body receives a continuous release of the progestin, levonorgestrel, until the end of the 3-year or 5-year term when the hormone starts to deplete. On a side note: a higher dosage of levonorgestrel is found in the Plan B One Step pill, known as “the morning after pill”.

What we know about sex hormones is that they are chemical messengers that coordinate activities at the site of organs with sex hormone receptors. Thanks to laryngologist, Dr. Jean Abitbol, we know that this includes not only the vagina, but the larynx as well. He discovered that the squamous epithelial cells from your cervix are indistinguishable from the same cells in the mucosa of your vocal folds. The unfortunate thing is that there isn’t evidence-based research published on how an IUD can affect the voice of a professional singer. Therefore, based on what is scientifically known about progesterone and the voice, let’s consider the following…

Progestin is effective in birth control for a few reasons, and one of those is that it promotes mucous in the vagina, which makes the journey of sperm nearly impossible. Let’s take into account that a woman not on hormonal birth control often experiences symptoms associated with PMS, such as bloating and swelling just before her period starts when progesterone levels are at their highest. Therefore, we can see a parallel between the production of vaginal and laryngeal mucous and swelling.

Scientific findings related to the effects of progesterone on the voice reveal that it restricts fluid distribution within the vocal folds which leads to edema, or swelling. Singers tend to be sensitive to this condition and experience symptoms such as heavier and less flexible vocal production, a less vibrant vocal sound, diminished high notes, and difficulty singing softly. Women may also feel the need to frequently clear their throats due to mucous accumulation. The constant release of progestin while on a hormonal IUD could conceivably result in the presence of these vocal symptoms on a continuous basis.

A professional soprano shared with me her experiences with the IUD, Skyla, and its effect on her voice. She reported noticing vocal changes after 2 ½ years when the progestin started wearing off. Once the IUD was removed, at the recommended 3 years, she noticed obvious changes in her voice that were alarming at first. Three months after having the IUD removed, she states that her voice feels more vibrant, flexible, lubricated, and that her range has increased. At first, she felt a difference in her breath support, as the removal of the IUD made her feel less connected to her body. Now, she is able to sustain phrases unlike before. In hindsight, she recalls that the IUD made her voice fuller and gave her a “fuzzy” sensation through the passaggio, and that her passaggio had even lowered while on Skyla. She now feels that her passaggio has risen to its pre-Skyla range. Additionally, she has made adjustments to some of her repertoire and currently reports feeling less tension overall, with a voice that is less heavy, and she has regained her high notes.

While this may be just one woman’s story, as a singer this is especially helpful to hear when considering a hormonal IUD. Long-acting contraception, such as IUDs, are rising in popularity and are most used among women ages 25-34, according to CBS news. The news agency also reports that IUDs are being recommended for teens as their first method of contraception. There is a lot to consider when deciding which type of birth control to use. With that said, it is absolutely a personal choice, and may be a very difficult and confusing one to make. Even when consulting with your doctor, he or she might not be aware of the serious impact sex hormones can have on your voice. My advice? Be informed, be wise, and take charge of you!

Please send me questions, suggestions, and personal stories so I can address issues regarding hormones and the voice that matter to you. [email protected]

Vindhya Khare holds a Doctor of Musical Arts Degree in Vocal Pedagogy and Performance from the University of Miami, Frost School of Music with research in the field of sex hormones and the female singing voice. She receives invitations from around the country and internationally to present on the subject at universities, workshops, and conferences with the purpose of educating singers, teachers of singing, coaches, and music directors on this very relevant subject. Khare also holds a Master of Music degree in Vocal Performance from Florida International University, as well as an undergraduate degree in piano performance from California State University, Northridge. She serves as Coordinator of Vocal Studies at Florida International University in Miami where she teaches voice, vocal pedagogy, diction, and opera workshop.