Menopause Advice for Performing Artists

This resource provides information for people working in the performing arts, who have menopause-associated symptoms or who will experience menopause in the future. 

In this factsheet

• What is Menopause and perimenopause?
• How is Menopause diagnosed and assessed?
• How can Menopause affect the Performing Artist?
• What are the treatments available?
• How can Performing artists in perimenopause and menopause stay healthy and reduce their injury risk?
• Where can I get further information and support?

What is Menopause and Perimenopause?

Menopause is not a disease – it’s a natural transition. It is defined when menstrual periods cease for 12 months. Usually, menopause naturally occurs between the ages of 45 and 55 years. Perimenopause is the time leading up to menopause when hormones produced by the ovaries gradually decline. Perimenopause can last several years, during which changes or symptoms may be noticed.

In a small number of people, menopause occurs before the age of 40; this is known as premature menopause or premature ovarian insufficiency. Some people go into medically or surgically induced menopause, for example surgery to remove the ovaries, or treatments like chemotherapy, radiation therapy and endocrine therapy.

What are the symptoms of perimenopause and menopause? How is it diagnosed?

Hot flushes and/or night sweats occur in up to 80% of individuals. Other symptoms include sleep disturbances, fatigue, mood changes, brain fog, low libido, vaginal dryness, urinary tract irritability, muscle aches and joint pains, loss of stamina, skin changes and menstrual changes. Symptoms differ between individuals in severity, duration and impact on work and life. There are long-term consequences of low oestrogen such as osteoporosis or bone-thinning which increases the risk of fractures.

Doctors may perform assessments based on age, symptoms, menstrual pattern and medical history. Tests are not required to “diagnose” menopause in people over 45 years of age. These symptoms are very common in the general population and in some cases, it may be useful to check for thyroid function disorders and for anaemia, which can cause similar symptoms. Individuals whose periods stop before age 40 are usually offered tests for further evaluation, so that if the diagnosis of premature menopause is made, appropriate treatment can be given.

How can Menopause affect performance?

The Voice: voice changes in menopause are well documented and they include voice fatigue, decreased range, loss of high notes, loss of timbre, lowering of vocal intensity and control. Many singers report vocal instability in perimenopause.

The Musculoskeletal system: in menopause, muscle and joint pains are commonly mistaken for injury in performers. Bone loss, lean muscle loss (sarcopenia), and changes to cartilage, tendon, ligament and connective tissue can increase the risk of fatigue, drop in performance quality, injury and chronic pain. Pelvic floor dysfunction may be associated with urinary incontinence and impaired core strength and breath support, impacting performing artists whether in dance, musical instrument playing, or voice use.

The Brain: oestrogen decline affects memory, mood, sleep and temperature regulation by the brain. About 50% of menopausal people experience brain fog, memory lapses, mood changes including irritability, anxiety and depression, and insomnia, all of which may overlap. Fatigue, lack of sleep and hot flushes may worsen performance anxiety.

Psychological impact: some individuals experience a sense of loss during menopause – loss of identity, confidence, purpose and joy. They may feel shame, guilt, or suffer from burnout. For performing artists, whose work is often tied deeply to selfhood and emotional expression, these psychological shifts may be particularly destabilising.

What treatment is available?

Hormone replacement therapy (HRT) is considered the most effective treatment of symptoms of menopause.

Current medical consensus is that HRT is safe and effective in most cases if started near the time of menopause. The benefits include relief of symptoms and bone protection.

Different types of HRT are available including oral tablets, transdermal oestrogen (applied to skin) and vaginal oestrogen. Most people taking oestrogen should be prescribed progesterone in addition to balance the effect of oestrogen on the womb (so-called unopposed oestrogen increases the risk of uterine cancer).

There are very small risks associated with HRT which should be discussed with your doctor, taking into consideration your personal medical and family history.

Treatment with testosterone may help with post-menopausal low libido (also known as hypoactive sexual desire disorder) but should be used with caution in singers because of potential masculinising of the voice due to thickening of the vocal cords, lowering the fundamental pitch, which may be permanent. For those who choose not to use hormone therapy, there are effective non-hormonal treatments available to address symptoms.

How can performing artists in perimenopause and menopause stay healthy and reduce their injury risk?

As menopause is a natural part of life, not everyone requires treatment, but everyone who experiences menopause will benefit from healthy lifestyle measures which reduce symptoms and injury risk, as well as protecting the heart, brain and bones.

• A healthy and balanced diet, rich in nutrients, and low in processed foods, sugars and salt.
• Regular exercise involving a good mix of cardio, cross-training, and strength and resistance training. Pelvic floor muscle training helps to prevent and manage pelvic floor issues.
• Good sleep routines that encourage restorative sleep.
• Avoiding harmful substances such as tobacco, and reducing alcohol and caffeine intake (they all worsen hot flushes).
• Managing your mental health – staying calm and positive, using relaxation techniques like meditation, yoga, and cognitive behavioral therapy are all helpful in coping with stress, anxiety and low mood.
• Positive social connections contribute to better physical and mental health and wellbeing.

For singers, adaptations in singing techniques, range, repertoire, and shorter rehearsal and practice times are helpful in managing voice changes through the menopause transition, in addition to observing good vocal hygiene. With the right support, most singers experience vocal stabilisation after menopause.

Getting help

Performing artists who experience symptoms of menopause impacting their work or life should seek help early from a healthcare professional. Choose a health provider who is willing to listen to your concerns, respects your priorities as a performer, and is able to personalise your treatment or point you in the right direction. Speak to your NHS GP.

BAPAM can provide clinical consultations to those concerned with menopause symptoms, focusing specifically on the way symptoms affect your work in the performing arts, and giving advice about further care.

Where can I get further information and support?

NHS Guidance:

Menopause – NHS
Menopause: Causes, Symptoms, and Treatment

NICE guidance is produced for medical professionals and details the care you should be able to access via your doctor: Overview | Menopause: identification and management | Guidance | NICE

A directory of menopause specialists registered with the British Menopause Society is available here: thebms.org.uk/find-a-menopause-specialist

Women’s Health Concern is the patient arm of the British Menopause Society. Their factsheets on menopause and related issues are evidence-based and regularly updated: womens-health-concern.org

Queer / LGBTQIA+ Menopause – A range of LGBTQIA+ menopause resources collated by psychotherapist, Tania Glyde: queermenopause.com

Freelancers Make Theatre Work Menopause hub –freelancersmaketheatrework.com/menopause

Writing the Rage – Resources for Writers Experiencing Menopause: sensiblecreative.co.uk/projects/menopausal-writers-1

Sheren, J.T., & Sataloff, R.T. (2026). Menopause and the Singing Voice: An Update on Menopause Care and Menopausal Hormone Therapy. Journal of Singing 82(3), 317-332. This article provides an overview of menopause and current menopause treatment, written for voice teachers and singers but also highly relevant to performers across disciplines. The article is shared here with the editor’s permission: Sheren&Sataloff Menopause and the Singing Voice

Bozeman, J., Frazier-Neely, C., & Bos, N. (2020). Singing Through Change: Women’s Voices in Midlife, Menopause, and Beyond. This book draws on the combined expertise of three experienced vocal pedagogues, singers and educators who specialize in women’s voices, vocal health, and teaching through midlife voice transition.

BAPAM clinics for performing arts professionals with work-related health concerns: www.bapam.org.uk/clinics

BAPAM Health Resources contains useful information on optimising all aspects of performance health. www.bapam.org.uk/health-resources