Menopause and the Singing Voice - Breaking the Silence with Jessica Rose Cambio

 

Samantha Nahra
Apr 2, 2026

For many singers, the voice is inseparable from the body that produces it. Training, technique, and careful lifestyle choices are all part of maintaining a healthy instrument. Yet one natural stage of life has historically been shrouded in silence in the opera world: menopause. For soprano Jessica Rose Cambio, that silence became impossible to ignore when she was diagnosed with early menopause at the age of 37.

“What we have in front of us is you’re 37 years old, you’re in menopause,” her doctor told her. “We have to treat it because you’re way too young.”

The diagnosis initially came as a shock. Like many women, Cambio had always associated menopause with a much later stage of life.

 

Challenging Long-held Myths

One of the biggest surprises for Cambio was not the diagnosis itself but the cultural baggage surrounding treatment. As a young singer, she had absorbed warnings about hormone replacement therapy (HRT) when a voice teacher of hers had implied that using it to manage menopause was somehow an unfair advantage when it came to singing.

“I grew up thinking that if you take hormone replacement therapy, you’re cheating,” she says. “Like you’re using something to be able to sing longer.”

Over time, she realized how misguided that belief was.

“If you’re diabetic, you take insulin. If you have a thyroid problem, you take thyroid medication,” she says. “If you have menopause, you might need hormone replacement therapy. It’s pretty much a no brainer.” She now believes these misconceptions stem from a broader cultural reluctance to discuss women’s health openly.

“What I had been told was that hormone therapy was taboo and that it causes breast cancer,” she says. Those assumptions, she believes, are rooted in generations of misinformation. “We’ve been living in a patriarchy that knows nothing about menopause,” she says. “So we’ve been misleading each other for centuries.”

 

The Road to Diagnosis

Cambio’s diagnosis came after consultations with multiple doctors when she was trying to freeze her eggs. At one point she wondered whether the fact that she had begun menstruating early, around age 10, might have contributed to early menopause. Doctors reassured her that it likely wasn’t connected. “What matters is how many eggs you release over time,” she explains. “You don’t get them back.”

Menopause typically occurs around age 50 to 52, but the timing varies widely. Some women experience it earlier or later depending on a variety of factors. Like many people facing unexpected medical changes, Cambio initially wondered if she had somehow caused the condition. “I thought maybe it was my fault,” she says. “But the doctor said basically, no, it’s not your fault. This is a natural, normal thing that we all go through, even opera singers.”

 

Hormones and the Singer’s Body

Following the diagnosis, doctors recommended hormone replacement therapy to help stabilize her estrogen levels. Her treatment was/is a progesterone pill and estrogen gel. There was an adjustment period though after treatment started.

“It took me a really long time to regulate again, like three years,” she says.  Still, the changes were noticeable quickly. “The very first day after starting the medication, I had pink again in my cheeks.” Hormone therapy can also help address broader health concerns associated with early menopause, including bone density loss and muscle changes. Both factors are particularly important for singers whose bodies function as their instruments.

How Menopause Affects the Voice

For singers reading about menopause, the most pressing question is usually the same: what will happen to my voice? According to Cambio, the answer varies widely. “Each woman experiences it very differently,” she says.

Some people experience hot flashes or heart palpitations. Others struggle with insomnia, weight changes, or fatigue. Sleep disruption has been one of the most noticeable changes for her. “Throughout my career I slept eight or nine hours before performances,” she says. “Now sometimes I sleep four or five hours, and that definitely affects singing the next day.”

Hormonal changes interact with many other factors that singers already navigate, including allergies, asthma, reflux, and environmental conditions. “It’s not just one element,” she explains. “Hormones are part of it, but there are many factors.”

During the period when doctors were still adjusting her hormone dosage, Cambio noticed something unusual in her singing. At first, she described the sensation as an unstable vibrato, but later realized that wasn’t quite accurate. “It wasn’t actually my vibrato,” she clarifies. “It was that my larynx felt unstable.” Searching for answers, she reached out to colleagues and discovered resources like Peri thru Post by Susan Eichhorn Young.

 

Technique as the Anchor

Through all of these changes, Cambio credits one thing above all for helping her continue singing: strong vocal technique. “The best remedy for not experiencing vocal changes is having your technique in order,” she says. Over the course of her career, technique has carried her through numerous personal and physical challenges.

“I’ve gone through a car accident with my technique and still sung,” she says. “I went through menopause with my technique, and I still sang.” In fact, the experience reinforced her confidence in the fundamentals of singing. “At the beginning I thought, Oh God, my voice is ruined,” she recalls. “But that’s just ridiculous.” Instead, she encourages singers to trust their training to support them through life’s inevitable changes. “What you’ve learned and set up in your body will help you,” she says. “It will serve you.”

 

Opening the Conversation

For Cambio, one of the most important outcomes of sharing her story is helping normalize conversations about menopause within the singing community. She did talk with her mother about menopause, but those conversations had limits. “My mom isn’t a singer,” she says. “So while it was helpful to talk to her about menopause in general, it didn’t answer the questions I had about singing.” 

That gap is one reason she now speaks openly about the topic with colleagues and students. “It would have been really useful for me to speak to someone who was actively singing through it,” she says. By sharing her experience, she hopes to offer the kind of perspective she once needed. “That’s why I’m so open about it now,” she says. “As a voice teacher, I can help singers navigate their own changes because I’ve lived through it.” Previous generations of singers experienced the same transition but rarely discussed it publicly. Today, that silence may finally be breaking. And in doing so, singers may discover something reassuring: their voices and their artistry can continue to evolve long after menopause begins..

Why I Quit Singing - Eric McKeever

 

Why I Quit Singing

 

Eric McKeever
May 14, 2026

Singing is not a “forever” career for most singers, and the decision to move on can be a difficult one. CS columnist and (now former) singer Eric McKeever shares the reasons for this decision to leave opera.

In June of 2025, after a wonderful career singing in opera, I decided to quit. In the late fall of 2025, my editor asked me to write about the “why.” This is that story.

I want to preface this by saying the intention of sharing my journey is to spark a dialogue about this aspect of singing that is often whispered about but rarely said out loud. It’s also my intention to continue processing what this transition feels like internally as well as externally. To add legitimacy to this article, I think it’s important to share highlights of my career. It’s also a way to remind myself of the extraordinary opportunities I’ve been able to experience because of my voice and artistry.

I came to pursue opera a bit later than most singers. It wasn’t until I was in grad school that I had a sincere desire to take on this career. Like many young singers, I auditioned for the big Young Artist Programs and was fortunate that Richard Pearlman who, at that time, ran the YAP at Lyric Opera of Chicago, saw something special in me. While I never got into the program, I was given the opportunity to cover two small roles in the Lyric Opera of Chicago world premiere of Anthony Davis’ Amistad as well as sing leading roles with Lyric’s Education program, “Opera in Schools.” After that, I sang with at least five regional opera YAPs and created a relationship with my “home” company, Opera Columbus, where I started with small roles (my debut being the Cappadocian in Salome and, yes, I can still remember those five lines!).

After taking a four-year hiatus, I returned to opera, starting from nothing (thank you, Bel Cantanti Opera for jump-starting things for me again), and over the course of the next 14 seasons rose to enjoy a wonderful mid-level career. With Opera Columbus, I graduated to perform leading roles including Sharpless, Marcello and, most recently, Papageno in a reimagined take on The Magic Flute called The Temple. I also performed leading roles with many regional companies as well as with most of the companies in New York. Along the way, I performed with small and large companies, had three different agents, one voice teacher, and a small circle of “advisors” who helped me navigate all things opera.

The 2024–2025 season was one of my most successful (and profitable) with me singing with NYC’s now defunct On Site Opera, making my Seattle Opera debut, and having return engagements with Opera Memphis, Nashville Opera, Opera Baltimore, and Little Opera Theatre of New York. I was also profoundly grateful that my work received critical acclaim. I truly felt like I was turning a corner and rising through the ranks. So, what made me want to step away when it appeared that I was (finally) moving into a new career phase?

The decision to stop being an opera singer is probably one of the hardest decisions any artist makes. I struggled for years trying to decide if I should stay in the field. Okay, yes, I did “quit” singing at least once every two years and, yes, it became a running joke with people who knew me that when I said I was quitting, they would simply nod and say, “We’ll see what you say in six months,” as miraculously I would receive an operatic engagement that was so thrilling that the idea of quitting flew to the wayside and I would thrust myself back into the art of opera.

But this time things were different. First, my phenomenal voice teacher, Mark Oswald, who really helped tighten up my technique, retired. And deservedly so. After a world-class career as both a singer and teacher, he was ready for something new. Then, shortly after the COVID shutdown, my agent, the wonderful Nick Netos, announced that he was retiring.

As I continued to sing, coach, and perform, I found myself wading through the management search. From being told a polite “I don’t think we’re a good fit” to not hearing any response, I began to question if I was actually a viable artist. How is it that I had spent so many years working, getting great reviews, and being told I was a wonderful colleague and that I had something special, and yet not one agent seemed genuinely excited to represent me? It truly hurt.

The other consistent challenge I seemed to face was that I didn’t fit easily into a repertoire box. For so many singers it’s clear what roles they can vocally and physically embody based on the lineage of artists who have taken those roles on. Unfortunately (or fortunately), there wasn’t a great historical record of five-foot-nine African American lyric baritones to pattern myself after, so I often embraced what felt right vocally and dramatically and allowed myself to side-step trying to classify myself as any particular Fach. The upside was this allowed me to sing a diverse range of repertoire ranging from the title role in Henze’s El Cimarron to Monterone in Rigoletto to Sir Joseph Porter in H.M.S. Pinafore to the title role in Don Giovanni to a host of new operas. In essence, my niche was that I didn’t fit into one specific niche.

These two challenges, along with having only three engagements on the books for the 2025–2026 season made me really sit back and examine if this was the sign that I needed. While I’m all about being proactive in my career, I also believe that when you are aligned with what you are meant to do, there is a sense of ease about it. Yes, there are a multitude of stories of artists who stayed in a field and succeeded. But with opera being so focused on momentum, youth, and not only Fach categorization but of placing an age limit on when an artist is supposed to have blossomed, it is truly rare that a singer in their 40s or older shifts into a different echelon within opera.

Like many singers, I had mantras that I repeated to keep motivated. One of those: I am enough. During the summer of 2025 as I was working on the incredibly difficult Eine florentinische Tragödie by Zemlinsky, I had an epiphany. If being in a field continually made me question if I was enough, maybe I was asking the wrong question. What I needed to ask myself was if the career of being a singer was enough!

What was I getting out of it? Yes, I loved the work. I loved digging into a score and learning it inside and out. I loved working to perfect my vocal and dramatic intentions. I loved connecting with colleagues both on and off the stage and having those magical moments where your artistry and theirs creates something close to a spiritual experience. I loved the immediacy of having an audience who could respond to the story being filtered through my artistry. I loved all of that. But, for most of us, that is only a small percentage of the career.

The magic of performing was what motivated me to show up in my score study, my technical work, my interactions with colleagues, and the discipline it takes to be an opera singer. Unfortunately, the industry continued to lack transparency and often felt like it was the job of a singer to create a false sense of success through the announcement of a season, the idea of jet-setting around the world, and constantly posting clips of oneself singing. Some people love this aspect of the job, while for me, it sometimes felt like a distraction.

A general director told me that a person’s social media presence was often a determining factor in whether someone was getting hired. But I could cite countless singers who have a large social media following but were not actually singing much. On top of that, I often wondered if a singer spent so much crafting an online persona, did they truly have time to practice, audition, and improve or was it becoming a vicious cycle of producing content, content, content over quality of artistry. I still don’t know the answer, but I also knew that I didn’t want to keep asking.

Another major factor that made me consider the shift from opera was how our industry responded during the height of COVID. While many companies worked to pivot toward digital opportunities for audiences and artists, and I was extremely fortunate to participate in several, it always felt like each company was functioning in their own sphere. But when I looked at the musical theatre world, particularly Broadway, I saw the emergence of community, where it was not only important to preserve access to performances but create space for all of the theater: Broadway, Off-Broadway, regional theater.

It appeared that the musical theatre world cared about all of its own at a local, regional, and national level—and I realized that I was not getting that feeling from the opera world. I’m not completely naïve to believe that there is full transparency in the musical theatre sphere, but I do get the sense that there is a concerted effort to care for its own and a desire to embrace more and more diverse perspectives.

I’ve given a lot of reasons why I left. But as I type this, I have to acknowledge that I was far luckier than many. I also have to say that perhaps I’m not the most reliable narrator and that my take on the opera world could be a “jaded” singer who auditioned three times for the Met but never got hired.

What I know, however, is that I walked away from opera because I didn’t see a way to make a decent living in an industry where I never felt like I belonged. It was only through years of self-examination and clarity on the type of life I wanted to lead that I was even able to recognize that I no longer wanted to continue down that road. Deciding to leave opera has been cathartic, painful, confusing, and liberating.

The Dr. Is In: Voice Burnout Part 1: Symptoms, Diagnosis & Treatment

The Dr. Is In: Voice Burnout Part 1: Symptoms, Diagnosis & Treatment

 

James Aston
May 14, 2026

In this case study, Dr. Aston shares how voice burnout occurs and what factors contribute to it. If you’re experiencing vocal difficulties, consider these implications when you speak to your doctor.

Case: A 34-year-old opera singer presenting with vocal fatigue, effortful phonation, and pain with singing. Gradual onset.

Lucy is a 34-year-old soprano who presents to the clinic with some concerning new symptoms. She has noticed over the past few months that she has had to work harder to reach the top end of her range. Her practice sessions wear her voice out quickly, too—she just does not have the vocal endurance she enjoyed only a few months ago. Then there is the pain, especially while singing sustained notes that require extra volume. All of these symptoms are new to her, and she is worried that she has injured her vocal folds.

It appears that Lucy may be suffering from vocal overuse. These types of chronic injuries are biomechanically related to other overuse injuries in that they involve repetitive load stress applied to vulnerable cells and tissues. (Toles & Mau, 2025, pp. 4823–4829) Repetitive loading typically causes microtears in muscles and ligaments, which heal with sufficient recovery time. (Fundamental principles of rehabilitation and musculoskeletal tissue healing, 2017)

Think of these microtears like tiny paper cuts on your vocal folds—if you sing again before they have healed, it’s like those cuts reopening every rehearsal. Over time, these little injuries start to build up. Consequently, tissues adapt to imposed stress by strengthening as they heal. But if recovery time between stressors is too short, stress converts acute damage into cumulative minuscule rips in vocal structures that progressively become chronic injuries. (Sielska-Badurek et al., 2017, pp. 23–509) Your vocal tissues need adequate time and resources to rebuild, restore, and rejuvenate!

Eventually, elevated contact stress at the vocal folds increases due to faster closing speeds and stronger vibrations during singing. (Liu et al., 2022, pp. 608–621) Here’s how these collisions lead to Muscle Tension Dysphonia (MTD):

1. Repeated collisions between the vocal folds cause irritation and microscopic damage to the tissues. (Kimball & Rousseau, 2024, pp. 2128–2138)
2. In response, the surrounding laryngeal and pharyngeal muscles start to tighten and compensate in an effort to protect the injured area and maintain vocal output. (Ahmadi et al., 2022, pp. 2989–2996)
3. Over time, this ongoing extra muscle activity results in excessive muscle tension and coordination issues, a condition called Muscle Tension Dysphonia. (Houtte et al., 2011, pp. 202–207) MTD happens when the muscles around your voice box become overly tight, making it difficult for your vocal folds to vibrate freely. For singers, this can lead to a strained, rough, or weak voice. You might notice your voice tires out quickly, feels tight or effortful, or that your notes crack or break more easily. In short, MTD makes singing and speaking feel much more challenging than they used to.

This “caregiver fatigue” is a form of musculoskeletal burnout that looks like what you think burnout is: vocal fatigue, effortful phonation (making sounds takes more effort than it used to), and pain with use.

What to Know before Seeking Treatment

Lucy thinks that she is suffering from vocal fold overuse injury and possible MTD, so what should her next step be? Before starting any treatment, someone needs to visualize her vocal folds to determine what’s going on and rule out other potential diagnoses. Overuse voice injuries are either functional disorders or structural lesions that result from or mimic phonotrauma, and differentiating them requires special skills, knowledge, and equipment. (Hsiao et al., 2001, pp. 837–40)

When considering other possible diagnoses for Lucy, it’s helpful to group them into three categories. Grouping these diagnoses reduces cognitive load while still covering the full range of possibilities. (Sielska-Badurek et al., 2017, pp. 23–509)

Structural Lesions

• Vocal fold nodules
  • Vocal fold polyps (which are not nodules)
  • Vocal fold cysts
  • Vocal fold hemorrhage (needs immediate vocal rest)
  • Early glottic laryngeal carcinoma (especially if you are a smoker)

Neurologic Causes

• Vocal fold paralysis/paresis
  • Spasmodic dysphonia

Inflammatory and Functional Conditions

• Secondary muscular tension dysphonia
  • Laryngopharyngeal reflux

Although it’s a good idea for Lucy to see her primary care physician to start the workup, all of the above would need to be evaluated by an otolaryngologist (ENT) specializing in voice. These highly skilled physicians can visualize vocal folds (how amazing is that—they can actually watch your voice in action!) using a video endoscopy and video stroboscopy, and then be able to sort through the different causes based on your symptoms and history and their examination of your folds. (Kapoor et al., 2025, pp. 1271–1275)

During the stroboscopy, Lucy might watch a live monitor as a tiny endoscope is gently passed through her nose or mouth. With a flashing strobe light, the movements of her vocal folds are shown in slow motion on the screen. Think of it like a slow-motion movie: she could actually see her vocal folds vibrating, opening and closing, and see if both sides are moving evenly or if there are any irregularities. This makes the technical terms come alive—not just medical jargon, but an up-close look at the mechanics of her own voice.

Through the scope, the ENT can visualize your vocal fold structure and mobility, check the medial edge configuration (which just means looking at how the edges of the vocal folds line up when they come together), observe the activities of the supraglottic region (the area just above the vocal folds that can affect sound and airflow), and explore the fold’s vibration.

Other tools at their disposal include acoustic analysis (analyzing the sound of your voice), aerodynamic measurements (which are tests checking how efficiently you move air through your vocal folds when you speak or sing), auditory-perceptual evaluations (a specialist listens closely and rates how your voice sounds), and patient self-report measures (including questionnaires like the Voice Handicap Index, where you describe what you have been noticing about your own voice). (Puig-Herreros et al., 2021)

At this point, you may be asking yourself why we would do such an extensive workup. What is the value of this assessment when we could just do therapies? Starting with baseline measures can also help voice therapists evaluate a patient’s response to treatment, allowing those therapists to further fine-tune their approach. The two main therapeutic approaches for treating MTD are commonly used and, depending on exam findings, the chosen therapies are tailored to each patient’s needs. (Latoszek et al., 2024, pp. 18–26)

For patients with voice-related overuse injuries, either Vocal Function Exercises (VFEs) or Resonant Voice Therapy (RVT) has been shown to be effective. VFEs are a series of specific vocal exercises designed to strengthen and balance the muscles involved in voice production, increase vocal range, and improve endurance. (Angadi et al., 2019, pp. 13–124) They often include gentle pitch glides, sustained vowels, and easy onset exercises to help restore healthy vocal function. RVT, on the other hand, focuses on producing voice with the least amount of effort and minimal strain by finding the most efficient vibratory sensations (resonance) in the face or mouth. (Chen et al., 2014, pp. 596–602)

According to a 2024 article by Stacey M. Menton and colleagues, voice therapy for patients with primary muscle tension dysphonia aims to help individuals use their voice more effectively while minimizing strain on the vocal folds. However, measures such as maximum phonation time and S:Z ratio do not consistently show improvement following this therapy. According to another recent article, patients with muscle tension dysphonia and neck pain improved their Voice Handicap Index-10 scores after participating in a specialized physical therapy program, regardless of whether they also received voice therapy.

Concrete, objective measures not only help guide a personalized treatment plan but also dramatically increase your chances of vocal recovery and long-term success.

James Aston

James S Aston, D.O., is a family medicine physician in Fort Worth, Texas, who is also the world’s first fellowship-trained specialist in performing arts medicine. He trained under Drs. Sajid Surve, D.O., and Yein Lee, D.O., at the University of North Texas Performing Arts Medicine Fellowship and has since joined the faculty of the fellowship. His emphasis is providing performance-aware primary care for performers of all kinds. His wife Martha is a pianist, and his children take piano lessons and sing in church. Reach out to him on Instagram: @pam_d0c.

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