Is the opera house hot or is it just me? Menopause, which can mean disaster for a diva at her peak, is opera's last taboo

Version française...

The "Modigliani Women" is the most susceptible to menupause. I believe La Callas suffered from post-menauposal syndrome.

It's the opening night of a production of Don Carlos -- one of Verdi's most popular operas --conducted by Herbert von Karajan at the Salzburg Festival. The role of Princess Eboli -- the femme fatale who loves Don Carlos -- is being sung by one of the greatest mezzo-sopranos of the century, who has performed the part about 50 times over the last two decades.

Near the end, she launches into Eboli's show-stopping aria, O don fatal et deteste (O fatal, hated gift), in which she curses her god-given beauty and resolves to save Don Carlos, who has rejected her. As she reaches one of the aria's climactic high notes, her voice cracks.

It's one note, out of thousands, in a three-hour opera, and millions more over the course of her career. But in the brutal world of opera, that's all it takes for tongues to wag and knives to come out, and for a singer's sense of self-worth to crumble. Devastated and ashamed, she slinks out of town without finishing the run, and never sings Eboli again. "A star has fallen from the heavens," the newspapers announce.

Sound far-fetched? Well, the mezzo-soprano was Christa Ludwig -- a singer celebrated for her "powerful humanity" (The Guardian) as well as a "full, ripe, voluptuous" voice, as Opera, a respected English journal, has described it. Ludwig recalled the experience during a recent conversation about one of the great taboos of the singing world: menopause.

Hot flashes, memory loss, vanishing libido, vaginal atrophy, fatigue, insomnia, mood swings, anxiety -- many people can recite the classic symptoms of menopause. But for divas and non-singers alike, there's no standard road map through "the change." Half the battle is realizing what's going on: the cessation of menses is the last event of menopause, and hormonal changes can kick in when a woman is in her late 30s, with all the power of an earthquake.

Hormonal changes begin shortly before menopause, when the ovaries start winding down production of the female hormones oestrogen and progesterone. But the body's production of male hormones (androgens) stays at the same level, so these now play a more dominant role in the hormonal scene. The higher proportion of androgen, among other things, thickens the vocal cords and causes the voice to drop -- the same thing, on a smaller scale, as what happens to a boy at puberty. The reduction in female hormones causes swelling or dehydration of the vocal folds, which can directly or indirectly affect the vocal mechanism. This change is irreversible.

A controversial, but widespread, way of controlling the earthquake is hormone replacement therapy (or HRT), which usually involves administering a combination of oestrogen and progesterone. But many women -- those with a personal or family history of gynaecological cancers, for instance -- cannot take HRT. And finding the right level is tricky. Jean Marmoreo, a family physician who treats large numbers of menopausal women at Toronto's Women's College Hospital, estimates that about 70% of women come off HRT because they're given an incorrect dose.

Every woman has her own oestrogen threshold, explains gynaecologist Morris Notelowitz, founder of the Woman's Medical and Diagnostic Center in Gainesville, Fla. "That is why some women can go through menopause without a single hot flash, while others are very sensitive to minute changes of oestrogen level."

Ironically, there's some truth to all those jokes about fat ladies and singing. Jean Abitbol, a world-renowned French otolaryngologist and laser surgeon who specializes in the female voice, explains that fat cells store oestrogen and convert male hormones to oestrogen. So women with a little extra padding may in fact have an easier menopause, and require less HRT, than the stylishly thin.

We call it "la merde," Ludwig laughs. She did, in fact, sing for many years after that infamous Don Carlos in Salzburg; she retired in her late 60s after a series of ecstatically reviewed farewell recitals. But like many of her colleagues, Ludwig had a rough ride through menopause.

From her home on the Cote d'Azur, Ludwig speaks with humbling candour and warmth. Her voice is relaxed and melodious, her German accented English vivid and direct. "It was a hell of some years," she recalls. "Sometimes I had the impression that my vocal cords were made of glass, they felt so fragile. Sometimes I would be afraid to sing a forte tone. There was a real fear, every day, whether the voice was there."

When, in her early 40s, Ludwig went to doctors with vocal problems, they told her that she was singing or talking too much. It turned out she was having an early menopause -- brought on, she believes, by turmoil in her personal life. ("I had a new love and an old divorce.") Ludwig tried innumerable hormone-related medications, none of which worked longer than six weeks. Finally, in desperation, she tried a drug called ovestin, an estradiol hormone that gynaecologists assured her would not make any difference. It did the trick.

Abitbol notes that menopausal singers often come to him because they're losing their top notes, and find that their voice is less supple and sensual. They may have more trouble singing softly; and their vibrato -- the warm, controlled pulsing that's used constantly in most opera singing -- may start to wobble.

"Typically," Abitbol says, menopausal sopranos fear that they are going to lose their femininity if their voice lowers. "I tell them that they're still a Strad -- I'm just the luthier [the violin restorer]."

"Menopause always brings a fear in high sopranos that they will cease to be high sopranos," says William Riley, a leading New York voice trainer whose clientele includes many famous opera singers. "But it doesn't always happen that way. Sometimes the quality of the voice changes and the range stays the same. Sometimes range changes and the quality stays the same. Sometimes both change significantly. Sometimes the changes may be harbingers of tragedy, but they may bring new, wonderful things -- like a better quality in the voice." A diva's hearing may change as she enters middle age; this too can upset the finely-tuned mechanism of singing. And, of course, there's also the possibility of memory loss, for an opera singer one of the most terrifying symptoms of "the change."

Ageing is a major phobia in the opera world. For one thing, the juiciest female roles tend to be sex symbols -- steamy heroines like Carmen, or Aida's passionate rival, the Princess Amneris. Just as our society as a whole values beauty and youthfulness over age, the opera world is rarely willing to forgive a few less-than-perfect notes in exchange for the wisdom that age. Stories of sopranos past their prime receiving bouquets of dried flowers strike chills into the doughtiest heart.

"I always tell young singers that if you're going to survive in this profession, you need to have the hide of an elephant and the soul of a butterfly," says soprano Evelyn Lear, who was a regular at the Metropolitan Opera during her illustrious career, and was especially famous for her sizzling incarnations of the title role of Alban Berg's Lulu, another operatic femme fatale. Lear, now 74, sums up her menopause this way: "You're not singing on your interest any more. You're singing on your capital. And that can be dangerous."

Brigitte Fassbaender, the great German mezzo-soprano, speaks of " the horrible vocal indispositions" of menopause, and of "the cruelty of public and agents" that emerges during that time. "You have one evening when five tones are not so under control," she said on a CBC profile in 1994, "and you're out." Because singers rarely discuss menopause, Fassbaender said, few learn to cope with the vocal problems it can cause. "And they stop singing much too early."

Deborah Rosen, a Philadelphia-area medical psychologist who works extensively with performing artists, points out that HRT is not yet sophisticated enough to replicate a singer's premenopausal hormone levels. "As with birth control pills, sometimes they overshoot, sometimes they undershoot," says Rosen. A woman's vocal mechanism is "exquisitely sensitive to fluid balance," she adds, and oestrogen therapy can upset that. In any case, "with or without hormone replacement therapy, the menopausal singer has a different instrument, and she has to learn to use it" without developing bad compensatory habits and injuring her voice. Rosen generally recommends that menopausal singers find a top-notch voice teacher who isn't inhibited by the client's fame and will take her back to the the fundamentals of excellent singing technique.

That's precisely what Lear did when menopause provoked a major vocal crisis in her mid-40s. She withdrew from the stage, found a good teacher, and rebuilt her technique from scratch. She made a triumphant comeback in 1970, aged 48, and enjoyed a robust career until she was over 60. Asked about hormone replacement therapy, she says, "I never went to the doctors. How would a doctor know about singers?"

It seems she's right. Researchers only started to look at singers and menopause less than two decades ago, says Margaret Baroody, a singer and voice teacher who works at the American Institute for Voice and Ear Research in Philadelphia. "We have a lot of theory and anecdotal evidence, but not a lot of hard-core facts."

When Jean Abitbol began working with singers and hormones in the early 1980s, a number of coloratura sopranos complained to him that they couldn't sing for several days before their menses. At first, Abitbol delivered the classic patriarchal medical response: It's all in your head.

But his wife, gynaecologist Beatrice Abitbol, took a different view, and gave her husband a remedial course in pre-menstrual syndrome. The couple then collaborated on a ground-breaking study. Abitbol did a smear test of women singers' vocal folds at different stages of the menstrual cycle. After each test, he'd send the patient down the hall to his wife, who'd do a cervical smear.

"When we put the two [sets of] slides together, we could not tell whether it was the vocal fold or the cervix," he said. In other words, the cellular changes in the vocal folds over the course of the menstrual cycle mirrored those of the cervix. So they proved that the larynx is indeed a "target organ" for hormonal changes. Ludwig cuts through the medical jargon. "The vocal cords are very much like the vagina -- it is the same tissue," she explained. "And when the one is dry, the other also is." A humbled Jean Abitbol, meanwhile, learned that "when we say 'it's psychological,' that's garbage. It means: 'We don't know.' "

Riley encourages singers to see menopause as just another stage in the lifespan of the voice, which matures throughout a singer's career. "We tend to think that any change in the status quo is a bad thing," he said. "But in art, change is a good thing. If we can use menopause as an infusion of new ideas or new energy into an artistic career, it should be viewed as a new chapter, and not as a death knell. What can a Brigitte Fassbaender do when her voice changes? Well, there are lots of things she can do, because she is a performer of the highest quality. So we were very happy to see her step into a slightly different repertoire, and other aspects of the industry, such as directing".

There are spiritual dimensions, and a tremendous potential for dignity in this phase of life, as well. "One of the things I try to help singers to do," says Rosen, "is to realize they are not merely their voices. I see it as an enormous opportunity to discover roundness and the beauty of wisdom, as opposed to the angularity of life."

Ludwig, once again, goes to the heart of the matter. "It was good for me in the end," she said. "This is a sign of maturity, that you start to know that for a certain time, a singer has a voice," she said. "Singing is not everything in life."

Originally published in The National Post, May 10, 1999. Reprinted and condensed with permission. © Tamara Bernstein.