Oral Health in Perimenopause and Menopause

Perimenopause and menopause are life stages that every woman will experience, yet their impact on oral health is often overlooked. While many people are aware that hormonal changes can affect mood, sleep and bone health, few realise that these changes can also significantly affect the mouth. This article aims to explore some of the oral health challenges associated with perimenopause and menopause and how oral health educators can support patients through this transition.

Perimenopause is the period leading up to menopause when hormone levels, particularly oestrogen, begin to fluctuate. Menopause is diagnosed in women over 45 who have not had a period for 12 consecutive months and are not using hormonal contraception¹. Whilst the average age for onset of perimenopause is considered to be mid-to-late 40s, some women may experience this early. Menopause occurring before the age of 45 is described as early, and before the age of 40 as premature². This may be due to genetic factors, autoimmune conditions, surgical removal of the ovaries, chemotherapy/radiotherapy or in some cases the cause is unknown. Women who experience menopause at a younger age may be exposed to reduced oestrogen levels for longer, increasing their risk of osteoporosis and other long-term health consequences².

During both stages, hormonal changes can affect the soft tissues, saliva production and bone density³. One of the most common oral health complaints reported during perimenopause and menopause is xerostomia³. Oestrogen receptors are present in the salivary glands and oral mucosa, and declining oestrogen levels may contribute to a reduction in salivary flow, although the evidence is mixed and the picture is likely to be multifactorial⁴. Medications commonly taken at this stage of life, including some antidepressants and antihypertensives, can also reduce salivary flow and are worth considering⁴. Saliva is essential for lubricating the oral tissues, neutralising acids and helping to prevent caries. Patients experiencing dry mouth may also complain of difficulties with eating, speaking or wearing dentures. They may also be at increased risk of caries and oral infections such as candidosis⁴.

Changes in hormone levels can also affect periodontal health. Oestrogen helps to regulate inflammation throughout the body, including within the gingival tissues. As hormone levels decline, some women may notice increased gingival inflammation, bleeding and sensitivity⁵. Research suggests that postmenopausal women may also be at greater risk of periodontal disease progression, particularly if other risk factors such as smoking, diabetes or poor plaque control are present³,⁴.

Bone health is another important consideration. We often associate menopause with osteoporosis, but the jawbones are not exempt from these changes. Reduced bone density may contribute to the loss of alveolar bone, which can affect tooth stability and may be a consideration in implant treatment planning and long-term periodontal health³,⁶. It is also worth remembering that many women are prescribed anti-resorptive medicines such as bisphosphonates or denosumab to manage postmenopausal osteoporosis, and these carry a risk of medication-related osteonecrosis of the jaw. A thorough and up to date medical history is essential so that these medicines are identified and the patient is managed accordingly⁷. This highlights the importance of regular dental examinations and periodontal assessments for patients during this stage of life.

Some patients experience a condition known as burning mouth syndrome. This presents as a persistent burning, tingling or scalding sensation affecting areas such as the tongue, lips, palate or cheeks, despite the tissues appearing clinically normal. Whilst the exact cause is not fully understood, hormonal changes are thought to be a contributing factor. Burning mouth syndrome is a diagnosis of exclusion, so patients reporting these symptoms should be referred to the dentist so that other causes, such as vitamin deficiency, candidal infection, diabetes or medication side effects, can be ruled out. These symptoms can be distressing and may have a significant impact on quality of life⁸.

Taste disturbances may also occur during perimenopause and menopause. Patients sometimes report a metallic taste or changes in their ability to taste certain foods⁴. Combined with dry mouth, this can affect appetite and enjoyment of food. Taste changes are likely to be multifactorial, so other causes such as medication, nutritional deficiency or candidal infection should also be considered⁴. Although these symptoms are not always severe, they can be frustrating and may leave patients feeling concerned if they are unaware that hormonal changes could be responsible.

Oral health educators can play a particularly valuable role during this life stage. Many patients are unaware that menopause can affect oral health and may not connect their symptoms with hormonal changes. Taking the time to discuss these issues can help patients understand what is happening and empower them to take proactive steps to protect their oral health. It also provides an opportunity to discuss wider lifestyle factors such as diet, smoking cessation and alcohol consumption, all of which can influence oral and general health.

Menopause is receiving increasing attention in healthcare, but oral health remains an area that is often forgotten. By improving awareness amongst both patients and the wider dental team, we can ensure that women receive the support they need to maintain good oral health throughout perimenopause, menopause and beyond.

If you would like to explore more of the latest evidence and common oral health concerns experienced during menopause, and provide practical advice to support your patients, join me on Wednesday 2 September for a live webinar at 7.30pm. Register here.

References

1. National Institute for Health and Care Excellence (2024). Menopause: identification and management. NICE guideline NG23. Available at: https://www.nice.org.uk/guidance/ng23. See also NICE Clinical Knowledge Summary: Diagnosis of menopause and perimenopause [accessed 28 August 2026].

2. NHS. Early or premature menopause. Available at: https://www.nhs.uk/conditions/early-or-premature-menopause/ [accessed 28 August 2026].

3. Syed S (2024). Menopause and oral health: it is not just hot flushes! Dentistry.co.uk, 27 March 2024. Available at: https://dentistry.co.uk/2024/03/27/menopause-and-oral-health-its-not-just-hot-flushes/

4. Labunet A, Objelean A, Kui A, Rusu L, Vigu A, Sava S (2025). Oral manifestations in menopause: a scoping review. Medicina. 61(5):837. doi: 10.3390/medicina61050837

5. Jawed KTK (2025). Understanding the link between hormonal changes and gingival health in women: a review. Cureus. 17(6):e85270. doi: 10.7759/cureus.85270

6. Thompson D, et al. (2019). Loss of alveolar bone density in post-menopausal, osteopenic women is associated with circulating levels of gelatinases. Journal of Periodontal Research. 54(5):525-532. doi: 10.1111/jre.12656

7. Scottish Dental Clinical Effectiveness Programme (2017, guidance supplement 2024). Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw. Available at: https://www.sdcep.org.uk/published-guidance/medication-related-osteonecrosis-of-the-jaw/

8. The Menopause Charity (2025). Burning mouth syndrome (BMS). Available at: https://themenopausecharity.org/information-and-support/symptoms/burning-mouth-syndrome/