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March/April 2025
Menopause and oral health Learning objectives • To understand the impact of hormonal changes during menopause on oral health • •o learn how to support patients with some common oral health symptoms associated with menopause • To recognise the importance of raising patient awareness of some additional oral health needs during menopause GDC Development Outcome: C
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What is menopause? Natural menopause is defined as a spontaneous cessation of menstruation for 12 consecutive months, generally between the ages of 45-55, caused by the loss of ovarian follicular function and a decline in circulating blood oestrogen levels. Menopause can also be a consequence of surgical or medical procedures.v When occurring as part of the natural ageing process, the menopausal transition can be broken down into three stages. Perimenopause, the time leading
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up to menopause, is characterised by possible symptoms including fatigue, insomnia, unpredictable and heavy periods, depression, mood-swings, hot flushes and xerostomia. Many of these symptoms carry over into menopause, the mid-stage of the transition, which is defined by total menstrual cessation. Post-menopause is the timespan following this, which can be divided into early post-menopause, where the production of follicle stimulating hormone (FSH) is still variable, and late menopause, where it stabilises.vi Menopause affects the production of sex steroid hormones (SSHs), like androgens (particularly testosterone), oestrogens and progestogens. SSHs not only regulate sexual differentiation, secondary sex characteristics, sexual behaviours and reproduction, but also affect the development and cellular function of skeletal, immune, muscular and cardiovascular systems.vii
Saliva production The function of salivary glands is dependent on androgens, particularly testosterone.viii Saliva contains minerals such as calcium and phosphate, which remineralise teeth, while the flushing effect of saliva helps to remove food particles from teeth and gingiva. Reduced saliva production can lead to xerostomia, increasing the risk of caries, periodontal disease and fungal infections.ix
Periodontitis Oestrogen inhibits some of the inflammatory activity of cytokines. Deficiency of this hormone is thought to contribute to increased gingival inflammation, heightening the risk of bone loss and periodontal attachment loss. During menopause, the subgingival microbiome can shift, promoting harmful periodontal pathogens like Fusobacterium nucleatum and Porphyromonas gingivalis. x
Brush Up on CPD
ormonal changes during menopause can impact oral health in various ways, affecting key processes such as saliva production, taste perception, inflammation, and bone health. These changes may influence the health of periodontal tissues, teeth, and salivary glands. During menopause, the oral mucosa becomes more susceptible to candidiasis, oral lichen planus (OLP) and idiopathic neuropathy. Hormone-dependent salivary glands may experience changes in saliva secretion and consistency, which in turn affects oral health, increasing the risk of caries and periodontal disease.i Medications like gabapentinii and clonidineiii which are sometimes prescribed for hot flushes, can also impair saliva production. Although treatments exist to support women going through menopause, almost half of women experiencing symptoms do not seek medical advice.iv As a clinician, it is important to understand the unique oral health challenges that come with menopause. Not only will this improve conversations with patients, leading to more personalised and empathetic care, an increased awareness of the processes affecting oral health during menopause can result in more effective and appropriate approaches to treatment.
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