What is menopause/perimenopause?

In simple words, menopause is when a woman stops having her periods due to a reduction in hormone levels and this usually happens between the ages of 45-55. Perimenopause is the time during which the reduction in hormones occurs, resulting in menopause.

What do the hormones oestrogen, testosterone and progesterone do?

Oestrogen, testosterone and progesterone are reproductive hormones, essential for sexuality and reproduction. They all have widespread effects on the body, but the key effects are:

Oestrogen is a hormone responsible for the evolution and preservation of the female productive system. It is important in physical and physiological development in females, including ovulation and maintenance of bone density and muscle mass.

Progesterone is a steroid hormone primarily involved in pregnancy and the menstrual cycle.

Testosterone is a hormone responsible for the development of the male reproductive system, but is also important in female development.

In women, oestrogen, progesterone and testosterone decrease significantly in perimenopause. Testosterone reduces at a slower rate and naturally occurs with age affecting both males and females.

What age does perimenopause start/end?

Perimenopause usually starts between the ages of 45-55. In some cases, can happen earlier, it can be because of genetic reasons, because of the removal of the ovaries or uterus or for cancer treatments.

Menopause does not typically end, although medication is available to minimize the effects.

How does menopause affect oral health?

The lowering of hormones in menopause can affect your oral health and smile. The most common symptoms are dry mouth and gingivitis, in some severe cases even gum disease leading to tooth loss. With the decrease of hormones in menopause, in some women, the salivary glands are no longer producing enough saliva and this causes dry mouth. Saliva helps protect teeth against bacteria and when this decreases, you are more likely to develop decay. Similarly the gum tissue, with the decrease of oestrogen levels the bacteria in the mouth can contribute to gingivitis. This, in severe cases, can lead to periodontitis (gum disease) which is a leading cause of tooth loss.

• Gum disease or periodontitis is when your gums appear red, swollen and are bleeding when brushing teeth or spontaneously. This can happen when you are not brushing your teeth well and the buildup of plaque and bacteria in the mouth are caught between teeth and gums creating inflammation, destroying the supporting structures around the teeth. Gum disease can be cured by brushing regularly, using interdental cleaning and having regular hygiene visits and dental checkups. This is a common side effect of menopause in women.  

Technical note: The reason gum disease increases in incidence in menopause is not fully understood, but it is likely the bone density reduction increases susceptibility to disease as well as the reduction in salivary flow. Gingival crevicular fluid ordinarily assists in the flushing of the gums around teeth, and in their event of dry mouth this benefit is lost, leading to a higher risk of gum disease.

• Xerostomia also called dry mouth, is when the salivary glands are not producing enough saliva. This can be cause by certain medications and can also be an effect of menopause in women. This can be mitigated by taking saliva supplements.

• Drifting sometimes called tooth movement or relapse. A reduction in bone density can increase the risk of teeth drift towards the midline. Everyone will experience teeth drift at some point in their life, and during perimenopause or menopause this can be exacerbated.

What is HRT?

HRT stands for Hormone Replacement Therapy and is a treatment that helps to relieve the symptoms of menopause by replacing the hormones that are decreasing with menopause.

Types: The most common types are combined involving oestrogen and progesterone or oestrogen only medication.

Delivery Method: The above combinations can be taken via tablet, skin patch, subcutaneous implant, topical gel or spray.

Is there anything we can do to prevent the effects of menopause?

• Gums- improving your home care routine, brushing regularly and using interdental brushes will help your oral health.
  
• Saliva replacement– taking saliva supplements can help increasing the saliva production and relieve the effects of dry mouth
  
• HRT– helps replacing the hormones decreasing during menopause and early research links to a reduction in risk of developing gum disease
  
• Regular dental health checks/hygiene therapy – seeing the dentist regularly can help identifying gum disease and regular hygiene visits can improve the gum health.
  
• Wearing a retainer– better late than never! Retainers maintain the alignment of teeth, making it easier to keep them clean and in turn reducing the chances of developing gum conditions.
  

• Reducing risk factors – stress, coronary heart disease, diabetes type II, obesity, smoking/vaping

All the above risk factors can increase the risk of gum disease and if you have any of them alongside menopause, modifying your lifestyle choices can help reduce the severity of menopausal/perimenopausal effects.

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Can SLS free toothpaste help with dry mouth?

Sodium lauryl sulfate is found in many toothpastes and is that ingredient that makes toothpaste foam up. The dentistry profession is not at a consensus as to the effects of SLS on dry mouth. Dr Wesley Mullins reports that SLS is an irritant and can cause tissue sloughing especially with those who have friable tissue. The majority of the population use SLS containing toothpastes at the advice of dentists worldwide, and the percentage of those than suffer irritation is relatively low.

Can menopause cause recession?

The lowering of oestrogen levels during menopause can increase the risks of bone loss and receding gums. This is not a direct result of menopause, but a secondary effect due to the gum disease bringing about gum recession.

Can menopause cause burning mouth syndrome?

One of the unusual effects of menopause can be burning mouth syndrome due to the decrease of the saliva production. BMS is still considered idiopathic (cause unknown) but research is ongoing as to the effects of menopause on its development.

Are transgender women, women, in the sense of oral health?

Transgender women are typically not born with ovaries, therefore, the hormone output is derived from replacement therapy at the point of transitioning. Due to this, there would not be a physiologically driven menopause, however, the transgender hormone therapy programs are balanced on our human understanding of appropriate levels of oestrogen progesterone, and testosterone, which may or may not reflect that of a cis-female.

The research and data on the long-term oral health implications of genre transitioning has yet to deliver any meaningful results, and ethical approval for any experimental studies would unlikely be approved by today’s standards.

The transitional hormone therapy will artificially keep oestrgoen and testosterone levels at a level that can sustain the therapeutic effects, such as maintain bone density and salivary flow. For these reasons, we at Marylebone Smile Clinic do not feel there would be any ill effects from hormone therapy long-term. Please note that our opinion is solely based on our understanding of pharmacodynamics, pharmacokinetics and oral biology.

Does menopause apply to transgender people?

No, because there are typically no ovaries present in transgender females. Pseudo-menopause could occur if one takes hormone therapy, and then stops later in life, to pursue a new gender identity or to return to cis-female.