8 Perimenopause Mouth Symptoms and How to Treat Them

Calling someone “long in the tooth”—a not-so-subtle dig at aging—can be literal for women entering menopause. Fluctuations and declines in estrogen affect nearly every tissue in your mouth, making perimenopause mouth problems like dry mouth, and gum issues like bleeding gums frustratingly common.

A 2023 survey of women 50 and older found that 70 percent experienced oral health changes like dry mouth, receding gums, or tooth sensitivity when they entered the menopause transition. ¹ Worse, 84 percent of those women were unaware that their oral health symptoms could be related to menopause.

These issues aren’t just uncomfortable; studies have linked systemic inflammation from gum disease to an increased risk of cardiovascular disease and diabetes ². Since women of menopausal age are already at higher risk for those illnesses, taking care of oral health is a top priority.

About the Experts

Shelly Chvotzkin, D.O., is a board-certified OB/GYN based in Sarasota, Florida. She specializes in hormonal health, perimenopause, and menopause care.

Jossen Gastelum, D.M.D. is a general and cosmetic dentist based in Scottsdale, Arizona.

Why Does Perimenopause Affect the Mouth?

Estrogen plays a key role in keeping your mouth healthy, from salivary glands to gum tissue. When levels drop in perimenopause, it sets off a cascade of changes—less saliva, more inflammation, and an increased risk of infection, explains OB/GYN and menopause specialist Shelly Chvotzkin, D.O.

Estrogen receptors exist all over the mouth and salivary glands, including the oral mucosa (the skin inside your cheeks), the roof and floor of your mouth, and your gums. ³ When estrogen declines, it affects:

• Salivary glands, by reducing natural moisture and increasing infections like oral thrush. ^{4 5}
• Gum tissue, making it more prone to inflammation and bleeding.
• Collagen production, weakening the integrity and health of gums. ^{6 7}

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According to Chvotzkin, other causes of perimenopause mouth problems include:

• Loss of bone density in the jaw, which can lead to tooth movement or loss. ⁸
• Teeth clenching and grinding (bruxism), which is often triggered by stress and anxiety—common occurrences in perimenopause and menopause—or by antidepressants prescribed to treat menopause symptoms. ^{9 10}
• Nutritional deficiencies, like low vitamin D and B vitamins, can disrupt the balance of beneficial and infection-causing bacteria in your mouth. ^{11 12}

Common Perimenopause Mouth Problems

The most commonly reported perimenopause-related mouth problems include:

• Dry mouth
• Bad breath
• Burning mouth syndrome
• Tooth sensitivity
• Bleeding gums
• Oral thrush
• Mouth sores
• Shifting teeth

Dry mouth

As many as 50 percent of women of menopausal age experience dry mouth, compared to 32 percent of men in the same age group, according to one small study from dental researchers. ¹³

When the estrogen receptors in your mouth are starved of the hormone, saliva production can fall, drying out your mouth. ¹⁴ The arid conditions can put you at risk for cavities, damaged tooth enamel, and gum disease.

“Adequate salivary flow promotes a healthy balance of good bacteria, and more importantly it buffers out the acids that can cause cavities,” explains dentist Jossen Gastelum, D.M.D.

In addition to cavities, dry mouth can contribute to mouth sores and other oral infections and make talking, chewing, and swallowing a challenge, adds Chvotzkin.

Bad breath (Halitosis)

A dry mouth can also lead to bad breath during the perimenopause and menopause years. Why? Changes in estrogen and saliva production can allow harmful (and stinky) bacteria to flourish. ¹⁵ Gastelum points out that bad breath can also be a sign of poor gum health, so it’s important to get to the source of the problem rather than cover it up with mints or gum.

Burning mouth syndrome

Research suggests between 10 and 40 percent of menopausal women have burning mouth syndrome (BMS), a condition that feels exactly like it sounds: a burning, scalded, tingling, or painful feeling. ¹⁶ The pain can be anywhere in the mouth or tongue—usually on the front two-thirds or the tip, which are especially sensitive to taste and other sensations. ^{17 18}

Dips in estrogen during perimenopause can cause burning mouth syndrome via nerve damage in these sensitive areas controlling taste and pain. “Estrogen regulates pain receptors in the mouth; burning mouth syndrome likely occurs because you lose estrogen’s effects on those receptors,” says Chvotzkin.

To make things worse, women experiencing issues with a painful tongue in perimenopause might struggle to get treatment for BMS. Burning mouth syndrome is easily dismissed or misdiagnosed, says Chvotzkin. One sign you have it: Pain gets worse as the day goes on but subsides at night.

Tooth sensitivity

Menopause tooth pain can happen for some of the same reasons as burning mouth syndrome: estrogen loss affects nerves in the mouth that control pain sensitivity.

Drops in estrogen also contribute to a reduction in the collagen that supports the gum and oral tissues. As gums recede, more of the sensitive tooth root is exposed.

Tooth problems during perimenopause and menopause can also be linked to dry mouth symptoms, which can wreak havoc on healthy gums ¹⁹.

Bleeding gums

In a 2013 review of women in menopause with mouth problems, 60 percent reported poor periodontal health, which includes bleeding gums. ²⁰

Bleeding gums in menopause are associated with inflammation, which can be caused by hormone changes, says Gastelum. When estrogen drops, so does blood flow to the gums.

That lack of blood—plus the changes in the oral microbiome and reduced saliva production—make the gums more susceptible to plaque formation and bacterial infection, says Chvotzkin. In severe cases, this can cause menopausal gingivostomatitis, a condition that causes sore, red, shiny gums.

Oral thrush

With less saliva and disrupted microbiome balance from perimenopause hormone fluctuations, yeast can overgrow in the mouth, leading to oral thrush, says Chvotzkin. The fungal infection can show up as white patches on the tongue, inside of your cheeks, gums, or the roof of your mouth—or as areas of redness and soreness in these same locations.

Certain medications, like antibiotics or steroid inhalers, can increase the risk, adds Chvotzkin.

Mouth sores

Canker sores and ulcers can increase during perimenopause, likely due to immune system changes and inflammation, Gastelum says. Mouth sores can also be related to nutritional deficiencies that are common in perimenopause, like low iron, vitamin B9, and B12. ²¹

Teeth shifting

Changes in bone density are common during perimenopause—including in the jawbone, says Chvotzkin. Loss of bone in the jaw can contribute to your teeth shifting around, or even getting looser or falling out, she adds.

Some research circulated online and cited in the documentary, The M Factor, may have sensationalized menopausal tooth loss. The study in question looked at more than 1,000 postmenopausal women and found that more than 28 percent lost a tooth during the five-year study. However, the subtext of the study is that participants had an average age of 65.88—they weren’t experiencing tooth loss in the midst of menopause ²².

Menopause-related gum recession can also contribute to teeth shifting, since gums help keep teeth in their place, says Chvotzkin.

How to Treat Perimenopause Mouth Problems

There are many different ways to treat and manage perimenopause mouth problems, from updating your dental hygiene routine to medications.

And advocate for yourself: A 2025 review found healthcare providers often exhibit poor attitudes toward advising menopausal women on the importance of regular dental check-ups and informing them about potential oral health changes during this period. ²³

A good oral hygiene routine

Your brushing habits may need an update in perimenopause. Gastelum recommends:

• An electric toothbrush. These brushes reach a larger surface area of the tooth than manual back-and-forth brushes, leading to less bacteria and tartar.
• A water flosser. These handheld tools are more effective than traditional floss at removing plaque, food, and bacteria between the teeth ²⁴. They can also decrease bleeding from inflamed gums.
• A gentle-on-the-enamel toothpaste. Pick one that doesn’t contain sodium lauryl sulfate, which can contribute to sensitivity or mouth pain. A new—but pricey—non-fluoride toothpaste called Livfresh has been shown to reduce inflammation and bleeding in people with early-to-moderate gum disease ²⁵.
• Tongue scraping. Using a metal tongue scraper can remove odor-causing bacteria to reduce bad breath.

Mouth rinses

Many mouth rinses contain alcohol, which can dry out the mouth and make symptoms worse, says Gastelum. His recommendations:

• For dry mouth: A rinse that contains the saliva-stimulating ingredient xylitol, like TheraBreath Dry Mouth Oral Rinse.
• For gum health: A pH-balanced formula to support beneficial bacteria in the mouth, like TheraBreath Healthy Gums Oral Rinse.
• For canker sores: A rinse with a numbing agent like menthol for temporary relief, like Orajel Alcohol-Free Medicated Mouth Sore Rinse.
• For infections like oral thrush: A prescription, antifungal antifungal solution that contains diflucan or a fluconazole.

HRT

Taking hormone replacement therapy (HRT, also called menopause hormone therapy or MHT) for perimenopause symptoms could also improve mouth problems. “Women who are on HRT tend to find that their symptoms improve—though they may not fully go away—on estrogen therapy,” says Chvotzkin.

Specifically, HRT may:

• Reduce gum disease: One study published in Menopause involving nearly 500 women aged between 50 and 87 found that those receiving HRT plus calcium and vitamin D had significantly lower rates of gum disease, with many experiencing a 44 percent improvement in gum health. HRT with estrogen helps increase estrogen levels, and the higher circulation of estrogen from the therapy could reduce your risk of gum disease. ²⁶
• Strengthen bones: Estrogen supports bone density, including in the jaw, which can protect against tooth shifting and tooth loss. ²⁷
• Prevents dry mouth: Research indicates that HRT may effectively relieve oral dryness symptoms in postmenopausal women. ²⁸

Moisture-replacement

Stay as hydrated as possible if you’re suffering from dry mouth, says Chvotzkin. Sugar-free gums or lozenges containing xylitol stimulate saliva production and help prevent cavities, she adds. Avoid anything containing alcohol, which can dry out the mouth further.

Topical treatments

For burning, sores, and other mouth pain, you might find some relief from cooling agents like peppermint oil, aloe vera, or hydrated glycerin. Chvotzkin also recommends topical creams, gels, and sprays that contain pain-relieving ingredients such as benzocaine, lidocaine, menthol, or capsaicin, all of which temporarily numb or desensitize nerve pain receptors. These are helpful on a short-term basis, but may not be as effective for severe pain or symptoms that persist all day, such as burning mouth syndrome, adds Chvotzkin.