Oral cavity status in menopausal and postmenopausal women

Literature review





menopause, postmenopause, periodontitis, osteoporosis


The purpose of this review was to analyze and summarize the available literature data on changes of oral tissues in menopausal/postmenopausal women. We searched for the relevant references in Pubmed database using appropriate key words. We had revealed about 3,500 references on these topics and analyzed the most relevant.
Postmenopausal women have an increased risk of the decrease of bone mineral density due to estrogen deficiency. Estrogens induce osteoclast apoptosis and intensity of this protective mechanism decreases after the cessation of menstruation. Most cross-sectional radiographic studies have confirmed an association between age-related osteoporosis and decreased alveolar bone height. It has been established that postmenopausal women with generalized chronic periodontitis are characterized by severe destruction of the periodontium, which progresses in parallel to a decrease in bone mineral density. Sex hormones maintaining bone integrity and strength, involved in regulating the proliferation, differentiation, and growth of keratinocytes and fibroblasts of the gums. The effect of low estrogen levels on keratinization of the gum epithelium and decreased salivation can lead to menopausal gingivostomatitis.
Estrogen deficiency also adversely affects the microenvironment of gingival sulcus, including the composition and circulation of crevicular fluid. Postmenopausal women have lower salivary pH and lower salivation, which is associated with deterioration of periodontal tissues. In addition, the postmenopausal period is characterized by the changes in the microbial composition of the oral cavity, IgG decreases in the crevicular fluid and prooxidant changes of saliva.
Conclusions. The oral cavity status in menopausal and postmenopausal women undergoes significant changes: a decrease in bone mineral density, dryness of mucous membranes, microbiome changes, and activation of oxidative and immune processes. These changes necessitate regular examinations, timely treatment and application of all measures of preventive dentistry. There is also a need for randomized clinical trials and create standardized guidelines for the management of postmenopausal patients with periodontal disease.

Author Biographies

I.P. Mazur, Institute of Dentistry, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

MD, professor, Department of Dentistry

V.A. Habal, Institute of Dentistry, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

Assistant, Department of Dentistry

M.S. Drohomyretska, Institute of Dentistry, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

MD, professor, Department of Orthodontics

K.M. Lykhota, Institute of Dentistry, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

MD, professor, Department of Dentistry


  1. Dillaway, H. Living in Uncertain Times: Experiences of Menopause and Reproductive Aging. The Palgrave Handbook of Critical Menstruation Studies. Palgrave Macmillan, Singapore. DOI: 10.1007/978-981-15-0614-7_21
  2. Sen, S., Dutta, A., Abhinandan., et al. “Oral manifestation and its management in postmenopausal women: an integrated review.” Prz Menopauzalny 19.2 (2020): 101–3. DOI: 10.5114/pm.2020.97867
  3. WHO Scientific Group. Research on the menopause in the 1990s. World Health Organ Tech Rep Ser 866 (1996): 1–107.
  4. Dillaway, H. “When Does Menopause Occur, and How Long Does It Last? Wrestling with Age- and Time-Based Conceptualizations of Reproductive Aging.” Feminist Formations 18.1 (2006): 31–60. DOI: 10.1353/nwsa.2006.0006
  5. Gold, E.B. “The timing of the age at which natural menopause occurs.” Obstet Gynecol Clin N Am 38.3 (2011): 425–40. DOI: 10.1016/j.ogc.2011.05.002
  6. Bhat, S., Hegde, S., Sujatha, D. “A study on evaluation of the effect of menopause on saliva and dental health.” J Adv Oral Res 1 (2010): 33–6.
  7. Svedha, P.R., Mahendra, J., Theayarajar, R., Namachivayam, A. “Comparison of bone mineral density among pre- and post-menopausal women with and without chronic generalized periodontitis.” J Indian Soc Periodontol 21.2 (2017): 119–24. DOI: 10.4103/jisp.jisp_43_16
  8. Maldonado, A., Laugisch, O., Bürgin, et al. “Clinical periodontal variables in patients with and without dementia – a systematic review and meta-analysis.” Clin Oral Investig 22.7 (2018): 2463–74. DOI: 10.1007/s00784-018-2523-x
  9. Mascarenhas, P., Gapski, R., Al-Shammari, K., Wang, H.L. “Influence of sex hormones on the periodontium.” J Clin Periodontol 30 (2003): 671–81. DOI: 10.1034/j.1600-051x.2003.00055.x
  10. Amar, S., Chung, K.M. “Influence of hormonal variation on the periodomtium on women.” Periodontol 2000 Oct.6 (1994): 79–87. DOI: 10.1111/j.1600-0757.1994.tb00028.x
  11. Suri, V., Suri, V. “Menopause and oral health.” Journal of Mid-life Health 5.3 (2014): 115–20. DOI: 10.4103/0976-7800.141187
  12. Almeida, M., Laurent, M.R., Dubois, V., et al. “Estrogens and androgens in skeletal physiology and pathophysiology.” Physiol Rev 97 (2017): 135–87. DOI: 10.1152/physrev.00033.2015
  13. Romandini, M., Shin, H.S., Romandini, P., et al. “Hormone-related events and periodontitis in women.” J Clin Periodontol 47.4 (2020): 429–41. DOI: 10.1111/jcpe.13248
  14. Deepa, D., Jain, G. “Assessment of periodontal health status in postmenopausal women visiting dental hospital from in and around Meerut city: Cross-sectional observational study.” J Mid-life Health 7 (2016): 175–79. DOI: 10.4103/0976-7800.195696
  15. Yýldýrým, T.T., Kaya, F.A. “The effects of menopause on periodontal tissue.” Int Dent Res 3 (2011): 81–6. DOI: 10.5577/intdentres.2011.vol1.no3.2
  16. Akcalі, A., Akcalі, Z., Batool, F., et al. “Are Sex Steroid Hormones Influencing Periodontal Conditions? A Systematic Review.” Curr Oral Health Rep 5 (2018): 33–8. DOI: 10.1007/s40496-018-0168-0
  17. Levin, V.A., Jiang, X., Kagan, R. “Estrogen therapy for osteoporosis in the modern era.” Osteoporos Int 29.5 (2018): 1049–55. DOI: 10.1007/s00198-018-4414-z
  18. Pouillès, J.M., Gosset, A., Trémollieres F. “Ménopause, traitement hormonal de ménopause et ostéoporose. RPC Les femmes ménopausées du CNGOF et du GEMVi [Menopause, menopause hormone therapy and osteoporosis. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines].” Gynecol Obstet Fertil Senol 49.5 (2021): 420–37 [in French]. DOI: 10.1016/j.gofs.2021.03.015
  19. Ucer, S., Iyer, S., Kim, H.N., et al. “The Effects of Aging and Sex Steroid Deficiency on the Murine Skeleton Are Independent and Mechanistically Distinct.” J Bone Miner Res 32.3 (2017): 560–74. DOI: 10.1002/jbmr.3014
  20. Farr, J.N., Rowsey, J.L., Eckhardt, B.A., et al. “Independent Roles of Estrogen Deficiency and Cellular Senescence in the Pathogenesis of Osteoporosis: Evidence in Young Adult Mice and Older Humans.” J Bone Miner Res 34 (2019): 407–1418. DOI: 10.1002/jbmr.3729
  21. The NHTPSAP. “The 2017 hormone therapy position statement of The North American Menopause Society.” Menopause 24.7 (2017): 728–53. DOI: 10.1097/GME.0000000000000921
  22. Wang, Y., LaMonte, M.J., Hovey, K.M., et al. “Association of serum 17β-estradiol concentration, hormone therapy, and alveolar crest height in postmenopausal women.” J Periodontol 86.4 (2015): 595–605. DOI: 10.1902/jop.2015.140533
  23. Wang, C.J., McCauley, L.K. “Osteoporosis and periodontitis.” Curr Osteoporos Rep 14 (2016): 284–91. DOI: 10.1007/s11914-016-0330-3
  24. Ko, Y.C., Tsai, M.T., Fuh, L.J., et al. “Association between Age of Menopause and Thickness of Crestal Cortical Bone at Dental Implant Site: A Cross-Sectional Observational Study.” Int J Environ Res Public Health 17.16 (2020): 5868. DOI: 10.3390/ijerph17165868
  25. Hernández-Vigueras, S., Martínez-Garriga, B., Sánchez, M.C., et al. “Oral Microbiota, Periodontal Status, and Osteoporosis in Postmenopausal Females.” J Periodontol 87.2 (2016): 124–33. DOI: 10.1902/jop.2015.150365
  26. Mashalkar, V.N., Suragimath, G., Zope, S.A., Varma, S.A. “A Cross-Sectional Study to Assess and Correlate Osteoporosis and Periodontitis among Postmenopausal Women: A Dual Energy X-Ray Absorptiometry Study.” J Midlife Health 9.1 (2018): 2–7. DOI: 10.4103/jmh.JMH_39_17
  27. Penoni, D.C., Fidalgo, T.K., Torres, S.R., et al. “Bone Density and Clinical Periodontal Attachment in Postmenopausal Women: A Systematic Review and Meta-Analysis.” J Dent Res 96.3 (2017): 261–9. DOI: 10.1177/0022034516682017
  28. Thanakun, S., Pornprasertsuk-Damrongsri, S., Na Mahasarakham, C.P., et al. “Increased Plasma Osteocalcin, Oral Disease, and Altered Mandibular Bone Density in Postmenopausal Women.” Int J Dent 24 (2019). DOI: 10.1155/2019/3715127
  29. Mazur, I., Dilbarkhanov, B., Kuracha, X., et al. “Periodontal status and bone metabolism in women in reproductive and postmenopausal periods.” Horm Mol Biol Clin Investig 41.3 (2020). DOI: 10.1515/hmbci-2020-0011
  30. Toy, V.E., Uslu, M.O. “Evaluation of long-term dental implant success and marginal bone loss in postmenopausal women.” Niger J Clin Pract 23 (2020): 147–53. DOI: 10.4103/njcp.njcp_295_19
  31. Gil-Montoya, J.A., Garrido-Martínez, M., Barrios-Rodríguez, R., et al. “Association between low bone mineral density and periodontitis in generally healthy perimenopausal women.” J Periodontol 92.1 (2021): 95–103. DOI: 10.1002/JPER.20-0029
  32. Pan, M.Y., Hsieh, T.C., Chen, P.H., Chen, M.Y. “Factors Associated with Tooth Loss in Postmenopausal Women: A Community-Based Cross-Sectional Study.” Int J Environ Res Public Health 16.20 (2019). DOI: 10.3390/ijerph16203945
  33. Bascones-Martínez, A., Muñoz-Corcuera, M., Noronha, S., et al. “Host defence mechanisms against bacterial aggression in periodontal disease: Basic mechanisms.” Med Oral Patol Oral Cir Bucal 14 (2009):e680-5. DOI: 10.4317/medoral.14.e680
  34. Zhang, L., Henson, B.S., Camargo, P.M., Wong, D.T. “The clinical value of salivary biomarkers for periodontal disease.” Periodontol 2000 51 (2009): 25–37. DOI: 10.1111/j.1600-0757.2009.00315.x
  35. AlJehani, Y.A. “Risk factors of periodontal disease: Review of the literature.” Int J Dent 2014 (2014). DOI: 10.1155/2014/182513
  36. Guncu, G., Tozum, T. “The effects of estrogen, progesterone and testosterone on periodontal tissues.” G.Ü. Dihek Fak Derg 22 (2005): 121–7.
  37. Thompson, I.O., van der Bijl, P., van Wyk, C.W., van Eyk, A.D. “A comparative light-microscopic, electron-microscopic and chemical study of human vaginal and buccal epithelium.” Arch Oral Biol 46 (2001): 1091–98. DOI: 10.1016/s0003-9969(01)00082-6
  38. Deepa, D. “An overview on influences of estrogen and progesterone on periodontium.” CODS J Dent 6 (2014): 26–9.
  39. Güncü, G.N., Tözüm, T.F., Caglayan, F. “Effects of endogenous sex hormones on the periodontium – Review of literature.” Aust Dent J 50 (2005): 138–45. DOI: 10.1111/j.1834-7819.2005.tb00352.x
  40. Lee, Y., Kim, I., Song, J., et al. “The relationship between hormone replacement therapy and periodontal disease in postmenopausal women: a cross-sectional study the Korea National Health and Nutrition Examination Survey from 2007 to 2012.” BMC Oral Health 19.1 (2019): 151. DOI: 10.1186/s12903-019-0839-9
  41. Sharma, N., Sharma, R.K., Tewari, S., et al. “Association of periodontal inflammation, systemic inflammation, and duration of menopausal years in postmenopausal women.” Quintessence Int 49.2 (2018): 123–31. DOI: 10.3290/j.qi.a39512
  42. Dharmayanti, A.W.S., Kusumawardani, B. “Deoxypyridinoline and mineral levels in gingival crevicular fluid as disorder indicators of menopausal women with periodontal disease.” Dental Journal (Majalah Kedokteran Gigi) 50.3 (2017): 131–37. DOI: 10.20473/j.djmkg.v50.i3.p131-137
  43. Yoshida, N., Sugimoto, K., Suzuki, S., Kudo, H. “Change in oral health status associated with menopause in Japanese dental hygienists.” Int J Dent Hyg 16.1 (2018): 157–64. DOI: 10.1111/idh.12282
  44. Rukmini, J.N., Sachan, R., Sibi, N., et al. “Effect of Menopause on Saliva and Dental Health.” J Int Soc Prev Community Dent 8.6 (2018): 529–33. DOI: 10.4103/jispcd.JISPCD_68_18
  45. Teles, F., Wang Y., Hajishengallis, G., et al. “Impact of systemic factors in shaping the periodontal microbiome.” Periodontol 2000 85.1 (2021): 126–60. DOI: 10.1111/prd.12356
  46. LaMonte, M.J., Andrews, C.A., Hovey, K.M., et al. “Subgingival microbiome is associated with alveolar bone loss measured 5 years later in postmenopausal women.” J Periodontol 92.5 (2021): 648–61. DOI: 10.1002/JPER.20-0445
  47. Adrianus, E.P., Masulili, S.L.C., Lessang, R., et al. “Immunoglobulin G Levels in the Gingival Crevicular Fluid of Menopausal Patients with Periodontitis.” Brazilian Research in Pediatric Dentistry and Integrated Clinic 21 (2021): e5940. DOI: 10.1590/pboci.2021.080
  48. Kemer Doğan, E.S., Kırzıoğlu, F.Y., Doğan, B., et al. “The role of menopause on the relationship between metabolic risk factors and periodontal disease via salivary oxidative parameters.” J Periodontol 89.3 (2018): 331–40. DOI: 10.1002/JPER.17-0314



How to Cite

Mazur, I., Habal, V., Drohomyretska, M., & Lykhota, K. (2021). Oral cavity status in menopausal and postmenopausal women : Literature review. REPRODUCTIVE ENDOCRINOLOGY, (62), 80–84. https://doi.org/10.18370/2309-4117.2021.62.80-84



Management of menopause