Menopause burning mouth, dry mouth, sores and ulcers

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Learn about the possible causes of burning mouth syndrome during menopause, the links to other oral health conditions and what can you do to treat your symptoms.

Burning mouth syndrome (BMS) is the name for a recurring, often unexplained, burning or tingling sensation that can affect your lips, tongue and other areas inside your mouth. It’s up to seven times more common in women than men and mostly effects menopausal women.

At its worst, burning mouth syndrome can negatively impact your sleep, your mood and your overall quality of life.

Although menopausal burning mouth syndrome doesn’t have a definitive cause, scientists believe changing levels of hormones like oestrogen are involved, and that other menopause symptoms, such as anxiety, stress and nutrient deficiencies, could also be contributing factors.

As well as looking at the symptoms and possible causes of menopause BMS, we’ll also assess some potential treatments, including HRT, alpha-lipoic supplements, herbal remedies, medication and stress management techniques.

Menopause is a time when you’re also more likely to experience certain other oral health conditions, such as dry mouth, sores and ulcers, all of which can cause mouth pain and discomfort. We’ll examine possible causes and treatments for these too.

Symptoms of burning mouth syndrome
Burning mouth syndrome (BMS) is most commonly felt on the tip and the sides of the tongue, as well as the lips and the roof of the mouth. You may also experience it around your gums and other parts of the lining of your mouth, known as the oral mucosa.

As the name suggests, BMS often feels like a burning pain but different women describe different sensations, including:

• burning
• scalding
• heat
• tingling
• tenderness
• numbness

The symptoms of burning mouth can start suddenly or increase more gradually. Some women find that the sensation is less intense in the morning and increases as the day goes on, reaching its worst late in the evening. For others, it can be unpredictable, coming and going.

The pain of burning mouth syndrome can also come with some other potentially unpleasant symptoms, including:

• dry mouth
• sensitivity to certain foods
• reduced or changed sense of taste
• a bitter or metallic taste

What causes burning mouth during menopause?
A number of health conditions, including viral infections, the oral rash lichen planus and oral thrush, also known as candidiasis, can cause mouth pain similar to burning mouth syndrome. This is called secondary BMS.

However, burning mouth syndrome during menopause very often comes without any clear-cut causes or obvious changes to the lining of your mouth. This is called primary BMS.    

Although a lot more research is needed before scientists fully understand what’s behind the increased risk for burning mouth syndrome during menopause, they do have some early theories.

Later in this article, we’ll also look at how a dry mouth could contribute to your burning mouth symptoms.

Hormone changes
Scientists suspect that hormonal changes during menopause – such as the fluctuation and reduction of oestrogen and progesterone – are involved in burning mouth syndrome and may account for why it’s most common in menopausal women.

These changes can impact the production of compounds called neuroactive steroids. This in turn can affect the small nerve fibres in the lining of your mouth, causing pain and other sensations.

Anxiety and stress
Anxiety and stress – themselves common symptoms of perimenopause and menopause – can disrupt neuroactive steroids too.

Stress also releases toxic free radicals – unstable molecules that can damage your cells. Some researchers have suggested that this could lead to nerve damage, causing BMS.

Whatever the mechanism, experts generally agree that increased stress or anxiety can make burning mouth symptoms worse.

Vitamin and mineral deficiencies
BMS is also associated with both iron deficiency and reduced levels of B vitamins, such as B1, B2, B6, B12 and folic acid.

This could be particularly relevant for menopausal women because during perimenopause increased blood loss from heavy periods can lead to low iron, while after menopause women may be less efficient at absorbing B vitamins from food.

Treatments for burning mouth syndrome
There’s no single agreed treatment for primary burning mouth syndrome. However, the following approaches have shown positive results for some women.

Alpha-lipoic acid supplements
Alpha-lipoic acid is a chemical compound with antioxidant properties. It’s produced by your body and also occurs naturally in certain foods, such as beetroot, carrots, potatoes, spinach, broccoli and red meat.

It’s possible that alpha-lipoic acid could help with BMS by protecting the nerves that cause mouth pain.

An analysis of several different clinical trials found that in most cases participants who took a daily supplement containing 600–800 milligrams (mg) of alpha-lipoic acid saw a greater improvement in their burning mouth symptoms than those who took a placebo.

Medication
There are a number of over-the-counter pain killers and anaesthetic medications that may help to reduce the pain of burning mouth syndrome. They’re all topical treatments, meaning you apply them directly to the affected areas as either a spray, mouthwash or gel, or by sucking a lozenge.

They include:

• benzydamine hydrochloride (brand name Difflam)
• benzocaine (brand name Chloraseptic)
• lidocaine hydrochloride

If your symptoms are impacting your quality of life, your doctor may prescribe medications designed for other health conditions that could also help some people with burning mouth syndrome.

These include:

• anti-convulsant drugs like clonazepam and gabapentin
• low-dose antidepressants, such as nortriptyline, fluoxetine or sertraline

Herbal remedies
There’s some evidence that mouthwashes made from certain medicinal herbs and spices can reduce the pain of BMS for some people.

One scientific review looked at studies involving mouth rinses containing flaxseed and the flowering plants chamomile and marshmallow. It found that this combination of ingredients improved the symptoms of oral health conditions including BMS by reducing inflammation and acting as a protective coating in the mouth.

Some older studies suggest that applying chilli pepper sauce, such as tabasco, diluted in two parts of water might also reduce BMS pain.

If you’re among those who find that eating spicy foods makes your burning mouth symptoms worse, this may seem counterintuitive. But the theory behind the positive results is that, when used in this way, capsaicin – the active ingredient in chillis – actually desensitises the nerves in your mouth.

Hormone replacement therapy (HRT)
HRT uses tablets, gels or skin patches to boost levels of reproductive hormones like oestrogen and progesterone during perimenopause and menopause. It can be an effective treatment for common perimenopause and menopause symptoms like hot flashes and anxiety.

When it comes to burning mouth syndrome, results are mixed. Some older clinical studies have reported that as many as 70% of the women who took part saw improvements in their BMS symptoms after HRT. But larger population studies didn’t find a link. Your doctor can help you to decide whether HRT is right for you.

Stress management
Stress or anxiety can increase your BMS symptoms. The pain can in turn lead to more stress, creating a vicious cycle.

If you think stress is making your burning mouth worse, there are a number of ways to manage it.

The following approaches can all help to reduce stress and stop you focusing on your symptoms:

• Mindfulness practices like breathing exercises, meditation and yoga
• The counselling treatment cognitive behavioural therapy (CBT)
• Staying physically active

In fact, the NHS says these can be more effective than medication for helping with burning mouth syndrome.

Another way to manage anxiety during perimenopause and menopause is by taking targeted probiotics. These friendly bacteria can have health benefits around your body, via your gut.

Fast relief from burning mouth syndrome
Depending on what’s causing your burning mouth syndrome, some of the medicated sprays and gels we’ve looked at above may help to ease the pain relatively quickly.

The NHS also recommends these other simple and potentially fast remedies to try at home:

• Sipping a cold drink
• Sucking on ice chips
• Chewing sugar-free gum

Menopause dry mouth
As we’ve seen, one of the symptoms sometimes associated with burning mouth syndrome during menopause is dry mouth, known medically as xerostomia.

This reduction in saliva can cause soreness around your lips and in your mouth and throat, and may contribute to the burning sensation of BMS.

Perhaps surprisingly, some women find that their mouth pain is less, or even disappears completely, when they eat. This may be because food stimulates saliva production.

Causes
As with so many perimenopause and menopause symptoms, one of the main causes of menopausal dry mouth is lower levels of oestrogen, which reduce the amount of saliva you produce.

Dry mouth can also be caused by anxiety, breathing through your mouth at night and dehydration – including from the increased sweating that comes with hot flushes.

Dry mouth can be a side-effect of certain medications too. If you think your medication might be causing dry mouth, talk to your doctor.

Treatments
The following tips may help to improve dry mouth:

• Stay hydrated: take regular sips of cold water or unsweetened drinks throughout the day and keep water by your bed at night
• Suck ice or chew sugar-free gum
• Limit alcohol and caffeinated drinks like tea and coffee that can dry your mouth
• Don’t smoke

Menopause mouth sores and ulcers
Along with the pain of burning mouth and the soreness caused by dry mouth, you may experience more specific areas of tenderness in your mouth during perimenopause and menopause.

This may include soreness and even bleeding around your gums, as well as mouth sores or ulcers – also known as canker sores – in places like your tongue or the insides of your cheeks.

Causes
Sore and bleeding gums may be a sign of menopausal gingivostomatitis. This inflammation of the gums may also cause pale-coloured, dry or shiny-looking gums, or a red rash.

Hormonal changes may increase your risk of mouth ulcers. Ulcers can also be caused by low levels of certain vitamins or minerals, such as iron, vitamin D and some B vitamins.

During perimenopause or after menopause you may require higher levels of these nutrients. At the same time, your body can become less efficient at absorbing them.

Treatments
Brushing your teeth at least twice a day, flossing regularly and using mouthwash can help to prevent menopausal gingivostomatitis.

Vitamin and mineral supplements, particularly those containing B vitamins, may help to prevent or heal mouth ulcers.

Does menopause burning mouth go away?
Because the causes of menopause burning mouth syndrome are not fully understood, it’s unclear how long it might last. However, it’s likely to vary from person to person.

If your menopause BMS is the result of fluctuating hormones, it’s possible it could go away as you get closer to menopause and your hormone levels start to settle down. However, if consistently low – rather than changing – levels of oestrogen are the culprit, reaching menopause may not necessarily make a difference.

The UK’s Menopause Charity says that half of people with burning mouth syndrome report that it eventually improves or disappears on its own, although in some cases this can take several years.

The good news is, if your burning mouth and other menopausal oral health issues do continue to persist, some of the treatments and remedies we’ve looked at may help.

*Source: Menopause burning mouth, dry mouth, sores and ulcers | The Better Menopause