If you’ve suddenly noticed that your gums feel tender or they bleed a little when you brush your teeth, a shift in hormones might be to blame—especially if you’re a woman. As women go through life, a hormonal ebb and flow creates inflammation that reveals itself, in part, via their gums and salivary glands.

While it’s impossible to fully prevent these oral changes, they are manageable, treatable, and foreseeable, says a professor at Tufts University School of Dental Medicine (TUSDM).

Over the course of their lives, women and men experience changes in the types and levels of hormones regulating certain bodily processes. That can affect susceptibility to gum inflammation, says Natalie Jeong, Professor and Chair of the Department of Periodontology at TUSDM.

Boys, for instance, experience a surge of testosterone in puberty, and the hormone then declines later in life. When it does, “this decrease may impact overall immune function, leading to a higher susceptibility to inflammation, including gum disease,” Jeong says.

Typically, men are more susceptible to gum disease than women, but the effects of hormone shifts “are generally less pronounced for men compared to women,” Jeong adds.

That’s because women experience more—and more dramatic—hormonal changes. As puberty, menstruation, pregnancy, perimenopause, and menopause punctuate women’s lives, a fresh combination of hormones orchestrates each phase.

No one hormone leaves its impact on oral health; rather, gums, salivary glands, and teeth can take a hit when hormones are in flux. “Hormonal changes can alter blood flow to the gums and people’s immune response, so shifting hormones make our body more susceptible to inflammation. And periodontal, or gum, disease is inflammatory disease,” Jeong explains.

Brushing gingerly with gingivitis

In fact, gum inflammation is common to all of a woman’s hormonal shifts, puberty through menopause. It can start with gingivitis.

“Gingivitis is basically inflammation of the gum. It’s the mildest form of gum disease,” Jeong says. With gingivitis, “some people’s gums bleed when they’re brushing their teeth and some people’s gums swell a little, are tender, or they have bad breath. Some people may also notice receding gums—gums pulling away from the teeth.”

While hormonal imbalances don’t usually affect the structure of teeth, “the indirect effects on gums and oral tissues can increase the risk of tooth decay, so the teeth get affected indirectly,” Jeong says.

In addition to swollen and bleeding gums, women can experience a variety of symptoms as they navigate the following reproductive stages:

• Puberty: Many girls start with orthodontic care during puberty, when their gums are more inflamed. “Braces, whether clear aligners or metal, can interfere with conventional home care,” Jeong says. Food caught in orthodontic gear exacerbates girls’ baseline gum inflammation.
• Menstrual Cycle: During their periods, women’s mouths might be especially sensitive. Moreover, hormonal fluctuations make oral soft tissues more sensitive and suppress the immune system slightly. These changes, combined with stress and fatigue before and during periods, can trigger canker sores.
• Pregnancy: During pregnancy, people can develop pyogenic granulomas, also known as pregnancy tumors, on their gums. While these localized growths are benign, Jeong advises consulting a dentist if you notice any unusual changes in the mouth, including pregnancy tumors. A dentist might remove a pregnancy tumor if it hurts or interferes with home dental care.
• Perimenopause: The estrogen and progesterone fluctuations in the years before a woman’s last period can decrease saliva production, leading to dry mouth. Because saliva helps to neutralize acids and wash away bacteria, dry mouth promotes tooth decay, gum disease, and oral inflammation.
• Menopause: As hormone levels (especially estrogen) decline more consistently during menopause, many women continue to experience dry mouth, which can be more significant than during perimenopause. Some menopausal women experience burning mouth syndrome, which is a burning, tingling, or scalding sensation on the tongue and lips.

Medications, contraception, hormone replacement

Some antihistamines, antidepressants, and other medications cause dry mouth, which further aggravates older women’s likelihood of tooth decay, gum disease, and fungal infection. “Bisphosphonates, used to treat osteoporosis, can cause osteonecrosis of the jaw, a rare but serious condition that causes bone cells in the jawbone to die and the jawbone to poke through an opening in your gums,” Jeong says.

Hormonal contraceptives such as birth control pills or hormonal IUDs, as well as hormone replacement therapy during menopause, mimic the body’s natural hormonal changes. In the case of contraceptives, elevated levels of estrogen or progesterone may lead to an exaggerated immune response and increase susceptibility to gum inflammation, Jeong says.

Women undergoing hormone replacement therapy or taking hormonal contraception should always tell their care providers, including dental care providers, especially before a surgical procedure, when antibiotics might be prescribed. “Certain antibiotics may make your oral contraceptive less effective, so alternative birth control methods might have to be used,” Jeong says.

Transgender people and hormone therapy

While there is limited information on how hormones affect transgender people‘s oral health, “most studies suggest that trans individuals tend to have poorer oral health compared to non-trans individuals,” Jeong says.

Hormone therapy plays a role. Estrogen therapy can cause dry mouth, which increases the risk of cavities and gum disease, while testosterone therapy can reduce saliva production, also leading to dry mouth. Testosterone can also cause gingivitis.

Managing hormone hurdles

While it’s impossible to eliminate the risk of oral inflammation, several steps can maintain optimal oral health along the way:

• Oral hygiene: “First of all, get regular dental checkups,” Jeong says. Also, “brush twice a day, and make sure to floss, especially when you’re pregnant or going through a menstrual cycle.”
• Watch what you eat: Even with good oral hygiene measures, she recommends avoiding particularly acidic or sugary foods and drinks—and if you do have those, be sure to brush your teeth.
• Don’t smoke: The most important thing is to avoid smoking or using any tobacco products such as smokeless tobacco, including e-cigarettes, or vapes. Jeong says. “If you are a smoker, quit, because smoking is a major risk factor for gum disease and it worsens hormone-induced inflammation.”
• Get treatment quickly: If you do develop gum inflammation or other symptoms from hormonal changes, Jeong says it’s important to get treatment to keep the situation from worsening. Gingivitis is treatable, but “once it progresses, periodontitis is a different issue; you will require a little more significant treatment from a periodontist,” she says.