Menopause and bleeding gums

Why your gums are inflamed and how to treat them

During the perimenopause, most of us know to expect erratic menstrual bleeding as a potential symptom. But gum bleeding? Although it’s not a well-known symptom, it isn’t unusual to experience this.

For women who do experience bleeding gums, it’s natural to worry about your oral hygiene and health – but it doesn’t necessarily mean you’re doing anything wrong.

Why do gums bleed?

Usually, the main cause of bleeding gums is a build-up of plaque.  This can irritate your gums and, if left for too long, hardens to tartar, which will continue to irritate. Irritation can cause the gums to bleed, and can lead to gum disease.

A vitamin C deficiency has also been linked to bleeding gums [1], plus certain medications – including ibuprofen, aspirin, warfarin, blood pressure medications, diuretics and antihistamines – can also cause bleeding gums.

Also medical conditions such as haemophilia and Von Willebrand’s disease make you more prone to bleeding while brushing.

Related: oral health and the menopause

How does the menopause affect gums?

Your hormones, particularly oestrogen and progesterone, are essential for healthy gums but rapid fluctuations can affect the gum tissue. Increases in progesterone can increase your susceptibility to bacterial plaque, plus when oestrogen drops, the blood flow in the gum tissue is affected, and the tissue can thin, so you bleed more easily. ‘It also decreases your body’s ability to fight off infections, and affects the ability to maintain a healthy balance of good and bad bacteria in the mouth,’ says dentist Dr Shabnam Zai.

Oestrogen-receptor cells can be found in your mouth, with many located in the membrane that coats the mouth and the saliva glands. When they receive a lower level of oestrogen, they produce less saliva. ‘This not only causes your mouth to become dry, but the reduction in saliva means less food and bacteria is flushed away, so it can be left to irritate the gums. Saliva is also a buffer that helps neutralise the acid in the mouth after eating,’ says Dr Shabnam.

RELATED: dry mouth and the menopause

A rare condition is menopausal gingivostomatitis. This is where gums appear dry, pale and shiny with redness and occasionally bleed easily [2].

How do I treat my bleeding gums?

It’s important to treat bleeding gums as it can be a sign of gingivitis, an early stage of periodontal disease.

It is caused by bacteria, so the first step is to keep up good oral hygiene so that you tackle bacterial plaque. Continue brushing twice a day, flossing daily and visiting your dentist twice a year.

The main risk factors for gum disease are smoking, diabetes, stress and a genetic link. Whilst you cannot help if you are genetically predisposed, if you smoke, consider getting support to quit.

If your diabetes is not well controlled, it can cause increased bone loss and prevent healing of the gums. But keeping it under control can significantly reduce symptoms, as can controlling your stress levels.

Ensure you don’t eat too many sugary foods. Acidic foods can irritate bleeding gums but you need to eat enough vitamin-C rich foods – these have been found to help manage bleeding gums and slow any potential development of gum disease.

‘Chlorhexidine gluconate is the gold standard for mouthwashes to help during acute episodes of bleeding,’ says Dr Shabnam. ‘It is not a substitution for a dental check-up, diagnosis and hygiene but when used, it can significantly reduce the bacteria load in the mouth. It should not be used at the same time as brushing with fluoride toothpaste (leave at least a 30-minute gap) and overuse can lead to brown extrinsic staining of the teeth. This can be avoided by not using for more than 5 days. I always recommend a blood test to ensure you do not have any deficiencies, and drink plenty of water between meals.’

Resources

Dentist Dr Shabnam Zai is clinical director at West House Dental, westhousedental.com Follow her on Instagram @drshabnamzai

References

1. Philippe P Hujoel, Tomotaka Kato, Isabel A Hujoel, Margaux L A Hujoel. (2021), ‘Bleeding tendency and ascorbic acid requirements: systematic review and meta-analysis of clinical trials’, Nutrition Reviews, 79 (9) pp. 964-975, doi: 10.1093/nutrit/nuaa115

2. Sen S, Sen S, Dutta A, Abhinandan, Kumar V, Singh AK. (2020), ‘Oral manifestation and its management in postmenopausal women: an integrated review’, Prz Menopauzalny. Jul;19(2) pp101-103. doi: 10.5114/pm.2020.97867