Burning Mouth as a Symptom of Perimenopause

A peculiar and disruptive symptom that deserves more attention

Add burning mouth to the list of perimenopausal symptoms women navigate.

Perimenopause is a frustrating time for most women. Weird things start happening to our bodies, and after two or three complaints, we feel like hypochondriacs—especially when our doctors have no answers for us.

Sure, we may expect a few symptoms to arrive at some time in our 40s, like hot flashes or mood swings, but I guarantee no one told you to watch out for Burning Mouth Syndrome (BMS). If you’ve experienced it, you’re leaning into your screen right now. If you haven’t, you’re thinking, “Oh, fak, what now?”

Some extra-lucky perimenopausal women will experience a peculiar symptom called burning tongue or burning mouth syndrome. It can range from being somewhat annoying to downright unbearable. It can affect your sense of taste, and may even affect speech. Yet it’s not widely known about or discussed.

In fact, I had never heard of it or thought about it until it happened to a friend. The crazier part is that she had never heard or thought about it either, but once it happened to her, her older sister said, “Oh, yeah, I had that for a few years.” Hello! Warn a sister, will ya!?

Know why she didn’t warn her? Because the sister didn’t even attribute it to her perimenopause. Why would she? Her doctor didn’t tell her to watch out for it, and no one around her was talking about it either. Such is the tragedy of perimenopause health care.

Since this is one of the more unusual symptoms (or is it? Perhaps women aren’t mentioning it.), it is often dismissed or misdiagnosed. (Of course.) Dozens of perimenopausal symptoms are filed into the “Nobody Knows; Don’t Mention It” folder.

What does it feel like?

You know when you’re overly eager to drink that hot cocoa and you burn the tip of your tongue? Or you bite down on that slice of piping hot pizza and the roof of your mouth suffers the rest of the night? Yeah, like that.

But, the feeling doesn’t go away in a day. It can linger for months. Some women report a sensation of tingling, while others feel a more intense burning pain. The tongue seems to be the most common site of discomfort, but other parts of the mouth may be affected, too—like the gums, lips, or entire inside of the mouth. The mouth may feel dry, raw, or inflamed. And food might taste overly salty, metallic, or bitter. If you experienced any change in your sense of taste during pregnancy, imagine that x5.

Some women report their symptoms worsening as the day wears on. Some experience relief when eating or drinking. But all agree it’s not easy or pleasant to manage.

Miss Diagnoses

You go into your physical and the doctor asks, “So, how are you? Is there anything you’d like to discuss?”

Do they really want the answer?

Or are they just hoping and praying your 48-year old self will simply say, “Nope. Everything’s the same.”

When you do mention a weird taste or feeling in your mouth, they begin with the usual questions:

• Have you been eating anything different?

• Taking new medications?

• Have you been to a dentist recently?

• Have you changed your toothpaste or mouthwash?

With “No’s” to all those questions, they may move on to the next level of potential diagnoses:

• Oral thrush is a common misdiagnosis. Yes, it can cause burning and discomfort. But it also presents with tell-tale white patches on the inside of the mouth and tongue.

• Allergies: since it’s possible to develop allergies as we age, the doctor may believe you’ve become allergic to something in your normal routine.

• Vitamin deficiencies could be the culprit, especially low levels of iron, zinc, and B vitamins.

• Acid reflux (GERD) is a common misdiagnosis. True, it can exacerbate perimenopausal burning tongue, but it’s not the root cause.

• Nerve pain: Some doctors may get out the prescription pad and prescribe meds to help alleviate neuropathic pain, but these will likely be ineffective for BMS.

What’s actually going on?

Women’s health needs more research. Much more. If I had a dime for every time I’ve been shaken down for money for “breast cancer awareness”, I could funnel it into all the other women’s health issues that don’t get pink ribbons or tons of press since I think we’re sufficiently “aware” of breast cancer.

What we’re not aware of is why some women suffer with BMS. The triggers are not fully understood (shocker!). But, BMS is believed to be connected to fluctuating estrogen. Though we generally classify estrogen as a sex hormone, it’s responsible for so much of women’s wellness, including regulating saliva production and maintaining oral tissue health. (Who knew!) When estrogen drops, so may saliva production, and the nerves in the mouth can become a little angry.

You might not be surprised to hear that anxiety and stress can exacerbate the problem by increasing nerve sensitivity and decreasing saliva flow. Is there anything anxiety and stress don’t make worse?

Are there solutions?

I’ll give it to you straight: some women don’t find much relief. I know; it sucks.

But, others find that some of these solutions (or a combination of them) alleviate their discomfort or at least make it more manageable.

Hormone Therapy: To mitigate the natural decline in estrogen, some women find relief for their symptoms by going on hormone replacement therapy. This typically involves estrogen delivered with progestins and possibly some testosterone. Seek out doctors experienced in HRT to understand your risk factors and potential HRT delivery systems.

Proton Pump Inhibitors: If acid reflux is the cause—or an exacerbating factor—medications called proton pump inhibitors may be prescribed to help decrease the amount of stomach acid you produce.

Antifungals: If the cause of the burning sensation is actually thrush, antifungals will be prescribed to help clear the fungal infection and restore the oral tissues to their normal state.

Vitamins and minerals: A blood test can determine if you’re experiencing vitamin deficiencies, and over-the-counter (or prescription) supplements may be recommended. If, however, your BMS is hormone related, vitamins may not help.

Alpha-lipoic acid is an antioxidant that’s shown promise in alleviating neurological pain. It may be recommended for BMS.

Saliva stimulators: Fixing the problem of dry mouth may help manage some of the BMS symptoms. Lozenges, artificial saliva sprays, and xylitol-sweetened gum may offer a bit of relief.

Ice, ice, baby: Some women find that sucking on ice chips or consuming cold foods or beverages alleviates the discomfort temporarily, but this isn’t really a fix.

Anti-anxiety meds: If BMS is a source of depression or anxiety (both of which can make matters worse), your doctor may consider prescribing an SSRI or antidepressant. Neither will “cure” the burning issue though.

Cognitive behavior therapy (CBT): reducing stress and finding techniques to manage it using CBT may make it easier to deal with persistent burning sensations.

Numbing gels: though these won’t address the root cause of the discomfort, nor are they recommended for long-term use, they may provide temporary relief.

Have you experienced BMS?

If you or someone you know has been experiencing BMS, we’d love to hear how it’s being managed.

Unfortunately, not nearly enough is known about the risk factors associated with this frustrating perimenopausal symptom that can be quite disruptive to a woman’s daily life. Hopefully, we can help shine a light on it so more women understand that they’re not imagining it and they’re not alone.

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