Dry mouth and altered taste during the menopausal transition

Perimenopause is characterised by hormonal fluctuations, particularly oestrogen. This often disrupts normal processes in the body leading to various symptoms. Oestrogen is important for the production of saliva and maintaining healthy oral mucous membranes. Just like it helps keep the vagina healthy and moist. 

The decline in oestrogen levels can affect the production of saliva, causing the mouth to get dry. In addition, as oestrogen drops, collagen production decreases along with it. As a result, the mucous membranes in the mouth become thinner, more sensitive and start to lose moisture. The medical term for dry mouth caused by a reduction in saliva is xerostomia. 

Changes in the mouth around menopause can also be influenced by other factors than hormones. Dry mouth can also be triggered by stress, anxiety or depression. These factors affect the nervous regulation of the salivary glands, decreasing their production. Dry mouth or throat can be a side effect of certain medications, such as antidepressants, and smoking can also increase symptoms of dry mouth. 

Many women experience a host of symptoms as they go through menopause, such as hot flashes, sleep problems and mood swings.

Reduced saliva production can change how you perceive taste. Many women can experience a strange or bad taste in their mouth around menopause, such as a salty taste, a bitter taste or a metallic taste, making it difficult to enjoy food. 

During digestion, saliva helps break down food into chemicals the body can use. Your taste buds have receptor proteins that detect these chemicals as different flavours. Dry mouth can disturb these taste buds, leading to taste changes. In addition, ageing also seem to be a factor: as we age, our taste buds not only diminish in number, but also change in function.  

In addition to dry mouth and a bad or bitter taste, you may also experience other oral issues: 

• Burning mouth: When saliva production decreases and the mucous membranes in the mouth become drier, this can cause a burning sensation in the mouth in some people. 
• Gum inflammation: A dry mouth significantly increases the risk of inflammation. Saliva protects the mouth. The less saliva you have in your mouth, the greater the chance of gum irritation. 
• Bleeding gums: Changes in your hormones can result in sensitive gums, which can make your gums more likely to bleed. 

The menopausal transition affects different women in different ways. Some symptoms of menopause are well known, like hot flashes and weight gain, but there are also some lesser-known symptoms, such as dry mouth, changes in taste (a metallic, bitter or bad taste in the mouth) or a burning sensation in the mouth. 

Although extensive research is lacking, a study conducted by American health specialist and nutritionist Emma Bardwell in cooperation with apple producer Pink Lady has shown that more than 40 percent of women experience changes in oral health during the menopausal transition, a fact of which 90 percent of women were unaware. More than 2,000 women participated in the study.  

Another small-scale study found a further decline in taste perception in postmenopausal women. Bad taste or dry mouth can happen at any age, but it is more common in women who have been through menopause. In addition to changes in hormonal levels during the menopausal transition, the ageing process can also contribute to oral issues such as dry mouth or taste disturbances, in both men and women. As we age, the number of taste buds that we have decreases, resulting in duller taste sensations. 

The good news is there are several things you can do to protect your oral health and alleviate oral symptoms as you go through menopause. 

• Practising good oral hygiene. Brushing your teeth twice a day helps keep your mouth healthy and prevent dry mouth. A dry mouth makes it easier for plaque to stick to the teeth. While mouthwash is not absolutely required for good oral hygiene, you can use an alcohol-free mouthwash with a mild flavour if you like. Use toothpicks to remove bacteria and food debris from between the teeth and gums that could cause bad taste. Tongue plaque can also affect taste perception. A tongue scraper can help to remove plaque from the tongue's surface. Make sure you see a dentist and dental hygienist for regular check-ups (twice a year). Last but not least, there are also products specially formulated to manage dry mouth or relieve dry mouth symptoms. 
• Avoid tobacco and alcohol. Drinking alcohol and smoking or chewing tobacco can irritate the taste buds on your tongue and lead to more dry mouth symptoms. Caffeine reduces saliva production, making the effects of dry mouth worse. 
• Drink plenty of water. This may seem very obvious, but if you lose a lot of body fluids (due to hot flashes or night sweats) this can lead to dehydration and therefore dry mouth. 
• Add probiotic foods to your diet. Probiotics support good bacteria in your gut and mouth. Foods naturally high in probiotics include fermented products such as kimchi, kombucha, sauerkraut and tempeh, but also yoghurt, kefir, fresh buttermilk and sourdough. Also eat foods that contain a lot of moisture and avoid spicy, acidic and salty foods. 
• Try oil pulling. Swish a tablespoon of high-quality, edible vegetable (or coconut) oil in your mouth on an empty stomach before breakfast for several minutes (before brushing your teeth). Do not swallow the oil. Rinse your mouth after and then brush your teeth. The idea behind oil pulling is that you ‘pull' bacteria out of your mouth. When done regularly, it also nourishes the gums and lining of your mouth. 
• Get at least 30 minutes of physical activity a day in addition to your normal activities. Exercise helps circulation as it increases blood flow, also to the oral mucosa. This stimulates the production of saliva. 
• Enrich your diet with high-quality supplements. A deficiency in certain vitamins or minerals, such as zinc deficiency, can cause dry mouth or a bad taste. Zinc supports the production of a protein that plays an important role in developing taste buds. In addition, a deficiency in vitamins B, iron, copper and folic acid can trigger a metal mouth taste. 
• Hormone therapy may help. Women using HRT are less likely to suffer from dry mouth. Do you have multiple symptoms and are they affecting your quality of life? Are the above tips not enough for you? Then consult a doctor to explore your options. Read more about hormone therapy.