Understanding the Link Between Hormonal Changes and Gingival Health in Women: A Review.

Sex hormones, particularly estrogen and progesterone, undergo continuous fluctuations throughout a woman's life, beginning at puberty and extending through the menstrual cycle, pregnancy, and menopause. These hormonal variations significantly influence gingival health, leading to various periodontal conditions. During puberty, elevated levels of estrogen and progesterone enhance blood circulation to the gingival tissues, increasing their sensitivity to plaque and resulting in puberty gingivitis. This condition is characterized by gingival enlargement, redness, and bleeding. Throughout the menstrual cycle, hormonal fluctuations can cause menstrual gingivitis, presenting as inflamed and bleeding gums, typically occurring prior to menstruation and subsiding thereafter. Pregnancy induces substantial hormonal changes, with heightened estrogen and progesterone levels exacerbating gingival inflammation. This often leads to pregnancy gingivitis, marked by swelling, bleeding, and tenderness of the gums. In some cases, a localized overgrowth known as a pyogenic granuloma or "pregnancy tumor" may develop on the gingiva. The use of oral contraceptives, which alter hormonal levels, has been associated with increased gingival inflammation and exudate, similar to the effects observed during pregnancy. Menopause brings a significant decline in estrogen levels, leading to various oral health issues such as dry mouth (xerostomia), a burning sensation in the mouth, and an increased risk of osteoporosis affecting the alveolar bone supporting the teeth. These changes contribute to a heightened susceptibility to periodontal diseases in post-menopausal women. The influence of estrogen and progesterone on the immune response, oral microbial composition, bone density, and enzymes like collagenase plays a crucial role in modulating gingival inflammation and the risk of periodontal diseases. Understanding these hormonal impacts is essential for developing effective prevention and treatment strategies for maintaining optimal gingival health in women across different life stages.