How periodontal diseases affect women’s health at different stages of life

How do the menopause and hormone-replacement therapy affect women's periodontal health?

Menopause and hormone-replacement therapy both have a significant impact on women's periodontal health, mainly because of the changes in hormone levels that occur during this time. During menopause, there is a decrease in oestrogen levels in the body, which can have various effects on oral health. For example, oestrogen deficiency can reduce saliva production and lead to xerostomia, which can increase the risk of caries, gingivitis, and periodontitis.

Oestrogen has anti-inflammatory effects, inhibits bone resorption, and promotes bone formation, which means that oestrogen deficiency can lead to net bone loss, with a deterioration of both bone density and bone microarchitecture. Women are therefore significantly more likely than men to suffer from osteoporosis, which also requires treatment. It should be noted here that antiresorptive and bone anabolic drugs are often used in the treatment of osteoporosis. Although these drugs are associated with a risk of drug-associated jaw necrosis, this risk is relatively low in the treatment of postmenopausal osteoporosis.

Hormone-replacement therapy is often prescribed to alleviate menopausal symptoms by restoring oestrogen levels. Its effects on periodontal health can be beneficial or neutral, depending on individual health factors and the specific therapy. Some studies suggest that oestrogen therapy may have a protective effect on periodontal tissues by reducing inflammation and potentially improving gingival health. Oestrogen may promote collagen production and bone metabolism. But not all studies agree on the benefits of hormone-replacement therapy for periodontal health, and although it may have some benefits, its effectiveness seems to vary and needs to be considered on an individual basis.

What is the latest research on how women’s health affects the health of their children?

Women's health is, of course, closely linked to the health of their offspring, and this may also apply to matters of periodontal health. Two interesting studies on this topic were recently published. One noteworthy study examined the subgingival proteome and microbiome of mothers with periodontal disease and their offspring, and it showed that the maternal periodontal microbiome and proteome are associated with those of the offspring and are also related to the maternal periodontal status. This could promote the susceptibility of offspring to dysbiosis and predispose them to periodontitis (Paz et al., 2025).

Another study focused on the microbial colonization in different dentition phases in individuals from birth to 18 years who either came from families with a history of periodontitis or from periodontally healthy parents. It was also found that the periodontal status of parents significantly influences the composition of their children's microbiome from an early age. Moreover, it was found that the mixed-dentition period was the phase associated with establishing a dysbiotic and pathogen-rich microbiome in offspring of parents with periodontitis (Reis et al., 2023).  During the mixed-dentition phase, biofilm is difficult to control. The accumulation of dental plaque can be exacerbated during this phase by the eruption of permanent teeth and by parents paying less attention to their children's tooth-brushing. In the children of parents with periodontal disease, transmitted pathogens could exploit this phase of instability to establish themselves permanently in the mouth.

It is well known that diabetes mellitus is associated with periodontitis. Does this also apply to gestational diabetes?

Yes. There is a significant association between periodontal disease and gestational diabetes. Periodontitis could promote the development of gestational diabetes by increasing the insulin resistance. Conversely, impaired glucose metabolism promotes the development or worsening of periodontal diseases.

Periodontitis is also associated with an increased risk of cancer. Is breast cancer more common in women with periodontal disease?

Indeed it is. There are meta-analyses on this topic that clearly show that breast cancer is associated with periodontitis.

Interestingly, a systematic review and meta-analysis suggest a significant link between oral Fusobacterium nucleatum species and their role in female breast cancer pathogenesis (Akbari et al, 2024). F. nucleatum could contribute to tumour development through several different mechanisms, such as production of cytokines and reactive oxygen species, which in turn can cause mutations and epigenetic changes. It was therefore hypothesized that targeting F. nucleatum could be beneficial in the therapy of breast cancer.

Can periodontitis also affect fertility in women?

Some studies have suggested that fertility is lower in women with periodontitis. However, further research and adequate statistical analyses are needed to confirm this correlation, as there is always the chance that common risk factors are largely responsible for it.  

What mechanisms underlie the links between periodontal diseases and impaired health in women?

On the one hand, female sex hormones have a significant impact on periodontal tissues, thereby promoting periodontal diseases. On the other hand—as is understood for other associations between periodontal and systemic diseases—it is micro-organisms in the dysbiotic biofilm, their components and products, and inflammatory molecules from the inflamed periodontium that can affect women's health via the bloodstream. There is therefore a causal relationship. Common risk factors—such as smoking, age, socioeconomic status, heavy alcohol consumption, obesity, and other systemic diseases and conditions—also play a role in the association between periodontal diseases and impaired health.

Conclusion

Research shows that periodontitis is closely linked to women’s health. While common risk factors play a role in associations between periodontal disease and specific conditions, some true cause-and-effect relationships are also responsible.

Although periodontitis is associated with general diseases that occur in both men and women—such as cardiovascular disease, type-2 diabetes, and neurodegenerative diseases—there are also associations that occur only in women: gestational diabetes, premature birth, and breast cancer.

Women should be informed about these associations and motivated to maintain good oral hygiene and keep their check-up appointments. Periodontitis treatment is safe during the second trimester of pregnancy. And even with antiresorptive therapy for postmenopausal osteoporosis, periodontitis can be of successfully treated. Close co-operation between medical and dental professionals is essential for the well-being of our patients.