Hormone Help for Burning Mouth Syndrome

By Susan E. Sklar, M.D.

I want to inform my readers that I have updated this article with the most current understanding of the relationship between hormones and pain. This understanding guides me in treating my patients.

What is Pain?

Pain is a reflex response in our bodies just something that potentially can damage us. Sometimes pain tells us to immobilize a body part that’s been injured so that repair can take place. These are examples of beneficial pain. There is a more insidious type of pain however, called neuropathic pain. This pain goes on beyond its biological usefulness.

As a holistic doctor, Dr. Sklar’s approach to treatment means that she looks at the whole body for a solution to the pain of Burning Mouth Syndrome. The conventional medical system only knows how to prescribe medication for pain. We have seen the benefit of looking within the body and augmenting the body’s healing abilities. Holistic medicine looks at the whole body. Our treatment approach, which uses hormones, is based on observation of our patients and the knowledge that 90% of people suffering with Burning Mouth Syndrome are perimenopausal and menopausal women.

How chronic pain happens

Nerves out in your extremities, mouth, and tongue send messages back to the brain. These messages are relayed via the spinal cord. Touch sensation is sent through large nerves which are coated with an insulation called myelin that helps the signals travel faster. Painful, potentially damaging sensations travel to the spinal cord and brain through thinner fibers which are not coated with myelin.

These the nerve fibers contain areas called nociceptors. These are locations on the nerve that help with transmitting the painful response to the brain. If the cause of pain is mild the nociceptors adapt. But if there is a stronger or longer source of pain the nociceptors begin to release factors from the damaged tissue.

These include substances called calcitonin gene-related peptide, histamine, and other inflammatory chemicals. These chemicals make the nociceptors more sensitive the future pain inputs. This hyperexcitability of the nerves create long-term changes in pain sensation that result in feelings of pain even after the original damaging source is gone.

What is the connection between sex hormones and the pain of Burning Mouth Syndrome? Neurosteroids!

These hormones which are made in various glands, are also produced by our nerves and in our brains. They are called neurosteroids when they are made by nerves and in the brain. Neurosteroids have three main functions related to pain management.

1. Suppress inflammation. The inflammatory cells of the brain which are called glial cells become activated when severe pain is persistent. This activation is the cause of pain centralization and Central sensitivity. This means that the pain in addition to being at the original site such as the tongue is now also in the brain. When this happens the pain can change from an intermittent mild or moderate one to severe constant pain.

2. Neurosteroids protect the nerve cells also called neurons and the inflammation supporting cells that glia from cell death.

3. The regeneration and growth of new nerves. This has been shown in animal studies with clear-cut healing effects in the spinal cord which has been damaged. The neurosteroids also maintain pain numbing receptors and prevent an excess pain response.

With this knowledge and 30 years of experience I understand how hormone balancing helps control the pain of Burning Mouth Syndrome. The use of hormones is one of the newest and innovative ways to treat not only Burning Mouth Syndrome but to treat pain that is called neuropathic pain. Neuropathic pain is pain that is caused by disease or damage to the nervous system.

Now let’s talk about how hormones help lessen the pain of Burning Mouth Syndrome. If you show up at your gynecologist’s office and tell her you want hormones to help your burning mouth, you will be faced with a blank stare. Mainly, the doctors who know about hormones and pain management are the pain management specialists and very few if any of them will have heard of Burning Mouth Syndrome. As far as gynecologists go, there are maybe a few gynecologists who have figured out this connection but the chances of finding one are nil. This is why it is important to have a holistic doctor’s approach, like Dr. Sklar’s.

“90% of people that have Burning Mouth Syndrome are perimenopausal and menopausal women.”

90% of people that have Burning Mouth Syndrome are perimenopausal and menopausal women. During menopause important hormones like estrogen, progesterone, and testosterone are no longer produced by the ovaries. You will learn how these hormones affect the pain of Burning Mouth Syndrome. Added to this, you will understand how severe chronic neuropathic pain messes up your hormones.

What is the role of cortisol?

Chronic pain causes an initial overproduction and then, a later depletion of another hormone called cortisol. Cortisol is the fight or flight hormone. It is the alarm hormone. And, it is supposed to protect the body from harm. In the normal, healthy person, cortisol is a healing hormone. It acts like an anti-inflammatory and is a natural painkiller.

However, the constant stress of pain causes high levels of cortisol for long periods of time. High cortisol for long periods of time causes the reverse effect. It has a toxic effect on the nerve cells and no longer dampens pain. Later, when it becomes depleted in chronic pain disorders like Burning Mouth Syndrome, pain increases. As an expert and advocate of hormone balancing for my perimenopausal and menopausal patients, I have seen the beneficial effects of hormones on Burning Mouth Syndrome.

What are the hormones that help with pain?

As I previously stated, 90% of the people that have Burning Mouth Syndrome are perimenopausal and menopausal women. I have searched the literature for the last 40 years and there are maybe four or five studies about hormones and Burning Mouth Syndrome. All these studies showed that hormones are a benefit to patients. Of course. they didn’t use bioidentical hormones.

Bioidentical hormones are safer and have fewer side effects. These are the ones we use. Regardless of the type of hormones used in the studies, however, they showed benefit. In one study from the Journal of Oral Surgery, Oral Medicine, and Oral Pathology in 1989, showed there was less depression and more ability to cope. And two thirds of the women experienced decreased mouth pain. So this really speaks to the benefits of hormones.

How do hormones help?

I prescribe natural steroid hormones. Not to be confused with pharmaceuticals like prednisone which are powerful drugs with serious side effects. People worry when they hear the term steroids, they think about steroid abuse. And they think about damaging things that happen. Say in the bodybuilding world with people abusing steroids and having organ damage and adverse consequences. The steroids that are used in bodybuilding are generally synthetic steroids. They do have a lot of side effects and we don’t use those. I want to make this clear to you, so you don’t worry that using steroids is a bad thing.

“Steroids are actually made in the nerves in your brain and in the nerves in other parts of your body.”

What is the safety of bioidentical hormones?

So first, I want to address the media view of hormones. I think everyone’s heard about the Women’s Health Initiative. It is almost 20 years since the results came out and it still makes big news when it hits the papers. Unfortunately, almost every time the media reports on hormones, the conclusion is that hormones are dangerous. This is because they are almost always reporting uses the conclusions of the Women’s Health Initiative study. What’s wrong with the Women’s Health Initiative?

First, they used the wrong estrogen in that study. The company that made Premarin (a type of estrogen) was sure that Premarin was going to be shown to be a fabulous advantage and raise it to even more of a blockbuster drug than it was. That didn’t happen. Second, they used Provera, which is a synthetic progesterone that does in fact, increase risk of breast cancer. And it’s still on the market. I honestly don’t know why it is still available. But, I certainly don’t prescribe it at the Sklar Center. Third, the study designers started women in their late 60’s on hormones when they were more likely to have heart problems.

“Bioidentical hormones do not increase breast cancer, uterine cancer, or cardiovascular disease.”

I use bioidentical hormones Bioidentical hormones the same chemical structure as the hormones in our own bodies.  There are studies that show bioidentical hormones, do not increase breast cancer, uterine cancer, or cardiovascular disease. In fact, we see reduced rates of Alzheimer’s. Women who are on hormones for menopause have half the rate of Alzheimer’s disease as women who are not on hormones. In addition, there is protection from cardiovascular disease and a number of other benefits like preventing osteoporosis and colon cancer prevention.

Hormones are protective, and pain-relieving.

Estrogen is a helping hormone

In menopause when you lose your estrogen. Estrogen is a tremendously important natural anti-inflammatory hormone. It has a huge impact on our bodies. Estrogen is made primarily in our ovaries, but as I mentioned, it’s also made in our brains and our nerves. Why is estrogen made in a nerve? What would it do there? It doesn’t have anything to do with reproduction and having babies. This is because estrogen does a lot more than that. It has anti-inflammatory properties.

“In menopause when you lose your estrogen, you lose a tremendously important natural anti-inflammatory hormone.”

Estrogen regenerates new nerves

Estrogen calms the pain pathways. Especially in the head and the face. And, it reduces pain producing inflammation. In addition, it protects and regenerates nerves. In Burning Mouth Syndrome, you have damaged nerves that are causing your pain. You want to regenerate new, healthy nerves that will then function properly. Estrogen helps with that regeneration.

Testosterone is good for women and men

Testosterone is an important pain decreasing hormone. In addition to pain relief, both women and men have lots of good benefits from testosterone in terms of mood and energy. But the one thing that’s been found in women is that testosterone improves overall sense of wellbeing. And goodness knows if you have chronic pain of Burning Mouth Syndrome, you need something to improve your wellbeing.

Vitamin D is a hormone

Vitamin D does similar things as the other steroids. It is really a hormone that helps healing. You guessed it. Vitamin D reduces inflammation, protects against toxins, and helps to make healing nerve factors.

What are other important hormones that help BMS pain?

Thyroid is essential

When I initially started treating burning mouth patients, I always screened for thyroid problems.    A study was done on 123 women who had Burning Mouth Syndrome and 123 women who didn’t have burning mouth. 58 people had low thyroid function in the burning mouth group. Only 13 in the group without Burning Mouth Syndrome showed low thyroid. When the 58 patients in the burning mouth group received treatment, two thirds of the people had their symptoms resolved! So, there definitely is a thyroid connection.

What about melatonin?

We think of melatonin as being the sleep hormone. It is more than that. Melatonin has potent antioxidant and anti-inflammatory properties. And just like the other hormones, it helps the healing of nerves.

 A new understanding about how hormones help

See, you have expanded your understanding of hormones beyond reproduction and menopausal hot flashes. The use of hormones for pain relief is one of the newest modalities in the relief of neuropathic pain conditions like Burning Mouth Syndrome. Take advantage of this new information for relief of your pain. Contact us for a Burning Mouth Consult.

References for healthcare professionals and visitors to my site who want more in-depth information
  1. Mathias Strittmatter, Oliver Bianchi, D. Ostertag, M Grauer, Christoph J. Paulus, C. Fischer, Sara Meyer
    Altered function of the hypothalamic-pituitary-adrenal axis in patients with acute, chronic and episodic pain.
    LINK: Altered function of the hypothalamic-pituitary-adrenal axis in patients with acute, chronic and episodic pain.
  2. W. Wardrop, J. Hailes, H. Burger, P.C. Reade
    Oral Surg Oral Med Oral Pathol 1989 May 67 (5)
    LINK: ://doi.org/10.1016/0030-4220(89)90269-7
  3. Roberto Cosimo Melcangia, Giancarlo Panzica
    Neuroactive steroids: An update of their roles in central and peripheral nervous system.
    Psychoneuroendocrinology Volume 34, Supplement 1, December 2009, Pages S1-S8
    LINK: Neuroactive steroids: An update of their roles in central and peripheral nervous system.
  4. Felice Femiano, Alessandro Lanza, Curzio Buonaiuto, Fernando Gombos, Monica Nunziata, Luisa Cuccurullo, Nicola Cirillo
    Burning mouth syndrome and burning mouth in hypothyroidism: proposal for a diagnostic and therapeutic protocol
    Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Jan;105(1):e22-7
    LINK: Burning mouth syndrome and burning mouth in hypothyroidism: proposal for a diagnostic and                    therapeutic protocol
  5. Forest Tennant, MD, DrPH
    Oxytocin, an Opioid Alternative, Ready for Regular Clinical Use to Manage Chronic Pain
    LINK: Practical Pain Management Volume 17, Issue 9, 2017
  6.  Gordon Blackburn-Munro and Ruth Blackburn-Munro                                                                                                  Pain in the Brain: Are Hormones to Blame?                                                                                                                            LINK: TRENDS in Endocrinology and Metabolism Vol.14 No.1 January 2003

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