Hormone Help for Burning Mouth Syndrome

By Susan E. Sklar, M.D.

This article is about 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.

“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 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 the 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.[1] 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.[2]

How do hormones help?

There are a couple of classes of hormones. The first is the steroid class of hormones. These are estrogen, progesterone, testosterone, DHEA, pregnenolone, and vitamin D. You might say, well, what’s vitamin D doing in there? When you look at the chemical structure of vitamin D it looks like a steroid. In fact, vitamin D functions very much as a steroid hormone.

These are your 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.”

Your body’s steroids are not only made in your ovaries and adrenal glands. Steroids are actually made in the nerves in your brain and in the nerves in other parts of your body. They are called neurosteroids. Neurosteroids have tremendous healing and protective value. The most important neurosteroids are DHEA (dehydroepiandosterone) and pregnenolone.[3] There are also other hormones that benefit Burning Mouth Syndrome. These hormones are thyroid, melatonin, and oxytocin.

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.

I picture nerves and nerve stem cells as little tiny seedlings that you put in a pot with fertilizer, or even better compost. Then, you water it and you give it sunlight. Soon it grows up into a big, beautiful plant. And that’s what we want to see. New little baby nerves turning into new healthy grown up nerves. Estrogen, as I mentioned before, calms the distress response and lowers the release of cortisol. Cortisol at high levels over long periods of time damages nerves. Estrogen dampens this aspect of the pain response.

What about progesterone?

Progesterone is another female hormone. Its primary function is regulation of ovulation and menstruation and maintenance of a pregnancy. Progesterone has other benefits. It is very brain calming. In addition, it helps with sleep. And, It helps with mental focus and helps with anxiety. Progesterone is pain-relieving and increases endorphin release. Endorphins are your own internal pain relievers.  In addition, endorphins function like narcotics like codeine.

All by itself, progesterone is also a natural pain reliever. These two natural chemicals protect nerves, calm pain, and increase your natural pain-relieving chemicals. Levels of progesterone fall during perimenopause and menopause which is one of the things that triggers the start of burning mouth syndrome.

Testosterone is good for women and men

Testosterone is another 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.

Pregnenolone helps promote healthy nerves

Pregnenolone is a neurosteroid. It is available as a supplement. It is one of the very important neurosteroids made in nerves and needed by your brain for neuroprotection. What causes Burning Mouth Syndrome? We don’t know if it’s some toxic assault or if it’s caused by a virus like Lyme disease. We really don’t know what gets it going. But we do know that these hormones protect your nerves against toxic assault. Pregnenolone is a chemical that is another one of your body’s own natural pain relievers.

What is the role of DHEA?

DHEA is another natural hormone that helps healing nerves. It restores injured nerves. Moreover. DHEA levels fall when you get stressed. You make your cortisol from DHEA. It is an intermediate step to the production of Cortisol. If you’re very stressed and you’re making a lot of cortisol, you are converting a lot of your DHEA into cortisol. Therefore, you end up with lower DHEA levels in your body. I actually see this in our stressed patients when we do their lab testing. If they’ve been through a really stressful time in life, their DHEA is low.

If DHEA is low, it cannot work to restore injured nerves. Scientists have done studies on the saliva of people with burning mouth. Their morning saliva has decreased DHEA. So, they are not having as much DHEA to help those nerves in the mouth. This may result in a loss of protection for the nerves leading to the pain of Burning Mouth Syndrome. 

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![4] 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.

Oxytocin the cuddle hormone has multiple effects

Oxytocin is known as the cuddle or love hormone. It is a peptide hormone. A peptide is a class of small chain amino acids that shows a lot of promise in treating pain. So, oxytocin is the birth and nursing breastfeeding hormone. It is a pain dampener. How would we get through labor, if we didn’t have oxytocin? Moreover, there is growing evidence that oxytocin relieves pain associated with headaches, chronic back pain, irritable bowel syndrome, and other types of pain.[5]

It is made in the hypothalamus gland, which is our part of our brain. That is our master hormone regulating gland. At times of stress or pain, the hypothalamus releases surges of oxytocin into the brain and out to the nerves in the extremities. So, oxytocin stimulates your own natural painkilling receptors. You have opioid receptors in your brains and in your nerves. Opiod receptors decrease our pain. Your endorphins are your natural pain relievers that attach to those opioid receptors. Oxytocin’s action is to stimulate these receptors and lower pain.

Oxytocin also affects the nerves of the spinal cord. The spinal cord is the initial site of pain transmission from your tongue up to your brain. Oxytocin blocks the pain sensation in the spinal cord neurons. That’s where chronic pain gets amplified–in your spinal cord. And it has calming effects on that area of the spinal cord. In addition, it prevents that amplification or enlargement of pain that happens with chronic neuropathic pain.

Oxytocin also has calming affects on the amygdala. The amygdala is the fear center in the brain. So that’s a key factor in negative emotions and reaction to pain. Oxytocin also decreases the production of cortisol. Decreasing cortisol then reduces symptoms related to stress and, as a result, reduces pain. So, you can see there are many ways in which oxytocin helps. I am currently prescribing it as a nasal spray because it can get directly into the brain, through your nose. There is a very thin bony, porous plate between your nose and your brain. And so nasal sprays are a good way to get medications to the brain.

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.


  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

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