Menopause sets in motion a series of changes at the physiological level in women, some of which impact oral health. Decreased levels of estrogen have been linked to a loss in bone density and inflammation, both of which make gum disease worse. Periodontitis, a chronic inflammatory disease which destroys the soft tissue and supporting bone around the teeth, becomes more frequent after menopause. While HRT is commonly administered to control symptoms of menopause like hot flashes and mood swings, it has not previously been evaluated for all its oral health benefits. This case-control study, conducted on 372 postmenopausal Saudi Arabian women, was designed to study the relationship of HRT with periodontal health, i.e., prevalence and severity of periodontal disease.
The study was performed in several healthcare centers in Jeddah, Saudi Arabia. 372 postmenopausal women took part in the study, of whom 186 had periodontitis and 186 had healthy periodontium. Periodontal status was evaluated according to the 2017 classification by the American Academy of Periodontology. A validated questionnaire was filled out by the participants, and some of the periodontal parameters were measured, including Clinical Attachment Loss (CAL), saliva secretion rate, and bone loss. Statistical analysis included logistic regression and odds ratios for categorical variables and t-tests and linear regression for continuous variables.
Key Findings
• The findings indicated that women who applied HRT were less likely to develop periodontitis significantly.
• The chance of having periodontitis was 3.2 times lower in HRT users than in non-users (OR = 0.31, p < 0.05, 95% CI: 0.11–0.89).
• After controlling for medical and demographic variables, the odds reduced further to almost six times less likely (OR = 0.17, p < 0.05, 95% CI: 0.04–0.81).
• Although HRT lowered the risk of gum disease development, it did not appreciably affect the severity of the disease if it was already present.
• Use of HRT was strongly related to lower clinical attachment loss (Coef = -1.13, p < 0.05, 95% CI: -2.26 to -0.02), although this lost significance after adjusting for medical and social variables.
• There was no difference in levels of bone loss and saliva secretion between the HRT user and non-user groups when considered as both numerical and categorical data.
The authors suggest increased coordination between medical and dental practitioners in menopause management and recommend further study to investigate the long-term implications and different preparations of HRT on oral health outcomes.
Reference:
Ageel, R., Abaalkhail, B. & Natto, Z.S. Effect of hormone replacement therapy on periodontal health in post-menopausal women in Jeddah, Saudi Arabia. BMC Women's Health 25, 383 (2025).https://doi.org/10.1186/s12905-025-03757-5
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