Hormonal Influences on Periodontal Health in Women

Sex steroid hormones, notably oestrogen and progesterone, exert profound effects on the periodontium across the female life course. Fluctuations during puberty, the menstrual cycle, pregnancy and menopause modulate vascular permeability, immune cell function and cytokine production within gingival tissues. These changes foster alterations in microbial composition, with shifts towards dysbiotic communities that promote gingival inflammation and, in susceptible individuals, progression to periodontitis. Pregnancy is characterised by marked increases in oestrogen and progesterone, which heighten gingival blood flow and crevicular fluid volume, amplify inflammatory mediator release and favour the proliferation of specific periodontal pathogens. Menstrual-cycle–related variations in hormone levels have been linked to functional remodelling of the salivary microbiome, affecting metabolic pathways that support biofilm persistence. In the postmenopausal state, declining oestrogen contributes to thinner mucosa, reduced salivary flow and impaired tissue repair, further elevating periodontal risk. Understanding these interrelationships underpins tailored preventive and therapeutic strategies, including timing of dental interventions, modulation of hormonal status and targeted microbiome management to safeguard oral health in women.

Research from Nature Portfolio

Recent studies have detailed how pregnancy and lifestyle factors combine to drive periodontal dysbiosis. One investigation of systemically healthy pregnant women demonstrated trimester-specific shifts in subgingival microbial communities, correlating higher serum progesterone in early gestation with increased Porphyromonas gingivalis abundance and augmented gingival inflammation. Another analysis examined the dual impact of pregnancy and active smoking on subgingival plaque, revealing that each perturbation induces distinctive changes in community structure and co-occurrence networks, with pregnant smokers exhibiting the most pronounced departure from a health-associated microbiome. These findings highlight the synergistic effects of hormonal and environmental challenges on periodontal ecology.

Hormonal Influences on Periodontal Health in Women publication trend

The graph below shows the total number of articles in hormonal influences on periodontal health in women across all publications each year (not limited to Nature Index journals).

Technical terms

Periodontium: The specialised tissues, including gingiva, periodontal ligament and alveolar bone, that support and anchor the teeth.

Subgingival biofilm: A structured microbial community adhering to tooth surfaces below the gumline.

Gingival crevicular fluid (GCF): The serum-derived fluid found in the sulcus between gingiva and tooth.

Dysbiosis: A state of microbial imbalance that favours pathogenic species over a normally symbiotic community.

Metabarcoding: A DNA-based technique for profiling complex microbial assemblages through targeted gene sequencing.

References

1. The Influence of Sex Steroid Hormones on Gingiva of Women. The Open Dentistry Journal (2009).
2. Sex Hormones Enhance Gingival Inflammation without Affecting IL‐1β and TNF‐α in Periodontally Healthy Women during Pregnancy. Mediators of Inflammation (2016).
3. Dysbiosis of the Human Oral Microbiome During the Menstrual Cycle and Vulnerability to the External Exposures of Smoking and Dietary Sugar. Frontiers in Cellular and Infection Microbiology (2021).
4. Smoking, pregnancy and the subgingival microbiome. Scientific Reports (2016).
5. Correlation of periodontal and microbiological evaluations, with serum levels of estradiol and progesterone, during different trimesters of gestation. Scientific Reports (2019).
6. Metabarcoding analysis of oral microbiome during pregnancy. Frontiers in Cellular and Infection Microbiology (2024).
7. Periodontal pathogens of the interdental microbiota in a 3 months pregnant population with an intact periodontium. Frontiers in Microbiology (2023).