At the start of the 20th century, a woman’s average life expectancy was 49 years.[i] Today, the average age for the menopause is slightly higher at 51; improvements in health and sanitation, research, education, lifestyle choices and medical care have ensured that women now have a life expectancy of 80, meaning over a third of their life extends beyond the menopausal transition where once it often did not.[ii]
Despite affecting half of the world’s population, the menopause is wrapped in taboo and has been disproportionately overlooked in health and research, with ageism and sexism contributing to a stigma around this critical turning point in a woman’s life.[iii] For dental practitioners, the menopause is important to note – highlighting the relationship between perimenopause and sleep deprivation can not only support patients at-risk from oral health complications, but it can also ensure an all-round healthier patient and break the stigma through effective communication.
Perimenopause problems
Perimenopause is experienced roughly 4-8 years before entering menopause, often for those aged in the early 40s but can also emerge in the mid-30s.[iv] This change sees the ovaries producing less oestrogen, disrupting the menstrual cycle. This limited production will eventually stop, leading to the menopause. The change in hormone levels can lead to many symptoms:
Fatigue
A low sex drive
Sudden shifts in mood
Depression
Vasomotor symptoms such as hot flushes and night sweats
Sleeping issues
Sleep disruption is one of the most common symptoms. Whereas 16-42% of women with no symptoms of perimenopause report problems sleeping, this increases to 39-47% for those with symptoms. For postmenopausal women, the range is 35-60%.[v] With insufficient sleep the body is unable to recharge, leading to daytime sleepiness and a lack of productivity. Constant fatigue can impact a patient’s work life and also bring them harm – tiredness is often the root cause of major accidents.[vi] Whilst there are many other factors to explain disrupted sleep, such as the back aches and joint pains associated with the menopausal transition, the fluctuations in hormone levels are a major contribution to a poor night’s rest.
A balancing act
One of the key disruptors is the imbalance between oestrogen and the stress hormone cortisol: low levels of oestrogen lead to higher levels of cortisol. Heightened stress then prevents the body and mind from relaxing, with low oestrogen levels also making it harder to stay asleep, impacting sleeping patterns. Similarly, higher levels of follicle stimulating hormone (FSH) is associated with greater odds of repeatedly waking up.[vii]
However, it has been identified that sleep alleviates perimenopause symptoms, with those achieving 6-9 hours of sleep showing improvements in hormone levels compared to those who only managed 3-6 hours.[viii] This highlights the importance of raising awareness on sleep management, perimenopause symptoms and overall wellbeing to patients. Dental practitioners can educate perimenopausal women on the relationship between diet and sleep by encouraging a diet filled with milk products, fish, fruit and vegetables for optimal sleep-promoting effects.[ix] Moreover, a healthy diet and regular exercise can reduce high levels of cortisol, improving sleep.
A perfect storm
A perfect stormBoth disordered sleep and the menopause have been linked to adverse oral health outcomes.
Xerostomia is one of the most commonly reported symptoms of the latter, with postmenopausal women experiencing decreased unstimulated and stimulated submandibular and sublingual salivary gland flow when compared to premenopausal patients.[x] This is not related to medication use.x The composition of the saliva may also change, with the literature noting an increase in calcium in the saliva of postmenopausal women, which provokes faster plaque mineralisation.x
Reduced salivary flow may mean debris is not moved from the dentition, and the encouragement of plaque mineralisation may contribute to increased bacterial irritation of the gingival tissue, alongside an elevated caries risk.x
Sleep disturbances exacerbate the issue, as inadequate rest has been correlated with a lower number of present teeth and increased periodontal disease. Fatigue induced by a lack of sleep can increase gingival inflammation,[xi] meaning patients must take active care to remove any controllable irritants such as plaque or interproximal debris.
Alongside twice daily toothbrushing, patients could use the Waterpik™ Cordless Advanced water flosser. It features 3 adjustable pressure settings, and removes up to 99.9% of plaque following a 3-second application.[xii] The Waterpik™ Cordless Advanced is also 50% more effective at improving gum health compared to traditional floss,[xiii] meaning fewer patients have to lose sleep over periodontal diseases.
The huge changes that menopause can cause demand greater research and awareness going forwards. Dental practitioners must grow their knowledge and skills in this area to offer treatments and management options that make a difference in alleviating symptoms. By doing so, consistent sleep and optimal health can be restored to affected patients.
For more information on WaterpikTM water flosser products visit www.waterpik.co.uk. WaterpikTM products are available from Amazon, Costco UK, Argos, Boots and Tesco online and in stores across the UK and Ireland.
Author: Annastasia Kellett Wright
Annastasia qualified as a Dental Hygienist and Dental Therapist from the University of Sheffield in 2013 and currently practices her full scope of practice with paediatric and adult patients in London. Annastasia has been a professional educator for Waterpik since 2016 and is actively involved with the British Society of Dental Hygiene and Therapists, acting as the trade liaison for their London regional group since 2015.
[i] Parliament.uk. (2024). Grey Britain. [online] Available at: https://www.parliament.uk/business/publications/research/olympic-britain/population/grey-britain/.
[ii] Parliament.uk. (2024). Grey Britain. [online] Available at: https://www.parliament.uk/business/publications/research/olympic-britain/population/grey-britain/.
[iii] Tate, J. (2023). The silence surrounding menopause is putting women’s lives at risk. [online] The Health Policy Partnership. Available at: https://www.healthpolicypartnership.com/the-silence-surrounding-menopause-is-putting-womens-lives-at-risk/.
[iv] Pelc, C. (2024). More sleep may improve perimenopause symptoms caused by low estrogen. [online] Medicalnewstoday.com. Available at: https://www.medicalnewstoday.com/articles/more-sleep-improve-perimenopause-symptoms-low-estrogen.
[v] Kravitz, H.M. and Joffe, H. (2011). Sleep During the Perimenopause: A SWAN Story. Obstetrics and Gynecology Clinics of North America, [online] 38(3), pp.567–586. doi:https://doi.org/10.1016/j.ogc.2011.06.002.
[vi] Health and Safety Executive (2022). Human factors/ergonomics – Fatigue. [online] www.hse.gov.uk. Available at: https://www.hse.gov.uk/humanfactors/topics/fatigue.htm.
[vii] Baker, F.C., Lampio, L., Saaresranta, T. and Polo-Kantola, P. (2018). Sleep and Sleep Disorders in the Menopausal Transition. Sleep Medicine Clinics, 13(3), pp.443–456. doi:https://doi.org/10.1016/j.jsmc.2018.04.011.
[viii] Pelc, C. (2024). More sleep may improve perimenopause symptoms caused by low estrogen. [online] Medicalnewstoday.com. Available at: https://www.medicalnewstoday.com/articles/more-sleep-improve-perimenopause-symptoms-low-estrogen.
[ix] St-Onge, M.-P., Mikic, A. and Pietrolungo, C.E. (2016). Effects of Diet on Sleep Quality. Advances in Nutrition, [online] 7(5), pp.938–949. doi:https://doi.org/10.3945/an.116.012336.
[x] Ciesielska, A., Kusiak, A., Ossowska, A., & Grzybowska, M. E. (2021). Changes in the oral cavity in menopausal women—a narrative review. International journal of environmental research and public health, 19(1), 253.
[xi] Muniz, F. W. M. G., Pola, N. M., e Silva, C. F., da Silva, F. G., & Casarin, M. (2021). Are periodontal diseases associated with sleep duration or sleep quality? A systematic review. Archives of Oral Biology, 129, 105184.
[xii] Gorur, A., Lyle, D. M., Schaudinn, C., & Costerton, J. W. (2009). Biofilm removal with a dental water jet. Compendium of continuing education in dentistry (Jamesburg, NJ: 1995), 30, 1-6.
[xiii] Rosema, N. A., Hennequin-Hoenderdos, N. L., Berchier, C. E., Slot, D. E., Lyle, D. M., & van der Weijden, G. A. (2011). The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol, 13(1), 2-10.
