At Gennev HQ, we joke that Burning Mouth makes us think of Burning Man. 

It’s not funny though: if you’ve ever gulped too-hot coffee or bitten into a pizza fresh out of the oven, you know the serious pain of a burnt tongue.

And for some of us, this sensation happens without any known cause or injury.

If you feel like you’ve scalded your mouth and just can’t remember when or where, it may not be midlife brain fog: there really might be something going on, even if you (or your doctor) can’t pinpoint the source.

It’s called Burning Mouth Syndrome (BMS) and, for some reason, people in perimenopause are more likely to experience this affliction.

What is Burning Mouth Syndrome?

BMS is, in medical terms, a “chronic orofacial pain disorder.” 

BMS symptoms include feelings of burning (hot, tingling, and painful), other paresthesia (abnormal sensations of the skin, like prickling, tickling, chills, or numbness), and pain inside the mouth without an obvious lesion or injury.

Most sufferers feel pain on the front part of the tongue, but the roof of the mouth, palate, gums, lips, and other tissues may also be affected.

People with BMS may also experience dry mouth, sensitivity to certain foods, and strange tastes.

While some infections, medications, diseases, nutritional deficiencies, dental work, or psychological conditions are known to cause these symptoms (called secondary BMS), primary BMS is idiopathic: there isn’t a discernible cause. A third type may stem from an allergy to certain preservatives

For sufferers with primary BMS, pain typically gets worse over the course of a day; people may feel fine when they wake up, and the discomfort peaks in the evening. With secondary BMS, the pain remains consistent.

We don’t know why primary BMS happens, but research suggests that it’s possibly due to nerve fibers malfunctioning, potentially those in the back of the head or in the front of the tongue.

Overall, Europeans are more likely to experience BMS than Asian or American residents (7% prevalence vs. 2-3% and 0.7%, respectively).

Anyone can get BMS but because a disproportionate percentage of sufferers are perimenopausal women of all races and backgrounds, experts suspect that hormonal changes are be involved. Depending on who you ask, anywhere from 10% to 40% of menopausal women may experience BMS, though different diagnostic criteria are not well-defined.

This hormonal tie-in does make sense: like your genitals, the mucous membranes in your mouth have sex hormone receptors, and we know that decreases in estrogen around menopause can lead to both decreased saliva production and the periodontal issues associated with dry mouth.

Other potential causes or links to BMS include oral parafunctions (like clenching your jaw or grinding your teeth), an allergy to dental materials, diabetes, vitamin B, folic acid, or iron deficiencies, gastrointestinal diseases, psychiatric and neurological disorders, or pharmaceutical side effects.

In up to a third of cases, multiple causes are suspected.

Great. So what can I do about my BMS?

Like many benign conditions, BMS won’t kill you, but it can make your life miserable. The discomfort can disrupt your sleep, make it difficult to eat, and lead to anxiety and depression.

The bad news is that treating BMS is mostly managing symptoms. The good news is that you have options. 

See your doctor and your dentist! They’ll want to rule out all other potential causes, like some anti-depressants (dry mouth), Alzheimer’s, Parkinsons, or hypothyroidism (change in taste), lichen planus (sores) or a yeast infection (redness). Experts recommend examination of teeth, mouth, temporomandibular joint, and dentures (if applicable), as well as a full blood count, tests for folic acid, iron, B vitamins, sex hormones, and blood sugar and swabs for oral bacteria.

Fight fire with fire. Believe it or not, spicy foods can actually help BMS: capsaicin (the compound that makes hot peppers hot) can disable the pain-signaling chemicals in nerve cells. You can buy capsaicin oil over the counter or you can put a few drops of Tabasco sauce in a teaspoon of water and swish this around in your mouth. Too good to be true? Menopause Goddess Lynette Sheppard swears by capsaicin.

Manage stress. The relationship between stress and BMS and other chronic disorders is a little bit of a chicken-and-egg situation. Does your BMS cause stress, or does stress cause BMS? Regardless, stress is bad for your health. Yoga, meditation, exercise, psychotherapy, and cognitive-behavioral therapy have been shown to lessen BMS discomfort.

Try alpha-lipoic acid (ALA). Your body naturally produces this antioxidant, and it’s also found in foods like tomatoes, potatoes, and spinach. ALA promotes the production of nerve growth factor and is typically used to treat diabetic neuropathy and other nerve issues — potentially including BMS. While studies suggest improvement in BMS symptoms compared to placebo, more research is still needed. 

Hormone replacement therapy. We’ve written many times before about our stance on hormone replacement therapy. If this is something that works for you and your doctor, hormone replacement therapy can help BMS.

BMS is no picnic, but you have support and choices in how you manage it. Talk with one of our menopause-specialist doctors about your options for controlling your menopause symptoms via Gennev's telemedicine service

Do you suspect you may have primary or secondary BMS? We’d love to hear about your experience in our Gennev Community forums.