Can Hormones Affect Facial Pain?
Some women experience a change in their facial pain at various points in their menstrual cycles, when taking or stopping hormonal methods of birth control, during perimenopause, or in menopause.
For some women, the onset or peak of facial pain may coincide with perimenopause or menopause. This may indicate a period of vulnerability of the trigeminal pain system during these times. This may be because the trigeminal pain system has been adapted to the active, robust female cycle, cycling levels of female sex hormones, in a stable monthly rhythm. When this rhythm starts to become irregular and ceases, this may make the trigeminal system more vulnerable. Change of hormonal levels by stopping or starting birth control may facilitate such a process.
This does not mean that such hormonal changes during the life cycle of a woman are sufficient to elicit trigeminal pain – obviously that is not the case. But it might explain the typical clinical observation of an extensive trauma to the trigeminal pain system, such as operative dentistry including root canal, or cranio-facial trauma precipitating an ongoing trigeminal pain syndrome in women who were subject to these hormonal changes. This may be likened to the “multiple hit hypothesis” which is a speculation that chronic diseases may result from a combination of genetic and environmental factors.
Cells that are part of or contribute to the trigeminal pain system express functional receptors for female sex hormones. These cells’ function changes in response to activation of the sex hormone receptors by the cognate hormones. Important changes how the sex hormone receptors influence the cells that express them can also be evoked by fluctuations of the hormonal levels. Facial pain is not only rooted in nerve cells, such as the primary sensory neurons in the trigeminal ganglion. These nerve cells have support cells, and they are “plugged in” into the trigeminal sensory system within the brainstem and brain. In the periphery, e.g teeth, tongue, sinuses, eyes, cheeks, scalp etc., the trigeminal sensory nerve cells can be influenced by inflammatory cells, connective tissue cells, and others. These cells can be influenced in critical manner by sex hormones as well, for example immune cells.
FPA recommends that you speak with your family physician, neurologist and/or gynecologist before making any changes to your birth control method, hormonal replacement medication, or medications for your facial pain.
Related studies:
Ovarian steroids regulate neuropeptides in the trigeminal ganglion.
Puri V, Cui L, Liverman CS, Roby KF, Klein RM, Welch KM, Berman NE.Neuropeptides. 2005 Aug;39(4):409-17. doi: 10.1016/j.npep.2005.04.002.PMID: 15936815
Puri J, Bellinger LL, Kramer PR. J Cell Physiol. 2011 Dec;226(12):3169-80. doi: 10.1002/jcp.22671.PMID: 21321935
Association between female hormonal factors and oro-facial pain: study in the community
T V Macfarlane 1, A S Blinkhorn, R M Davies, J Kincey, H V Worthington
