Hormonal Imbalance May Raise Risk of TMD and Headache in Women With PCOS

Women represent a disproportionate share of people with temporomandibular disorder (TMD), making up more than 80% of cases.1 Interestingly, the incidence of TMD among women declines dramatically after menopause,2 raising the question: what role do hormones play in the pathogenesis of this disorder?

After reading a report that noted that 76% of patients with polycystic ovary syndrome (PCOS) had symptoms of TMD and headaches,3 two researchers decided to put together a case series to better elucidate the connection.

The investigators presented 3 cases that were referred to the clinic for the evaluation of anterior temporal and retrobulbar headaches, as well as musculoskeletal head and neck pain.4 A clinical examination was consistent with findings associated with TMD and trigger points. Magnetic resonance imaging and computerized tomography scans revealed degeneration of the intracapsular tissues and articular cartilage in the head of the mandibular condyle.

In addition to TMD, the patients had been previously diagnosed with PCOS and were being treated medically, including hormonal contraception. None of the patients had the typical triad of PCOS—hirsutism, anovulation, and obesity.

All three women were normal weight, and had various signs of PCOS including acne, pelvic pain, and ovarian cysts. All three had a history of headaches since their mid-teens.

In all three cases, advanced imaging confirmed symptoms of TMD—synovial tissues thickening, dislocations, and damage of the articular discs.

TMD was treated with an oral appliance used to “upload the temporomandibular joint, decrease muscular hyperactivity, and decrease the myofascial symptoms—including headache,” the researchers reported.

Proper design and manufacturing of an oral brace, also know as mutually protected occlusion (MPO) splint, combined with physical therapy for muscular symptoms, reduced pain and improved the quality of life of patients with PCOS. Patient’s pain levels improved from an average of 10 out of 10 to 2 out of 10.

The collaboration between dental and medical clinicians was essential for the diagnosis and management of these patients. “It is important for both dentist and physicians to be aware of the high association between headache, TMD and PCOS,” the researchers stressed. “Early recognition and management can vastly improve patient outcomes.”

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