Estrogen Status and Temporomandibular Disorders: A Systematic Review

Area of Science:

• Reproductive Endocrinology
• Oral and Maxillofacial Surgery
• Women's Health

Background:

• Temporomandibular disorders (TMDs) disproportionately affect women, suggesting a potential role for estrogen.
• Existing evidence linking estrogen status to TMD prevalence and severity is inconsistent.
• Understanding these hormonal influences is crucial for women's health.

Purpose of the Study:

• To systematically review the association between estrogen-related factors and TMD prevalence and clinical presentation in women.
• To synthesize current evidence on hormonal contraceptive use, menopausal status, menstrual cycle, pregnancy, and estrogen receptor polymorphisms in relation to TMD.

Main Methods:

• Comprehensive literature search across major databases (PubMed, Embase, Scopus, Web of Science, Google Scholar) up to September 2025.
• Inclusion of observational studies evaluating specific estrogen-related factors in women with TMD.
• Independent data extraction and risk-of-bias assessment, followed by narrative synthesis due to heterogeneity.

Main Results:

• Seven studies (2735 participants) were included, with moderate-certainty evidence linking hormonal contraceptive use and menopausal status to increased TMD risk or severity.
• Low-certainty evidence suggested associations with menstrual cycle variation, pregnancy, and estrogen receptor polymorphisms.
• Significant heterogeneity in hormonal exposure definitions and diagnostic criteria was noted.

Conclusions:

• Hormonal factors appear to play a role in the risk and presentation of TMDs in women.
• Definitive conclusions are limited by heterogeneity in study definitions and diagnostic criteria.
• Future research requires standardized protocols and validated hormonal assessments for clearer insights.