Why that burning feeling in your tongue isn’t “just in your head”, and how it might connect to midlife changes

The more women I speak with, the more I hear stories of symptoms that arrive quietly — often in perimenopause or post-menopause — and leave women wondering what’s going on. One symptom I didn’t expect to experience myself was a burning sensation in my tongue, painful enough some days to last for days.

At first, I didn’t connect it with menopause. In fact, there’s no definitive evidence that menopause directly causes burning tongue. But this symptom — often referred to clinically as Burning Mouth Syndrome (BMS) — is more frequently reported in middle-aged and post-menopausal women and can overlap with other oral issues such as ulcers and nutrient deficiencies (Dahiya et al., 2013).

In this article I’ll break down what the research says, how it might connect with other midlife changes like sleep and nutrition, and practical steps you can explore with your clinician.

What Is “Burning Tongue” and Burning Mouth Syndrome?

Burning Mouth Syndrome (BMS) is a medically recognised condition characterised by a burning, scalding, or achy sensation in the tongue or other parts of the mouth that occurs without visible signs of injury or disease. This means the mouth can look normal on examination, even when the pain is real (StatPearls, 2023).

Key points about BMS:

It often feels like your tongue or mouth is on fire even though there’s no visible lesion.
It can come and go, or linger for days — as I experienced.
It’s more frequently reported in women in midlife (Dahiya et al., 2013).

Although menopause is often part of the conversation, the research has not proven menopause as a direct cause — rather, it’s part of a broader constellation of factors that may make symptoms more likely during midlife.

Why Does This Seem to Show Up in Midlife?

There isn’t a single proven mechanism, but research points to several contributors that often change around perimenopause and menopause:

1. Nervous system changes

Many studies show that BMS has features of a neuropathic condition — meaning nerves that detect pain and sensation in the mouth may become more sensitive or dysregulated (StatPearls, 2023).

2. Salivary changes

Saliva plays a big role in mouth comfort and oral tissue health. Some research suggests salivary flow may reduce in menopausal women, which can contribute to discomfort (StatPearls, 2023).

3. Micronutrient status

Deficiencies in certain nutrients — especially vitamin B12, iron, folate, zinc and vitamin D — are commonly found in people with burning mouth symptoms. Some of these same deficiencies are also linked with oral ulcer formation (Morr Verenzuela et al., 2017; Chiang et al., 2018).

4. Sleep and stress

Poor sleep is common in midlife and in people with chronic pain symptoms. Sleep disruption can amplify pain perception and reduce healing capacity (Lee et al., 2018).

5. Psychological and emotional factors

Anxiety and stress can heighten nerve sensitivity and symptom awareness, though they are not the root cause of BMS.

Burning Tongue and Oral Ulcers: Are They Connected?

For me, burning tongue often appeared alongside oral ulcers, which led me to wonder whether these symptoms might be connected.

The short answer is, not directly, but they can have common contributors.

What connects them

Both burning sensations and recurrent oral ulcers (aphthous ulcers) are associated with:

Micronutrient deficiencies — particularly iron, B12, folate and zinc (Volkov et al., 2007)
Immune and mucosal health — oral tissues may be more sensitive when nutrient reserves or barrier function are compromised (Chiang et al., 2018)
Systemic contributors that affect gut absorption or chronic inflammation

These shared elements mean it’s worth looking at similar blood tests if you’re experiencing either or both symptoms.

How they differ

Ulcers are physical sores you can see and usually have a visible healing cycle.
Burning Mouth Syndrome usually happens in a mouth that looks normal on exam.

Still, the underlying terrain — especially nutrient status and inflammation — can overlap.

Sleep & Hormones: A Role in Sensation?

While hormones are often discussed in midlife symptom contexts, it’s important to keep the evidence clear:

Hormonal changes during perimenopause and menopause influence many body systems, including stress responses, sleep regulation and mucosal tissues (Dahiya et al., 2013).
No research has proven declining oestrogen directly causes burning tongue, but menopause fits into a period of broader physiological change that can make symptoms more noticeable or persistent (Dahiya et al., 2013).
Sleep disruption, very common during the menopause transition, can amplify pain perception and discomfort, making any oral symptom feel worse (Lee et al., 2018).

Practical Steps You Can Take (with Your Clinician)

Here’s how you might explore this symptom more intentionally:

1. Rule out treatable contributors

Discuss these tests with your GP:

Full blood count & ferritin (iron stores)
Vitamin B12 & folate
Zinc and vitamin D (if indicated)
Thyroid function and blood glucose

These can uncover deficiencies or systemic drivers that may contribute to mouth discomfort (Morr Verenzuela et al., 2017).

2. Look at oral health support

Chew fibrous foods (apples, carrots) to stimulate saliva
Sip water regularly
See a dentist to rule out local irritation or infection

3. Work on sleep and stress

Better sleep hygiene, stress reduction practices and circadian support can reduce pain sensitivity and improve quality of life.

4. Nutrition first

If you suspect limited intake of key nutrients (e.g., plant-based diet without supplementation), discuss tailored nutrition support with your clinician or dietitian.

A Coaching Perspective

If you’re living with a burning tongue sensation that lingers for days at a time, here’s what I want you to know:

✨ You’re not alone
✨ There are measurable things to investigate
✨ This symptom doesn’t mean you’re imagining it
✨ A whole-body lens helps you understand it better

When symptoms don’t have a clear visible cause, exploring connections like nutrient status, sleep quality, stress, and systemic health can make a difference.

Conclusion — What We Know (and What We Don’t)

We know:
✔ Burning Mouth Syndrome is real and can be painful
✔ It’s more commonly reported in midlife women
✔ Nutrient deficiencies, nervous system factors, sleep and stress play a role
✔ There’s overlap in how burning tongue and ulcers connect to body systems

We don’t yet know:
✘ A direct, proven causal link between menopause and burning tongue
✘ A one-size-fits-all explanation for why it happens

But because this often shows up in midlife, it deserves attention — not dismissal.

Feeling your best in midlife starts with taking responsibility for your health. The more you learn about supporting yourself, the stronger and more energised you’ll feel.

Further Reading