OpenHealth Q&A

Persistent Oral Lesions: Seeking Answers

My spouse, a 34-year-old woman, has been struggling with recurring oral ulcers for the past seven to eight years. These painful lesions emerge intermittently, typically appearing one to two times each month, particularly during her ovulation or the luteal phase of her menstrual cycle. The lesions typically manifest as shallow, white ulcers, bordered by a reddish area, and can be located in various sites including the back of her throat, her tonsils, and occasionally the roof of her mouth, although her tonsils remain unaffected in terms of swelling. Each episode brings significant discomfort, often accompanied by a mild sore throat, a stinging sensation, and heightened gum sensitivity. There are instances when these ulcers are accompanied by fatigue and a low-grade fever or chills. **Additional Health Context:** My wife has been managing ulcerative colitis (UC) for around a decade, taking Mesalamine daily to help control the condition. Fortunately, the typical UC symptoms are absent, but they sometimes coincide with her ulcer flare-ups, for example, occurring just two days following an otherwise successful colonoscopy. Additionally, she has polycystic ovary syndrome (PCOS) and is actively working on mitigating its effects through dietary and lifestyle changes. Her latest blood tests showed normal levels for androgens, testosterone, and estrogen, while her menstrual cycle remains consistent. However, it is possible that hormonal fluctuations could be influencing the timing of her oral lesions, given their correlation with her ovulation. When these ulcers arise, they usually last from one to one and a half weeks. Importantly, I have never contracted these lesions myself, nor have any of the close contacts she interacts with regularly. Blood tests show the presence of Epstein-Barr Virus (EBV) antibodies, but there is no active infection, and she has never experienced mononucleosis. Throughout this journey, she has consulted various specialists including several ENTs, her gastroenterologist, general practitioner, and a functional medicine doctor. Despite their efforts, a concrete diagnosis has not been reached, though a few potential explanations have been proposed: - **ENT Opinions:** Some ENT specialists believe the lesions may be associated with her UC. One doctor performed a biopsy, testing for pemphigus, but the results were inconclusive, classified as "non-specific background" with some surface epithelium absent, which hindered a thorough evaluation. - **Gastroenterologist Insights:** Her gastroenterologist suggested the possibility of latent virus reactivation as a result of immune system fluctuations, noting that some patients in similar situations have transitioned to biologic therapies, although he did not specify which viruses or indicate whether medication adjustments might help. - **General Practitioner Assessment:** Testing for sexually transmitted diseases was ruled out, based on the lesions' characteristics and her complete history of STD testing. **Current Treatments:** She is currently taking a variety of medications and supplements, including Mesalamine, low-dose naltrexone (to combat inflammation), vitamin D with K2, a B complex, berberine, fish oil, aged garlic, inositol, pumpkin seed oil, and saw palmetto. Notably, her use of Mesalamine began before the onset of these oral lesions, while the other treatments have been introduced subsequently after enduring years of recurring ulcers. We are reaching out for insights about what these symptoms might signify and what steps we should potentially take next. We're in ongoing discussions with her doctors, but the disruption caused by these episodes is substantial, and we are eager to explore additional viewpoints or recommendations.

Answers (1)

8/20/2025, 2:40:59 AM

OpenHealth AI

It sounds like your spouse is experiencing a challenging and frustrating situation with her recurring oral ulcers, which can be quite painful and disruptive. The combination of her history with ulcerative colitis (UC), polycystic ovary syndrome (PCOS), and the possibility of immune system fluctuations is certainly complex. Understanding the nature of these symptoms and exploring actionable steps is important.

Summary of the Situation

1. Recurring Oral Ulcers: Painful lesions appearing intermittently correlate with hormonal changes in her menstrual cycle.
2. Underlying Conditions: She has ulcerative colitis and PCOS, both of which can influence immune response and health.
3. Previous Evaluations: Multiple specialists have not pinpointed the cause, and while some possibilities were raised, a conclusive diagnosis remains elusive.

Explanation

Oral ulcers can stem from several factors, especially in individuals with underlying health conditions like UC and PCOS. The lesions could be:

• Aphthous Stomatitis (canker sores): Common and often linked with stress, hormonal changes, or nutritional deficiencies.
• Inflammatory Manifestations: Related to UC or other autoimmune processes, potentially exacerbated by hormonal fluctuations.
• Infection or Reactivation of Latent Viruses: Such as those associated with EBV, though it seems no active infection is present.

The recurrent nature of these ulcers, along with her systemic symptoms (fatigue, low-grade fever, chills), is concerning and warrants a thorough investigation.

Next Steps

Here are some prioritized, actionable steps to consider:

1. Consult an Oral Medicine Specialist: If not done already, seeing a specialist in oral medicine or a dermatologist familiar with oral conditions could provide new insights and management options.

2. Nutritional Assessment: Assess her diet for potential deficiencies (e.g., Vitamin B12, iron, folic acid) as deficiencies can contribute to the formation of ulcers.

3. Stress Management Techniques: Since stress can exacerbate ulcerative conditions, consider incorporating stress-reduction techniques such as mindfulness, yoga, or other relaxation strategies into her routine.

4. Monitor Symptoms: Keep a detailed diary of her symptoms, noting the timing in relation to her menstrual cycle, dietary intake, stress levels, and any new medications or supplements to identify patterns which can be shared with her healthcare team.

5. Consider Medications Adjustments: Discuss with her gastroenterologist the possibility of adjusting her medications or introducing biologic therapies that could target underlying inflammation more effectively.

6. Explore Immune Support: With the suggestion from her gastroenterologist about immune system fluctuations, it might be worth exploring therapies that support immune health or target specific pathways involved in ulcer formation.

Additional Considerations

• Hydration and Oral Hygiene: Encourage her to stay well-hydrated and maintain good oral hygiene, including using a mild mouthwash without alcohol to avoid further irritation during flare-ups.
• Regular Follow-ups: Ensure she maintains regular communication with her healthcare providers, particularly specialists focused on her conditions.

Navigating through these symptoms can be overwhelming, but you’re taking the right steps by seeking additional insights and remaining proactive in addressing her needs. Monitoring and adjusting based on responses to these recommendations will be key in managing her symptoms. Please feel free to share any further details or questions as they arise.