Surprising Changes in Estrogen Use

Hi everybody, I'm Dr. Sanda Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body as we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most in a natural way. Welcome everyone to another episode on the Holistic Dentistry Show. Today I'd like to discuss what's new and the latest in women's health. We have some very big news a couple of days ago, and with me today is Dr. Christina Masinople, who is going to help me decipher what was the news and what can we do about it. Let me tell you just a little bit about Dr. Masanople. She has over 25 years of clinical experience, combines her background in conventional medicine with advanced training in nutritional and lifestyle medicine to help high-performing women, such as myself, uncover and address root causes of their health challenges. So thank you so much, Dr. Christina, for being on our show today.

Thank you so much. I'm so happy to be here, Dr. Sanda.

I'm happy to have you here. Not just because, you know, you're a friend and you've helped me with some of my recent, uh, gut health issues, but, uh, really because you bring so much experience in this world of women's health. And I want to start with people getting to know you. What led you on the path of functional medicine? Because I'm sure at some point, just like all of us, you were a traditional doctor.

Exactly. So I'm a traditionally trained internal medicine doctor. And I really worked in the ER for about 15 years, ERs and urgent cares for about 20. And in that time, I discovered that I would see the same people over and over again. I felt like I was putting Band-Aids on bullet wounds. I was like, I was constantly just giving them something that will hold them off for a little bit, and then they would come back. And I really knew that we weren't truly creating health. So what I sought out to do was to really open my own practice that incorporated nutrition. And in doing so, I found the Institute for Functional Medicine. Started my training about 10 years ago and opened my functional medicine practice, CMASMD.

Amazing. Do you remember like what was like one memorable experience early in your functional medicine that really said to you, oh my God, I'm on the right path, or this was amazing?

Oh, absolutely. I mean, it was happening left and right. My first few patients that came in and I started with the basics, which as you know, is gut health. It is nutrition and gut health. That so many things were getting better. Autoimmune disease was getting better. I reversed somebody's lupus and I was like, oh my goodness, this is the first time I've seen this. You do not have a positive ANA anymore. And it was things like that. And it happened over and over. And I learned so much from my patients that the dietary changes make huge differences in their lives. And sometimes you don't realize— people think they're doing the right thing and they think they're eating healthfully. But you and I know we grew up with the Standard American Diet, which is the SAD diet, and called that for a reason, because it could be be the most inflammatory diet.

Yes.

That we've ever had. And so, so, so many thought they were eating the right thing and it was not nutrient-dense for their body. And people got used to processed foods, didn't know they were unhealthy because they make them look healthy.

Yeah, absolutely. So let's start with the big news this week. Can you explain the recent FDA decision to remove the black box warning from estrogen? And why is this such a major movement in women's health?

Okay. This could be the biggest monumental decision and not just the decade, probably in the last 100 years. So really, you know, the shift in women's health that is gonna happen from this is going to be huge. So for those of you who don't know, this black box warning has been on it for the last 23 years, and it stemmed from the Women's Health Initiative from 2002. So that study showed an increased risk of blood clots, cardiovascular disease, stroke, and invasive breast cancer with combination hormone therapy. Sounds pretty scary, right?

Was that, was that, uh, synthetic hormones that they were looking at then?

So that's the issue. These are the synthetic progestins and the conjugated equine estrogens, which we're not using today.

Mm-hmm.

So, but that information immediately hit the media before all the facts were out. So once that happened, like the damage was already done. And then in 2003, FDA put the black box warning on all estrogen-containing therapies, not just the, the synthetic estrogens and progestins that were used in the study.

I see. Wow.

Yes.

So basically what did that do to, to women who were taking like bioidentical hormones or like it made women afraid to take estrogen?

100%. So there was this trickle effect. So it wasn't just the women that were afraid, patients were afraid. Doctors started becoming afraid. They were like, oh my gosh, I'm gonna pull everybody off of their hormone therapy. It's causing cancer. So they pulled patients off of it. They actually, you know, and of course I love your cat. And of course all of the, all of the women were scared about it. And the other thing that happened, which has impacted many, many years of generations to come, is that our medical students were not taught how to treat menopause and perimenopause. They had no idea what to do because there was no treatment, right? Because it was too too dangerous. Mm-hmm.

Wow.

So that impacted a lot of people with symptoms of perimenopause, menopause.

They probably just get dismissed.

Absolutely. So they were dismissed and it really instilled this sense of fear in everyone. And so they weren't sure what they were supposed to do.

So, so why the change of heart now? All of a sudden the FDA, uh, reversed that or removed it.

Well, so they finally actually acknowledged that they got it wrong. Exactly. And so that, you know, the new research has shown that our newer bioidentical hormones are safe, not just safe, they're life-changing, they're life-saving for women. So the fact that we denied— we're talking about 60 million women that were essentially denied being able to use a life-saving therapy.

Amazing. Wow. So the question is, can this damage be undone fully?

Well, and you know, and that's a big question. So, you know, there has been, as you know, there is a big paradigm shift going on right now. And, you know, not just about women's health, but just creating our own health in general. And so you and I are part of this movement. It's why we do what we do, and it's about creating your own health. So I find that not only are those of us in the integrative and functional medicine world really coming together and more and more traditionalists are coming to join us now. And, you know, even if they're not— don't get certified in functional medicine, they are still very curious and they're wanting to learn about hormone replacement therapy from those who've been doing it for the last 20 years, despite the fact that there was this black box warning because we knew better.

So is it safe to do bioidentical hormones? Is there a risk of cancer with bioidentical?

So actually there is a decreased risk of cancer with bioidentical hormones. They have shown that with the correct types, right, of bioidentical estrogens and pro— progesterone, not progestins that were used, there is a decreased risk of breast cancer, not just breast cancer. There's a decreased risk of colon cancer.

Wow.

So really bioidentical hormones have been shown. I mean, the, the benefits are— go far and wide. So it's not just those cancers. It is decreasing the risk of cardiovascular disease in women. So as you know, and maybe, you know, I'm not sure if you do that, that is still the leading cause of death in women. It's not breast cancer, it's cardiovascular disease. Wow. And so they have found that hormone replacement therapy decreases the risk by almost 50, 5-0%.

That's incredible.

Huge. Huge.

So basically, how early should women start getting tested to see if they're a candidate for bioidentical hormones?

Well, so there is this time period and it can range, but you know, even 10 to 15 years in the perimenopausal period before you actually are diagnosed as menopause. So menopause is not having a period for a year prior. So really all of, you know, all of the symptoms start, start much before that. And everybody's different. Could be 5 years before, could be 10 years before, but is this massive fluctuation of hormones, usually the progesterone drops first, this testosterone starts dropping, estrogen starts going up and down wildly. So that's why women start having so many symptoms and mood swings and anxiety and sleep disorder, which then causes more brain fog. And, you know, it's this vicious cycle.

Yeah. What are the most overlooked symptoms or, or ripple effects of imbalances that women experience during perimenopause and menopause?

Yeah. So, you know, there are estrogen receptors throughout our entire body. And so it's not just about the vasomotor symptoms that we're, we're most used to hearing about. So women having hot flashes, night sweats, all of that. So that's just one little piece of the puzzle because again, estrogen receptors are across our entire body. So it causes blood sugar instability. It causes gut dysbiosis or an imbalance of the gut microbiome. As we know, it also causes brain fog and cognitive decline. In women. It can also cause elevated cortisol to happen, which of course then disrupts sleep even more. And it becomes this wonderful vicious cycle that women have during this time period. And so not only that, there's changes in collagen, there's changes in our tissue integrity, there's changes in bone turnover. So there is, you know, there are multiple effects, ripple effects that occur if we don't really address the hormones at an early age.

Amazing to me how many symptoms we can have just from like a drop in estrogen. Oh, and progesterone, not, not just estrogen.

Right.

Now, most people don't connect hormones with oral health, but, uh, you know, I know as a periodontist that we have estrogen receptors in the gums, but how else can estrogen specifically impact the mouth, the gums, and the jawbone? Would love to chat about that a little bit.

Yeah. You know, definitely. So again, you know, it's this estrogen decline that can impact our bone health too. So think of the jawbone, right? So you can have problems with the teeth because of the decreased density in the jawbone. So that's one thing, but also, you know, we know our collagen production decreases, so it affects the oral mucosa and it also affects the gums.

Mm-hmm.

As well as decreases salivary flow. So when you decrease salivary flow, as you know, that kind of sets up, you know, not just dry mouth, but then you can have an oral microbiome dysfunction as well. So it leads to more pathologic bacteria potentially. So, you know, it's really, it's this kind of combination of things that can impact oral, oral health, gut health, and just full systemic health.

I'm so glad you're bringing this up because we have a lot of women, not just in our practice who are coming, a lot of women over 40 and over 40 could already be in perimenopause that are starting to complain of dry mouth, of thinning of the gums. 'Cause you said, you mentioned that, you know, the collagen thinning, not just in the face and the hair, but also in the gums that can cause more gum recession.

Yes.

And we also have women that are actually complaining of something called burning mouth syndrome. So that can actually be starting hormonal change, correct?

100%. 100%. So if you think about it, you know, the oral mucosa, let's compare it to the vaginal mucosa because we know what happens during perimenopause and menopause also with sexual function. And you know, like estrogen is a lubricant. It helps to lubricate all kinds of areas. So, you know, again, it affects the saliva. Salivary flow, and it also affects lubrication for sex as well. So it is, you know, it is a diffuse problem. And we know that burning mouth syndrome is definitely a potential sign that somebody could be— you just need to start looking for it. You need to ask some questions, you know, could this be the perimenopausal period showing itself in the mouth?

I know there's different ways to test. People listening might be wondering, oh, is there something I could test at home? Or do you recommend to actually be done through a functional medicine doctor?

Well, you know, ideally you wanna see a provider who's gonna look at the whole person. You know, testing is part of the picture. So I do like our traditional serum tests, but I also like to look at other testing that can look at saliva and urine because that tells us about the metabolites of the hormones. It also lets us know what pathway you go down. How are you breaking down your estrogens? We want you to use and lose estrogens in a certain way, and it has to do with detoxification. And I know, again, that's gonna be a podcast in and of itself. I think you and I can talk about detox for a very long time. And estrogen has everything to do about that too.

Amazing. Yes, yes, absolutely. So super important. I actually started checking my hormones when I turned 30, and mostly because I read a book by Suzanne Somers. I forgot the name of the book, but, you know, I don't know. Do you know that book?

And basically, I know which one you're referring to, but I cannot remember the name of it either.

So she was the one who actually brought this to the general public saying, hey ladies, check your hormones early to get a baseline to see where you're at. So that way we can see how, you know, when it's, it's starting to drop so we can maintain the levels that, for example, I was at, at 30.

Right. 100%. And it's very important to start looking that early. And we find that this is a little bit of a different topic, but we know infertility is becoming more of a, a bigger problem than it ever has before. And a lot of it does have to do with hormones. Obviously, it has to do with a lot of other things too. And toxins are a big factor in that as well. So really looking at it early on, if there's anything that seems to be off, and again, you know, I love our conventional medicine doctors, but they kind of don't think about the entire picture. A lot of times, you know, I know because I was taught the same way and we kind of think in this box. So we don't, we don't like connect all of the dots. So that's what we do differently in functional medicine. Because it's not just about one specific thing and you've got to look at the whole person and how it all interacts.

Can toxins, uh, affect hormone levels?

Yes. So toxins definitely can. And one of the biggest toxins out there that has been an issue for women and men alike actually is BPA. So bisphenol A, you've probably talked to your patients about that too and try to avoid it because It is a xenoestrogen, so it acts like an estrogen in the body.

Yeah. So actually, you know, uh, BPA is— some of the white fillings in dentistry have BPA. So, uh, highly recommend for those of you listening, if you're going to go and replace some fillings with other white fillings, just make sure that you ask your dentist, are these BPA-free?

Absolutely. And it's really interesting. So even in the health profession, in my health profession, when I worked in the ER and ran EKGs on people, handling EKGs all the time, well, guess what else has BPA on it? Thermal paper. Oh, like EKG paper. And it's the receipts when you get it from the grocery store. So really, it actually will get into— onto your skin and absorb into your skin. So we get BPA that way.

Wow. That's incredible. And plus the plastic bottles, you know, sitting in the sun that are cooking, they're releasing BPA in the water.

That's hilarious. Yeah, 100%. And so it's really, there's so many things, you know, and toxin again, toxins are its own kind of topic of discussion because there are specific things that we can do, very easy things that we can do every day that will decrease our toxic load. Cause it's really about that load. Certain things we can't control, but certain things we can.

Yeah, absolutely. Now, how do you work with, you work with women, uh, you know, they're high-performing women. What do you start? Somebody comes in with symptoms. Do you start with all the tests at once or? Start with nutrition.

You know, I don't, that's a little overwhelming. So, you know, I want to do a test when I am looking for something in particular. So really at the beginning, I have to clear the slate. So you've heard me say it before, but really it's about take, going back to the basics, getting on an anti-inflammatory diet, healing the gut, because there is not one person I have seen in my clinic, including myself, who does not have a gut permeability issue and a dysfunctional gut. You know, we all, we live in an industrialized world where we are again exposed to toxins that impact our gut. We are exposed to bad food and alcohol and ibuprofen and multiple other, and antibiotics that really disrupt the gut microbiome. So I have to start there. Otherwise I find that we're chasing our tail.

Yeah.

So that's just a foundational piece.

Yeah, absolutely. And since we are on the Holistic Dentistry Show, do you talk to your patients about oral health?

You know, I do, and it comes up a lot because especially when we talk about toxins, cuz I do talk about, you know, detox with all of my patients. It's one of the steps that we take. So I have what, what I call, it's my RENEW method. So the R is for restoring the gut. E is for elevating the nutrient status. N is for nourishing the adrenals. E is for eliminating toxins. And then the W is for weighing and balancing hormones. So that's really kind of the order in which I work in, and I find that that works best to take that stepwise approach. So, yes, I talk to my patients about it all the time and they love, you know, most of them are now using some fluoride-free toothpaste that don't have a bunch of additives and preservatives in there that are, you know, the reason our toothpaste tells you not to swallow it, you know, to call poison control. It's because it's got things in there that we shouldn't have in there.

Exactly. Absolutely.

Yes.

So other things, you know, can— should women avoid? We talked about BPA. What are the things that are maybe in our food or, you know, that we can avoid, um, uh, you know, there will be an estrogen type of change or either probably an increase.

Yeah. And there are multiple hormone disruptors out there that we are exposed to all the time. And, and one of the easy basic things, because, you know, it can be in our carpets and it can be in like different new things and new cars and things like that. But again, some of this is harder to control, but what I tell my patients is at the very least, let's eat clean. Let's look at— and every year the ewg.org, so the Environmental Working Group, comes out with the Clean 15 and the Dirty Dozen. I use that with my patients every year and I tell them to make sure they see the new list so they know those— that produce they need to be able to pick up that is organic and the ones that it's okay to not have it organic and you're safe.

Yeah. Okay. That's great advice, actually. And we're going to put the links to some of the things that you're talking about, including a link to your website where people find you. Uh, and, and speaking of where people find you, do you see, uh, do you do telemedicine today?

I do 100% telemedicine right now. Now I do have the ability to see someone in person that I have some leased office space that I can use if somebody's from out of state. So I am, I am actually in, uh, licensed in both Alabama and Texas right now, but I do see the surrounding states around me and usually we do our first visit in person. And then we can do telehealth after that. But the other thing is I also run group programs where it's really an educational and coaching program. So we can start if you're not sure if functional medicine is for you, wanna take the deep dive. I will be continuously running programs. Actually, I'm just finishing up one right now and we're probably gonna start another one in January when everybody needs a little detox and a little reset.

Sign me up for that one.

In the new year. I sure will. I sure will. So that is, you know, on my website. I will have—

You and I have worked together, you know, on my God, health and, uh, you know, I love how, you know, you're a great listener and, uh, I, I love it that you don't come down hard on me, you know, for my little vices. I was like, okay, well, just do as much as you can, which is, which is great. You know, you wanna come from a loving place. So I love that about you.

Exactly. And it's really meeting people where they are because, you know, I, I don't want to, we can't do 100%, 100% of the time. And I know that. And so I have an 80/20 rule that I tell my patients that if you can be good 80% of the time, just know when you go on vacation, that's counting for your 20%. When you go to the Christmas parties, it's counting for your 20%. Just come right back on because it's not, it's not about being perfect all the time.

Yes, that's great advice right before the holidays. Yeah, absolutely.

You will learn. And so the thing is, it's really about education, and, and you do this too in your practice. And the more knowledge you have about what things like you can avoid, you didn't know they were problematic, and if you just start avoiding them and you have better choices, it's a game changer. And those little teeny tiny habits that you can start building are become very big habits down the road.

Absolutely. I agree with you. And it's that lifestyle change that it's gonna make a big difference in our longevity and just the, in the way we feel.

100%. And that's what it's all about.

Now, if you could get our audience to understand one thing about hormones and how they impact our health, what would that be?

You know, it's, it's really about not just one thing. And I think it's really, we cannot compartmentalize the body and just say, okay, I've got a hormone problem. I'm just going to go get hormones. That, that can get you so far. But again, it's about laying these foundational pieces. And a lot of it is the things we do every day. It is our sleep. It's our stress. It's our food. It's, it's laying this foundation to improve our gut health and then everything else falls into place because believe it or not, we can make these impacts in people's hormones without giving them a hormone yet. So that's why we don't like to just start throwing things, medications at people. We like to lay the foundation first and then we layer that in.

Yeah.

As the need still exists.

Yeah. That makes perfect sense because if you change the terrain, the hormones might just adjust themselves.

100%. It is the terrain. And so we know we all have a little different terrain depending on our history and what we've been exposed to. And, you know, the stressors that we've had, the traumas that we've had, it all contribute to the terrain that we have in our genetics, of course. And so again, it's really taking this personalized approach and listening to our patients and really hearing what they have to say, understanding them as a whole person and knowing where we can make the biggest impact. And starting to lay that foundation.

Now, for some people listening might still say, how do I know what is a bioidentical hormone? How do I know my doctor's giving me bioidentical hormones versus synthetic? Cuz I'm sure there's probably still doctors out there that are prescribing synthetic.

They are. So if you have been told, like I was told 7 or 8 years ago, just to stay on birth control pills when I asked about hormone replacement therapy.

Wow.

Like, oh yes. And that is not uncommon. Wow. That was my male OB-GYN, of course. But yeah, so you need to be, you know, be an advocate for yourself and you need to understand what the differences are. And really, the synthetics are still out there and they will still be used again. They're in birth control pills. They're in a lot of other things. But what is the key thing that you need to ask? You say, I want to use the ones that are most like my body. And if someone says this is your only option, that's probably not the right provider to go to because you know what, there's a menu of options. There's a menu of options. And again, it depends on somebody's history, family history, and what their goals are, which one you use. Do we use a, you know, a systemic hormone? Do we need to use more of a local hormone? Is it more that they're getting recurrent UTIs? I mean, that's, that's one of the things with vaginal. Estradiol and, or even vaginal DHEA as well. So vaginal hormones will decrease the risk of UTIs and decrease death from UTIs as we get older. So really our grandmothers in the nursing home should be having a vaginal estrogen.

Oh, wow. So, so is that a, in the form of a suppository or a cream?

Yes. So there are suppositories and creams. Again, there is, there is a whole wide range of different options and it Whatever works for, you know, that patient individually, what is it that they would like? You know, personally, I find I try, I start my patients usually with a micronized progesterone orally at night because it does help with sleep in most of us. And then I also, I do like the transdermal patches just because they're easy. They're twice a week. Now I do find there's a little bit of fluctuation and now, you know, your insurance decides whether they'll pay for a certain brand or not. So it does change a little bit of the absorption from patch to patch, but I find that's a good starting point and their insurance will pay for it.

I had no idea that this is an insurance-covered supplement— not supplement, but prescription.

Well, so, so the prescriptions are now, there are compounded ones sometimes. Now there is another one that is very important for women's health. And again, a topic in and of itself is testosterone because there is no FDA-approved testosterone for women, despite the fact that we all have testosterone and we lose it. We offer it to our men, but we do not offer it to our women.

My goodness. And that's so important for, for bone density, for mental fitness. Yeah.

100%. And I tell you really what's happening right now with this, this, with this removal of the black box warning, it is opening up a huge door to everything else, women's health. I mean, this is just the beginning and we are in a movement. That is going to— is taking charge now. And there are— I really like a lot of the doctors that were on that FDA expert panel that encouraged the removal of the black box warning. And they have— I mean, I haven't really looked to see, but they are being followed by lots more people. They're actually teaching hormones to providers, like they're really getting it out there. And so, you know, it's time for us to take charge of our own health and ask the right questions to our doctor. And so I will tell you something, in a few hours, I'm going to be doing a Facebook live today because we have gotten so many questions. And, and so I'm gonna be speaking with one of my colleagues, another female physician out in California actually. And we are gonna be talking through what just happened and what it means for women's health because we are getting a lot of questions.

Amazing. Well, I'm glad you're speaking out. Uh, you know, we need this as women. Uh, it's time for us to stop being ignored by the medical professional. And really, I have no apology for wanting to be in optimum health. So we've got to stand up for ourselves.

Absolutely. And again, and I think now that that fear— because so many women have been afraid, and I tell you, when I would put women on hormones and they were already told by another doctor that, no, that's just going to increase your risk of breast cancer, it's a tough discussion to have with someone when they already think it's a problem. And so, you know, now it's going to be a little bit easier because when they go to pick up that hormone prescription, there is not a big black box warning staring at them saying that they are going to have a stroke in a heart attack and whatever was on the black box warning and scare them to death.

This is amazing. What a great conversation. Thank you so much for being on today's show. This is so enlightening and, uh, we, we need more women to understand the importance of bioidentical hormones and it's not going to hurt you. It's actually going to help you decrease the rate of cancer. Any other last minute advice that you wanna give our audience?

Well, you know, again, starting with the basics at home and, and we know women that you need to really be focusing on nutrient-dense whole foods. Like, that's key. And exercise and strength training in perimenopause and menopause— as we get older, we lose muscle mass. And what does muscle mass impact? It impacts not just how we're looking, which is nice, but it also impacts our bone health, it impacts our muscle health, and it impacts our metabolic health. It impacts our glucose control. So, again, it has to do with our longevity. So, those two things, focus on food and focus on getting that exercise and a little strength training in.

Okay, everyone, there you have it. Focus on food and focus on exercise. Those two things are gonna help regulate your hormones nicely and keep you young. And with that, please, uh, you can visit Dr. Christina's website. We're gonna put it below in show notes. Do you wanna say what is the website?

Yes. And it's just CMassMD.com. So, CMassMD.com. And my Instagram handle is C. Mass, MD, and my Facebook handle is Christina Massinopoulou, MD. I guess I should have made it shorter.

That's okay.

Yes.

Show notes. And everyone, thank you so much for listening. You can also share this episode if you like what the Holistic Dentistry Show is talking about. And with that, keep smiling. See you next time.

Thank you.

Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram @drsandamoldovanova. This is Dr. Sanda Moldovanova, and remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.