A new study explains something most people—doctors included—are missing: when estrogen declines, your gums become more vulnerable to inflammation, tissue loss, and disease.
If you’re already seeing early signs—bleeding, bad breath, gum recession—it’s not just a dental issue. It’s a whole body one.
As my own three adult daughters inch closer to perimenopause, I’m writing this newsletter with them in mind. There are so many things I wish my wife Roseann and I knew when she went through menopause in her 40s. We learned most of this the hard way.
So in this newsletter, you’ll learn:
- how estrogen, saliva, and gum disease are connected
- what role saliva actually plays in hormone balance
- what you can do right now to protect your mouth if you’re approaching or already in perimenopause
- the small, preventative steps you can take starting today—before problems get worse.
And if you have a friend, sister, or daughter who hasn’t heard this before, please forward this to her. As you’ll see by the end of this newsletter, early action could be the difference between simple prevention and years of chronic inflammation, irreversible tissue loss, and thousands of dollars in dental reconstruction.
Most people don’t realize that perimenopause often begins in your late 30s to early 40s, sometimes even earlier.
But because the symptoms can be subtle at first, many women don’t recognize them until much later—when damage is already happening.
This new study was published just two days ago, and I haven’t stopped thinking about it since. It confirmed what I’ve suspected for years.
Many decades ago, I noticed in my practice, that my patients in perimenopausal age noticed dry mouth and disrupted sleep. I started seeing the same pattern over and over: bone loss, gum disease, increased tooth decay, dry mouth, snoring, mouth breathing.
Snoring rates in women surge after menopause—research shows they nearly double compared to premenopause, closing the gap with men. Studies link this to declining estrogen and progesterone, which affect airway muscle tone and sleep regulation.
This study followed 372 postmenopausal women in Saudi Arabia to explore the connection between hormone replacement therapy (HRT) and gum disease. HRT helps smooth the transition into menopause by reducing the sharp hormonal decline. It doesn’t stop menopause—but it slows the drop, easing symptoms and lowering risk—including the risk of gum disease.
“The odds of having periodontitis was 3.2 times lower in HRT users compared to non-users.”
“After adjusting for medical and demographic variables, HRT users had approximately six times lower odds of having periodontitis.”
Estrogen, it turns out, is a key factor in protecting against gum disease.
Wait—our gums respond to estrogen?
They do. Your gums, salivary glands, and oral tissues all have estrogen receptors—the same kind found in bones and reproductive organs.
Estrogen starts declining in your mid-to-late 30s—often years before menopause. As that drop begins, your oral tissues lose some of their ability to regulate inflammation, heal, and maintain structure.
Women have all probably noticed this, but no doctor talks about it.
From the study: “Estrogen modulates immune responses by downregulating pro-inflammatory cytokines… and plays a crucial role in maintaining bone metabolism.”
In plain terms? Estrogen helps keep your gums resilient. Without it, you’re more vulnerable to inflammation and tissue breakdown—not just in the mouth, but across the body. Estrogen is a key regulator of immune activity, helping to balance inflammatory responses in the brain, gut, heart, and gums alike.
And it’s not just gum tissues, it’s also brain tissue and other systems in the body!
I used to give my mom estrogen injections when she was deep into her Alzheimer’s. The doctor recommended it; I was just the one administering. There would be a slight, short-term improvement. Of course, this is anecdotal—my mom was already far gone by that point. But I remember her perking up and speaking more lucidly afterward. Maybe it was the estrogen. Maybe it was just the jolt of getting jabbed in the leg with a needle. Either way, I never forgot it.
No one talks about this. Not doctors. Not dentists. Not even most menopause specialists. You shouldn’t be dismissed with “you’re just going through the change, don’t worry about it.” That mindset is a disservice.
This isn’t just a phase—it’s a physiological shift that touches nearly every system in your body. If you’re noticing more snoring, there’s likely more dry mouth too. These things are connected. And they deserve attention.
Once you have gum disease, HRT doesn’t reverse it. It’s preventive—not curative.
Smoking increased risk of gum disease 16x. Yes, we already know smoking is harmful—but what surprised me is how dramatically it showed up in the data. According to the same study, it was one of the strongest predictors of gum disease—more than age, income, or any single medical condition. And yet—how many young women are vaping right now, completely unaware of the damage it may be doing to their gums, saliva, and long-term oral health?
Saliva plummets in menopause. And saliva is your immune system’s frontline defense in your mouth. And that’s exactly why I recommend supplemental magnesium to 99% of my patients. It shouldn’t even be called a supplement—because it’s essential. Magnesium is essential for over 300 enzymatic reactions, including estrogen metabolism—and many women, especially under stress, are chronically deficient. If you don’t already have a magnesium you trust, here’s the one I’ve taken daily for nearly ten years, and so has Roseann.
Why does saliva decline in menopause? Two of the major salivary glands that supply your mouth slow down during menopause (see my previous newsletter on why saliva matters so much.) Human salivary glands express estrogen receptors—they rely on estrogen to function properly. Without it, saliva production drops. That’s why dry mouth is such a common symptom. Estrogen directly regulates how much saliva is there, so if it’s not there, then no saliva.
Education level was as protective as hormone therapy. Probably because the kind of person who reads newsletters like this is already paying attention—already connecting the dots.
What I’m telling my daughters
- Talk to your doctor about HRT. If it’s right for you, it may protect your gums long before they’re in trouble. (But do keep in mind that estrogen isn’t right for everyone—especially people with breast cancer that runs in the family, like ours. Again, speak to your doctor, because it won’t be right for everyone.)
- Notice your saliva:Is it dry when you wake up? Does it feel thick or sticky during the day? Healthy saliva should feel light, plentiful, and slightly slippery. When it’s off, it can mean your mineral balance is off, your estrogen is dropping, or your nervous system is under stress. It’s one of the first signs your mouth—and your hormones—might need support. Lack of saliva can lead to cavities as well, not just gum disease!
- Ditch the mouthwash: If you’ve been following me for a while (or if you’re one of my daughters), I know you’ve already tossed the mouthwash. But here’s why it matters: alcohol-based mouthwash disrupts your oral microbiome, dries out your mouth, and leaves your teeth more vulnerable to decay. Instead, use a tongue scraper to manually remove buildup and pair it with a microbiome-friendly toothpaste to keep your oral ecosystem in balance—and possibly protect more than just your teeth. There’s research linking oral inflammation to systemic conditions, including cardiovascular disease and even brain health.
- Hydrate with minerals: Mineral-rich water and balanced electrolytes help saliva do its job. I add electrolytes to my water every single day.
- Replenish your magnesium — Magnesium isn’t optional. It’s essential for estrogen metabolism, bone health, and maintaining saliva that actually protects your teeth. When you’re low, your saliva becomes thinner, less mineral-dense, and less effective at buffering acids and rebuilding enamel. You lose the ability to repair in real time. And since magnesium also supports mitochondrial health and modulates stress response, it’s a cornerstone not just for your mouth—but for your brain and hormones too.
- Get regular sleep studies: Estrogen and progesterone help keep airway muscles toned—when those hormone levels drop, your airway becomes more prone to collapse during sleep. If you’ve had a sleep study in the past, don’t assume it’s still accurate—your risk profile has changed.
Your gums take more abuse than just about any other tissue in your body. They’re where bone, blood vessels, nerves, and the immune system meet the outside world.
They’re constantly recovering from micro-injuries—tortilla chip scrapes, acidic drinks, bacteria, hormones—and still expected to heal flawlessly.
So when something shifts systemically, like a drop in estrogen, of course your gums are going to be one of the first places to show it.
P.S. This topic deserves more than a newsletter. I’ll be dedicating an entire chapter to it in my upcoming book with Penguin Life. If you’re navigating perimenopause—or supporting someone who is—I want to hear from you.
What questions do you have?
What’s been missing in the conversations you’ve had with your dentist, doctor, or even your friends?
Reply to this email and let me know. Your questions might shape what makes it into print.
Know someone who would appreciate this information?
Forward it to them & tell them to sign up for future emails here.
References & Further Reading
Ageel, R., Abaalkhail, B., & Natto, Z. S. (2025). Effect of hormone replacement therapy on periodontal health in post-menopausal women in Jeddah, Saudi Arabia. BMC Women’s Health, 25(1):383. https://pubmed.ncbi.nlm.nih.gov/40753442/
Harding, A. T., & Heaton, N. S. (2022). The impact of estrogens and their receptors on immunity and inflammation during infection. Cancers (Basel), 14(4):909. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8870346/
Leimola-Virtanen, R., et al. (2000). Expression of estrogen receptor (ER) in oral mucosa and salivary glands. Maturitas, 36(2), 131–137. https://pubmed.ncbi.nlm.nih.gov/11006500/
Bixler, E. O., et al. (2001). Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med, 163(3), 608–613. https://pubmed.ncbi.nlm.nih.gov/11254512/