Menopause with Dr. Anna Cabeca: Rational Wellness Podcast 93

Dr. Anna Cabeca discusses Menopause with Dr. Ben Weitz.

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Podcast Highlights

0:57   Menopause is when a woman’s body is shutting off its reproductive capabilities. There’s a sharp decrease in estrogen and progesterone production by the ovaries, resulting in a host of symptoms including hot flashes, night sweats, brain fog, mood swings, depression, weight gain, vaginal dryness, hair loss, and fatigue. There are various long term effects of menopause including increased risk of bone loss and of cardiovascular disease. Testosterone and DHEA hormones also decline, though not as precipitously as estrogen and progesterone.

2:38  Dr. Cabeca said that when she was 38 she went into early menopause, premature ovarian failure. She was told she would not be able to have another child. She traveled around the world looking for answers and found a way through Functional Medicine to reverse her early menopause and at age 41 she conceived a healthy baby girl, her daughter Ava Marie.  All was well until she hit 48 and started to experience menopause again and found that she was gaining weight, which was very disconcerting, since she had previously lost a lot of weight. Dr. Cabeca also started to lose hair. She found that by following a ketogenic, low carb diet and also incorporating a lot of greens into it in order to alkalinize herself, she was able to restore her health and stop the weight gain, which she calls Keto Green.  Keto Green allows women to gain mental clarity, restored physical health, and also spiritual health. 

5:58  In her book The Hormone Fix, Dr. Cabeca talks about three important hormones during menopause being 1. Insulin, 2. Cortisol, and 3. Oxytocin.  Oxytocin is the governing hormone that’s our joy-peace connection.  It’s the hormone that creates the instant bonding that women have for their newborn babies. Oxytocin is also the hormone that leads to uterine contractions and stimulates labor and also is fired up during orgasm. It is the hormone of love, bonding, and connection. When you are chronically stressed, your cortisol levels will rise and then eventually they will fall, along with your oxytocin levels.

9:40  One of the main menopausal symptoms is hot flashes, which we don’t fully understand why they happen, though we know they have to do with the body’s thermo-regulatory center. Hot flashes seem to be increasing today because women seem to be losing their metabolic flexibility. We need to get back in tune with nature, reset your circadian rhythm, and get various temperature exposures from our natural environment.  We also know that insulin resistance is a common trigger for hot flashes, so if women their improve insulin sensitivity with Dr. Cabeca’s Keto-Green diet, many will find that their hot flashes will decrease or go away.

13:35  Elevated cortisol levels from uncontrolled stress can result in reduced levels of other hormones that are further down the hormone pathway, like DHEA, estrogen, and testosterone.  Controlling lifestyle choices like stress, resetting our circadian rhythm, getting good sleep, reducing EMF exposure, and reducing blue light exposure at night would help to with weight loss and other menopausal symptoms. 

16:50  Dr. Cabeca’s Keto-Green diet helps with menopausal symptoms.  Low carbohydrate, dark leafy greens and cruciferous vegetables are essential on our plates every single day. She recommends using her test strips that test your urine for both ketone bodies and for pH.  This tells you whether you are burning ketones for energy and whether you are alkaline from eating enough green vegetables.  Having an alkaline pH of 7 or more will help with bone density and women after menopause tend to have osteopenia or osteoporosis, so this is important. This also decreases your risk of diabetes, heart disease, metabolic syndrome, and other chronic diseases. Getting your body and your brain to burn ketones instead of glucose for fuel is beneficial since when women are going through menopause, as their estrogen levels drop, they tend to get brain fog, memory loss, and they start to fear dementia. But ketones are the optimal fuel source for the brain and it’s not estrogen dependent, so as learn to burn fat for fuel, women get more mental clarity and the brain fog lifts. This keto-green program helps both to diminish hot flashes and with that stubborn weight loss, so women both feel better and look better. Dr. Cabeca also feels that it’s important to practice intermittent fasting and not graze and snack all day long, but snacking causes insulin resistance and worsens symptoms. She says that it is easier for men to skip breakfast, while it is probably better for women to skip dinner. It is better for women to eat by 10 am for hormone stabilization and not to eat after 7 pm, since they will secrete more insulin, which will worsen sleep problems and weight gain.

23:15   Dr. Cabeca believes in using diet and lifestyle changes first for helping women with menopausal symptoms, but she does also believe in bioidentical hormones as well.  She also done research into the use of the androgens like DHEA for women’s sexual health. As women age, they tend to have increasing problems with vaginal atrophy, pelvic floor relxation, and incontinence.  Dr. Cabeca has developed a natural anti-aging cream with DHEA to be used topically for the vulva called Julva that is sold through her website without prescription. Vaginal estrogen helps the mucosal, top layer of the vagina, whereas topical testosterone or DHEA helps with the deeper muscular and fascial layers. Her cream also includes stem cells from the Alpine rose and natural emollients emu oil, coconut oil, shea butter.


Dr. Anna Cabeca is a OB/GYN specializing in Functional Medicine, menopause, and women’s sexual health.  Her new book, The Hormone Fix  will be released Feb 26. Her web site is Dr.AnnaCabeca.comDr. Cabeca is offering a free 7 day trial of her Julva cream for vaginal health:  https://order.julva.com/trial-pack?oprid=41914&ref=223313

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.


Podcast Transcripts

Dr. Weitz:           This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field.  Please subscribe to Rational Wellness Podcast on iTunes and YouTube and sign up for my free ebook on my website, by going to drweitz.com.            Let’s get started on your road to better health.  Hello, Rational Wellness Podcasters. Thank you so much for joining me again today. And for those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us your ratings and review. That way more people will find out about the Rational Wellness Podcast.

Our topic for today is menopause with Dr. Anna Cabeca. Menopause is when a woman’s body is shutting off its reproductive capabilities. There’s a sharp decrease in estrogen and progesterone production by the ovaries, resulting in a host of symptoms including hot flashes, night sweats, brain fog, mood swings, depression, weight gain, vaginal dryness, hair loss, and fatigue. There are various long term effects of menopause including increased risk of bone loss and of cardiovascular disease. Testosterone and DHEA hormones also decline, though not as precipitously as estrogen and progesterone.

Today, my goal is to bring clarity to some of these issues. I would particularly like to highlight hot flashes and vaginal dryness and atrophy and discuss with Dr. Cabeca some strategies that can help women. Dr. Anna Cabeca is a triple certified OB/GYN in integrative medicine, in anti-aging and regenerative medicine, as well as an expert in Functional Medicine, menopause, and women’s sexual health.  She specializes in bioidentical hormone replacement, natural alternatives, and successful menopause and age management medicine. She has a soon to be published book, which is excellent. I’ve just finished reading it, “The Hormone Fix” which is an excellent look at how to help women deal with the hormonal imbalances and symptoms of menopause.  Hi Anna, thank you so much for joining us today.

Dr. Cabeca:         It is great to be here with you Ben, and for your listeners and viewers. Thank you.

Dr. Weitz:            Great. Maybe you could start by talking about your personal journey and how you found yourself struggling with hormonal issues and what you did to solve them.

Dr. Cabeca:         Yeah. Well, it’s been a long road and at 38, I was diagnosed with early menopause, a premature ovarian failure, early menopause, and I was told the devastating news that I would never be able to have another child. And that was it. Like all hope was erased from me, erased from me. And it’s something we know as gynecologists, I’m a Emory University trained gynecologist and obstetrician and I went to my colleagues. And what we know is that the likelihood of reversing early menopause is dismal.  We had a traumatic incident in our family and a lot of PTSD, and a lot of stress and grieving, and it was all around compiling upon that. That just set me off and I took a journey around the world actually looking for answers then. I looked in my doctor’s bag, I consulted with colleagues, and then I just started traveling. I took my kids, home-schooled them for a year as we went around the world and I looked for answers. So as a result of that and Functional Medicine and integrating that as well into my own life and the life of my family, lo and behold, at age 41 I conceived a healthy baby girl and that’s Ava Marie.

So grateful to God and grateful to medicine and the world of medicine to have healed me on that journey. And pretty much all was well till age 48. So for a decade approximately, I mean, all was well and then I experienced what so many women experience.  And that is my clients would come in and you hear this too, it’s like, “Dr. Anna, I’m gaining 5, 10, 20, pounds and I’m not doing anything different.”  Right?  You hear that all the time.

Dr. Weitz:            Correct.

Dr. Cabeca:         And I was like, “Sure you’re not, you’re more sedentary, not going outside as much, less active, whatever it is.” And lo and behold that happened to me, 5, 10, 20, pounds. And I had already lost 90 pounds in that journey and working to restore my health. And so anyone who’s lost a lot of weight and kept it off, when they see the scale uncontrollably rising, fear grips us. And not only that, I had a tremendous amount of hair loss. I was balding all the way past almost the crown of my head, and it was terrifying.  And that took me on another journey and that’s where I really incorporated the benefits of keto, getting our body into ketosis as well as enforcing the alkalinizing. I call that keto-alkaline or getting keto-green, which is hence what I write in my book about our Keto-Green Way to fix our hormones, because we know that it takes more than hormones to fix our hormones.  So that was my journey. Now I’m 52 with a 10-year-old and I am like just so emphatic on keeping this lifestyle and encouraging other women to embrace it as well because of the clarity, the mental clarity, the physical health, and not just that, the spiritual health that we gain and we can gain in the peri-menopause and post-menopause time period.

Dr. Weitz:            Great.  So when we talk about hormones in menopause, most of the experts talk about estrogen and progesterone and testosterone as the key hormones that drop during menopause.  But you write in your book that you feel that three of the key hormones in menopause are insulin, cortisol and oxytocin.  Can you explain why you say that?

Dr. Cabeca:         Yeah, absolutely. And oxytocin is the crowning hormone. That is absolutely my favorite hormone, and I believe that’s the governing hormone. There’s a spiritual basis to oxytocin, but ultimately that’s our joy-peace connection. And I would like and I’d love to get into more in oxytocin. I put a whole chapter in my book on it, but-

Dr. Weitz:            I don’t think most people know much about it. I mean, I’ve heard of it as the hormone involved in orgasm, but other than that, I didn’t have any clue about it. I’ve never seen it pop up on a lab test, so-

Dr. Cabeca:         No. And it’s really hard. You actually need to have a frozen sample in order to adequately, and it has to be delivered very quickly. It’s very hard to get oxytocin in blood levels. But most women experience oxytocin their first experience with an exogenous form of oxytocin is during labor, pitocin.  So we hear, “Oh my gosh, pitocin, we’re just giving it during labor.” And we’ve felt for so many years that it’s pretty harmless. And I think we’re starting to question some of that research, but pitocin is that hormone, it’s oxytocin and it works to contract our uterus. It works to help us deliver this baby. And the results of it are that instant bonding that defies all explanation. You never understand it until you experience it yourself, between you and that child that you’re looking at. That’s that imprinting that’s done because of oxytocin. You see this baby, look into this baby’s eyes and you’re like, “Wow,” and that’s that feeling. And oxytocin has that benefits.

It’s also a powerful analgesic. So it takes away the pain that we remember from Labor. It’s like, “Ah, I could do this again,” you think like several months later. And like, “What am I thinking?” when you’re in labor again. Right? “What was I thinking?” And the benefits of oxytocin, what it does is take away that pain. And same is true in so many ways. We know that when we orgasm, we’re fired up in the same brain center areas as we are in spiritual ecstasy.  And so there’s powerful connection, powerful spiritual growth that we can experience too with oxytocin. But it is that hormone of love, bonding, and connection. So from hugging, laughing, playing, giving, having pets, healthy, happy, laughter in your life and in your relationships can also stimulate oxytocin.

And that is, and one thing that’s really important to know what I learned from not just the everyday stress of running a family, wearing many hats, like so many women.  I was running a family, running a business, managing a practice, being a wife, all of those things.  So the everyday stresses, let alone post-traumatic stress, create this dysfunctional adrenal rhythm, and we can get into a state from of chronic high cortisol pushing down oxytocin to this chronically low cortisol and chronically low oxytocin.  And that is what we know as burnout or disconnect or divorce.  We can look at the physiology of all those things and look at those hormones and that’s how powerful they are.

Dr. Weitz:            Cool.  So one of the main menopausal symptoms is hot flashes. Can you explain exactly what causes them, is this due to low estrogen or progesterone or fluctuations or what exactly causes hot flashes and why do some women have hot flashes for a short period of time and then they go away, and I have other women in my practice in their 70s or 80s, and some of them still have hot flashes?

Dr. Cabeca:         Yes.  Yeah.  And that’s the conundrum with hot flashes.  And I don’t think I’ve read a really good explanation. I know the physiology of what happens, right? We believe like we have our thermo-regulatory center or internal thermometer, right? And so the hormones are adrenaline hormone, so when we’re getting a hot flash, we’re basically getting an adrenaline rush with vasodilation. It’s like, “Well, here I am just sitting on the couch, not doing anything and I’m getting this like physiologic outpouring of these hormones and hence sweat. What is happening?”  And we all know there’s always some women experience more or less, there are some theories. One very interesting theory that I came across as I kept hearing from my clients as I put them through what I discussed in my book, my “Keto-Green Way”, and they’re like, “My hot flashes are gone.” And that some clients would have hot flashes like every hour, every 20 minutes, and for years and within two weeks their hot flashes were gone.  And so I dug into that. And lo and behold, insulin resistance is a very common cause of hot flashes. So we’re predisposed to more and worse hot flashes with insulin resistance. I’m not clear on the mechanism of action there and I don’t think anyone is, if anyone listening knows, please email me because I have dug into some of the science and I can’t quite understand it.

But there’s that insulin resistant component to hot flashes. So as we control this powerful hormone insulin, which also has effects on progesterone, testosterone, estrogen, right? That’s why it’s the major hormones. And as we get more insulin sensitive, lo and behold, I mean, the hot flashes will go away. But also, hot flashes are worsening in our population now. And I think part of that is we have less metabolic flexibility in so many ways.  We go from a 70 degree home, to a 70 degree car, to a 70 degree office, and back 70 degree gym, when we go work out. Right? And so there’s not that opportunity to really gain this. Also there’s flexibility and this thermo-flexibility, let’s say. So really part of our prescription is to kind of get back in tune with nature, reset your circadian rhythm, get out in the environment, get all the exposures from our natural environment. And that includes the extremes of temperature as much as possible.

Dr. Weitz:            Yeah. I’ve heard a lot of people talk about exposing themselves to cold or jumping in a cold plunge or doing a cold shower.

Dr. Cabeca:         Yes. Yeah. To increase metabolic flexibility and burn fat I believe. And so it’s interesting that cold thermogenesis has a tremendous impact on helping our body also in resetting its circadian rhythm. It’s fascinating.

Dr. Weitz:            Seems to be one of the anti-aging strategies also.

Dr. Cabeca:         Yeah. And I just cannot bring myself to do it. Every once in a while I will like totally encourage going from hot to cold in the shower, but like got to get back to hot eventually. But the cold plunges, I’ve done the nitrogen chambers, where there are sub zero and I’ve done that for four minutes and yeah, no, I’m not a fan, but it was worth the experiment.

Dr. Weitz:            You’ve written in your book that elevated cortisol levels result in reduced levels of some of the other hormones like DHEA, estrogen, progesterone, testosterone, what does cortisol have to do with these other hormones?

Dr. Cabeca:         Yeah. Well, one of the things is that cortisol is derived from progesterone and pregnenolone.

Dr. Weitz:            Okay.

Dr. Cabeca:         So again, two of our mother hormones. And when we are producing cortisol, the hormones that are further down on that pathway, such as DHEA and our reproductive hormones, estrogen and testosterone, are diminished. This is just like a traffic jam, right?  All the traffics going in this direction, there’s very little coming down these roads. And that’s what’s happening essentially when we’re under a state of chronic stress and we’re producing cortisol. So we need to be conscientious of that, and resetting our cortisol balance, it has to be done through lifestyle.  And one of the things that I always say, Ben, is that diets fail because it’s a four letter word with the word die in it. So, I don’t love that. And yet 99% of diets fail, and the predominant reason is because it’s probably in my estimate, about only 25% of what we eat. The lifestyle factors, when, how, in what mood, and what else is in our food or in our environment or what other things are stressing us out, that has a greater impact. So controlling those lifestyle factors with simple disciplines and simple strategies can make a huge difference in our success, our quality of life.

Dr. Weitz:            Which lifestyle factors do you feel are most important in that regard?

Dr. Cabeca:         Definitely the part is resetting the circadian rhythm, so getting a good night’s sleep, uninterrupted sleep, removing the EMF exposure from … the EMF exposures, but also blue light exposures that are creating havoc with our own natural melatonin production. And that, again, an important hormone for-

Dr. Weitz:            Blue light is staring at computer screens and phones and things like that. So do you recommend blue light blocking glasses or?

Dr. Cabeca:         I do. When you’re at a computer screen, we should all be wearing blue light blocking glasses. So like typically, I have my glasses here on my counter and I’ll wear them when I’m working at the computer as well as looking at my phone. But definitely also just turning it off and going to good old-fashioned paper after sunset is key. And getting sunrises and sunsets, that inner eyes, not with glasses or contact lenses as a filter in between, but pure sunrises and sunsets to help us reset our rhythm.

Dr. Weitz:            Yeah. I was at an anti-aging conference and Dave Aspery was talking about using red light bulbs in your home at night.

Dr. Cabeca:         Yes. Yeah, to change that or red filtered glasses, which is another strange thing. And I always think of Amsterdam and the red light district when I think that. Yeah.

Dr. Weitz:            There you go. So you write a lot about diet and for help with menopausal symptoms. So specifically you talk about your keto-green diet. Can you talk about that and why that helps with menopausal symptoms?

Dr. Cabeca:         Yeah, it’s really essential. There’s a few things. Definitely we want to improve our urinary pH.  We want to improve the mineral-rich foods. So diet is a component of that and lifestyle is a component of that, hence the greens.  Low carbohydrate, dark leafy greens and cruciferous vegetables are essential on our plates every single day. And it’s not enough to guess, “Okay, I’m getting enough greens.” It’s important to check our urinary pH. And I’m a real big advocate of this and I talk about it in the book, but it’s so simple. It’s so inexpensive. We can buy pH paper at any pharmacy or health food store, and I created urine test strips that have pH and ketones both on them, one less step, right, to make it easy for us and check our urinary pH.  A higher urinary pH above seven is associated with strong bones. And that’s important for us as we get older because women in their 30s are being diagnosed with osteopenia, even osteoporosis. Well, again, we have to get these minerals into our body and we have to nourish our body to be able to detox the harmful chemicals we’re exposed to on a daily basis as well.  So urinary pH, the higher the better, seven or better. And I have clients check that so they can start to discern what works for them. And it’s a very personalized program as you figure out, “Oh, this works for me, this doesn’t work for me.” Or, “This is helping me and this isn’t helping me.” And it sometimes takes time to figure that out but that discovery process is brilliant and enlightening. And now I’ve had thousands of women in my online programs do this and find quite amount of joy doing it and discovery any weight loss and improvement of menopausal symptoms. So that’s key.

That alkalinizing healthy bones decreases our risk of diabetes, heart disease, metabolic syndrome, and the list goes on. The second part, ketosis, as our estrogen levels start to decline, estrogen or so our brain uses glucose for fuel as a rule or ketones for fuel. Well, when women are going through menopause, they’re getting brain fog, memory loss, and the immediate fear is dementia, being unable to take care of themselves, so as they grow older, being a burden to their families.  And so we start to kind of live this fear-based profile, not realizing it’s physiology. So glucose utilization in the brain is an estrogen-dependent process. So naturally as our levels are declining, “Huh, we should have some mental fog or something.” No big surprise. So let’s conquer it. Ketones are the optimal fuel source in the brain. It’s not estrogen-dependent. So as we learn to burn fat for fuel, we get this higher clarity, brain fog gets lifted.

I hear so many patients tell me, “Dr. Anna, my brain fog is gone,” and just that kind of getting your edge back. So getting into ketosis and getting alkaline at the same time, that combination, which I call keto-green is empowering. It helps with diminishing the hot flashes, helping with some stubborn weight gain or difficult weight loss, helps with just the healthy metabolism and feeling healthy.  It’s the one thing, we want to all look good, but it’s even better to feel good at the same time. So that’s what really counts and we see that combination really empower. And a lot of factors in ketosis, there’s components of the ketogenic diet that I like and that I don’t like. So in my program I describe them and we really want to work and getting it to that state of ketosis.  So intermittent fasting, which has been shown to decrease our risk of breast cancer, as well as no more snacking. Women hate it when I say that because they’ve been told to graze and three meals, three snacks. I’m like, “Where in earth did we ever get that?” Right?  So that causes a tremendous amount of insulin resistance and worse symptoms. So we want to eliminate that snacking.

Dr. Weitz:            Yeah, it’s funny how the Functional Medicine world has kind of gone through this major change because for years we were concerned about trying to help people manage their blood sugar, and that’s one of the reasons for this small meals every three hours to try to keep your blood sugar even. The worst thing you could do is skip breakfast, and now the Functional Medicine world has come around and said, “Hey, we just came up with something. The way to be healthy is to skip breakfast and have long periods of time between when you eat.” So it’s kind of funny how we have come complete circle. Everybody’s fat because they miss breakfast and they have too long a period of time between eating.  Now everybody’s too fat because they eat too often and they need to skip breakfast and have long periods of time between eating.

Dr. Cabeca:         Like the pendulum swings, right Ben? It’s like always like where is it swinging next? Well, I think the big thing is that one thing that I recognize is men can skip breakfast. This is one of the differences in the sexes that I found out. Men can do a more carnivorous keto. Women, we can’t and we need to really eat by 10:00 A.M. for hormone stabilization. And I mean, that’s just traditionally how we’ve been designed while the men are out hunting say, right?  So in 10,000 years, supposedly our genes haven’t changed. But I like women to, I prefer we skip dinner or have a lighter dinner.  We definitely want to eat by 7:00 P.M. because we know that if we eat after seven, we secrete 70% more insulin, hence worsening sleep issues, hence worsening weight gain and those issues. So for us, for women, women in my perimenopause, menopause and post-menopause, as they go through my program, I really work to say, “Okay, let’s try to breakfast by 10:00 A.M. and really try to eat by 5:00 or 6:00 P.M.”

Dr. Weitz:            Maybe it’s my feminine side, but I’m with you on that. I feel so good after a good breakfast and I get ready to go. And sometimes if I don’t get a chance to eat, I’ll just skip dinner and I’m fine with that.

Dr. Cabeca:         Perfect.  Yes, no one has died from skipping dinner, I guarantee you.

Dr. Weitz:            So do you recommend bioidentical hormones after menopause?  That seems to be the focus for most people in the functional medicine community. The main strategy is to replace the hormones.  What’s your feeling about that?

Dr. Cabeca:         So nutrition and lifestyle first, right, I really feel strongly about that, something I did in my practice. So since 1999, I really became involved in bioidentical hormones, especially for sexual health because we didn’t really have options for women who’ve had breast cancer.  And as a practicing gynecologist in a small town Georgia, because I was a national health service corps scholar, so I came to a small town from my repayment and I was in this shrimping area called McIntosh county.  And I had to find really industrious ways to help these women because they had no options and they were just told, “Well, you just kind of have to suffer. You’re lucky to be alive. Right?” I’m like, “What?” And so I dug into the research and that’s where I started understanding some of the differences between bioidentical and the synthetic hormones as well as how we can use the androgens such as DHEA and testosterone to help women in sexual health, even if they’ve had a history of breast cancer.

More and more research done, especially by Dr. Rebecca Glaser, a breast cancer surgeon in the Northwest and just fabulous good science around that. And now over the last 10 years with the research doing, looking at DHEA vaginally. So Ben, one of the things is that as we get older, the natural hormone decline, like hot flashes will eventually stop for the most part with few exceptions, but vaginal atrophy changes, pelvic floor relaxation, incontinence issues tend to get worse. And again, incontinence is one of the reasons why care givers put their beloved into a nursing home. And look, I have four daughters, like I’m 52 with a 10-year-old, almost 53 with a 10-year-old, so I’ve got to keep that mental clarity and I definitely don’t want to give any of them an extra excuse to tuck me away in a nursing home.

So the pelvic floor health is a passion of mine and that’s why I really went to create some natural solutions using bioidenticals, and that’s what I teach physicians on when I lecture, writing prescriptions for bioidentical testosterone, DHEA, progesterone, and estrogen when needed as well as a combination either by itself or individually or to use topically or vaginally, preferably in clients as we’re getting older to help that. And that’s one of the reasons I created Julva, which is my natural anti-aging cream for the vulva to help with those changes, the dryness, the accidental leaks when we cough and sneeze and just really improve the quality of the health of that tissue because that’s just compromising.  We stop exercising because of it. We stopped having sex because of it.  We have discomfort, pain, and feel that our body’s betraying us in so many ways because of it. So the first choice is always bioidentical.

Dr. Weitz:            It seems like we’re kind of confused. So since we’re transitioning to the topic of vaginal health and the vaginal dryness and atrophy that occurs after menopause, which makes intercourse uncomfortable or painful and can lead to incontinence. It’s interesting that estrogen can be effective, but testosterone can be effective, DHEA, I mean, there seems to be some confusion about this. What’s the story? I mean, what’s the key for vaginal health? Is it all those hormones? How can testosterone work as well as estrogen or DHEA?  Maybe we just need to know a lot more about it, but-

Dr. Cabeca:         Yeah, so this is the issue that’s come about with the pharmaceuticals, right?  We know that estrogen works to help regain moisture, vaginal moisture, but it works on the top layer.  So we’re talking about vaginal estrogen. All of these, anything inserted vaginally is by prescription.  So vaginal estrogens, for instance, that helps the mucosal layer, the top layer of the vagina. And then to go deeper to the muscular layers and the fascia layers, we really need the androgen, so testosterone. Well, even fascia has progesterone receptors. So, so many women are using progesterone creams, but they don’t think, “Well, let me apply it down my bottom.” And I always tell clients, “From the clitoris to the anus, apply your hormone creams there.” And that’s very beneficial.  But so that’s the difference between vaginal estrogen and vaginal testosterone. Testosterone, DHEA, work all three layers of the vaginal wall to the muscularis layer, so that helps us get this delicate muscle back and functioning and improving. So that’s where the androgens come in. So I think the combination is really ideal. And in fact, in my practice, I would start with the androgens and progesterone first, where typically, I’d use a bioidentical progesterone, pregnenolone topical cream, if they’re cycling on and we’re doing all the other stuff, adaptogens, lifestyle, right? I’m not going to give hormones to someone who’s not embracing a lifestyle of health and wellness because it takes more than hormones to fix her hormones. And we want to improve the entire quality of life, not increase any risk factors. So that’s it. And no bandaids in our care.

Dr. Weitz:            I’m a chiropractor, so we don’t prescribe these things. But I do get into discussions with women about bioidentical hormones. And this seems to be some push back from women who don’t want to apply progesterone and estrogen down there because it’s a hassle. Some of them are worried if they are going to have intercourse with a man, are they going to get exposed to these female hormones? So have you gotten some of that kind of push back from women?

Dr. Cabeca:         I’ve heard those issues for sure, but definitely not in my client population because we’re really working on getting clarity. So hence one of the reasons I created Julva is partly of that. Number one, it contains DHEA, which is safe over-the-counter. Right? It’s been in pills oral form for the last 50 years. We’ve been able to buy that off the shelf essentially.  And DHEA is a precursor and a supportive androgenic or pre-androgenic hormone. And we have a lot of safety. And not only that, it’s about 10 times more in men than it is in women. So you are using this with a combination that I included with plant stem cells, we know stem cell technology is incredibly anti-aging and rejuvenating. So I use plant stem cells from the Alpine rose, which is this rose that grows up and like blossoms in the Swiss Alps.  I mean for me that epitomizes women, right? Women will blossom and will shine in the harshest conditions. And so this plant stem cell of the Alpine rose has been shown to have incredible resilience properties, and that’s why I combined it with other emollients like emu oil, coconut oil, shea butter, into this because again, clitoral health is really important. There’s 9,000 nerve endings in our clitoris. Keeping that tissue healthy and keeping it sensitive is really critical for many reasons, but it’s certainly for pleasure as we get older and to stimulate the pelvic floor sacral nerves.  And so, and all the way to the anus too, we forget about the fissures and hemorrhoids and things that can develop as we get older, that creates so many problems and that causes increased use of over-the-counter creams or topicals that have parabens and synthetics and and petroleum-based products, I mean everything that can cause further hormone disruption and worsening of the skin in general.  So I really had tried to find something and then created my own that was natural without parabens, without synthetics to help women in that area. And yes, use it prior to foreplay. Absolutely. Because he’ll benefit as well. But again, it’s like a drop in the bucket. A little bit goes a long way and we can see that improvement in the skin. It’s anti-aging to the skin for sure.

Dr. Weitz:            So is there a good scientific data or a DHEA play topically to vagina versus testosterone versus estrogen and-

Dr. Cabeca:         Not versus, but we’ve seen a lot of good research with DHEA vaginally.

Dr. Weitz:            Okay.

Dr. Cabeca:         In work done by Ferdinand Libre out of Montreal. And he has been looking at DHEA vaginam and following his research for years. And he’s looked at it even in clients who have had breast cancer. So we can safely prescribe vaginal DHEA progesterone.  It’s just a straight DHEA and a gel suppository vaginally and get really good results as well. And that’s been, there are ongoing studies and clients who had breast cancer, but we’re seeing no increase in recurrence. In fact, we see improvement in morbidity and mortality. I’m really happy to see that research and the safety profiles and the safety studies being done.

Dr. Weitz:            Cool. Would you mind sending me a link to one or several studies that I can throw in the show notes?

Dr. Cabeca:         Yes, I have a white paper too that I’ve written on it,-

Dr. Weitz:            Oh, okay.

Dr. Cabeca:         … so I’ll send that to you as well. Yeah.

Dr. Weitz:            That’d be great. And so that Julva product is available over-the-counter or through your website?

Dr. Cabeca:         Yeah. We’ll give you a link for your listeners to get a free trial. So a free seven night trial of Julva. And I highly recommend it. Give it a try, and also we always give a 60-day money back guarantee when anyone buys a full tube of Julva too.

Dr. Weitz:            That’s great. So I think I’m pretty much done with the question for today. Is there any other issues you’d like to mention?

Dr. Cabeca:         I think that’s it. I just don’t want women to give up hope and I find, because there’s a survey that I just saw the preliminary results on it that are being published, that women in their 30s and 40s are willing to take action, are willing to make changes, but come 56 and older, we’re like giving up on ourselves. And I don’t want anyone who’s listening at any age to give up on themselves. I don’t care what diagnosis you’ve had, how long you’ve been struggling. There is a road to improvement.  And I want to encourage you, I was told again at 38, I’d never had another child. Right? And living proof that can totally reverse many of the physical changes that go on. But even more than that, to keep looking for that trust in your inner calling and your inner voice. And in my book, “The Hormone Fix”, I really strive to give you that power with no barrier to be able to make easy discipline strategic changes that will impact the quality of your life forever. So, I encourage you and I would love to offer your listeners a sneak peek into my book and I’ll give you that link as well.

Dr. Weitz:            That’d be great. Yeah, I think everybody needs to keep in mind that even though your ovaries stop producing estrogen and progesterone, there’s still estrogen and progesterone produced by the adrenals and other organs, in your body throughout the rest of your life. And even though we assume that the androgens like testosterone, DHEA, decrease with age, they don’t necessarily have to. We’re not programmed for that to happen. So I think if you can keep yourself healthy and do some of the things you’ve talk about in your book, there doesn’t have to be this huge drop off in those hormones.

Dr. Cabeca:         So true. Yeah.

Dr. Weitz:            That’s great. Okay, so links to get a hold of you?

Dr. Cabeca:         Dranna.com, so, D-R-A-N-N-A .com, that brings you to my website and on social media, Facebook at Dr. Anna C and @Dr. Anna Cabec on Instagram.

Dr. Weitz:            That’s great. And your book is coming out when?

Dr. Cabeca:         February 26.

Dr. Weitz:            Okay.

Dr. Cabeca:         “The Hormone Fix”, February 26th.

Dr. Weitz:            And can we pre-order it now?

Dr. Cabeca:         Yeah, it’s available on anywhere books are sold. So Barnes & Noble, Amazon, yeah.

Dr. Weitz:            Cool. That’d be great. Excellent. Thank you so much, Anna.

Dr. Cabeca:         Thank you for having me.


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