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Anna Cabeca:
Absolutely, absolutely. And I think this is the piece that’s so important that we understand and we teach our patients. It’s like, just like you can’t get well in the same environment you got sick in, you know, really addressing the trauma, the understanding physiology of that trauma. And so what I teach is the cortisol-oxytocin disconnection that happens as a result of post-traumatic stress. And if I hadn’t lived it, I wouldn’t have seen it. And that’s an important thing to understand because that’s the physiology of burnout, the physiology of disconnect, and is the physiology of stress on our body. And you know, and I think it’s so important as a provider to recognize that, to be able to see when that’s happening physiologically to clients, because it’s going to throw all the hormones awry when you’re in that state. Either chronic, everyday stress, post-traumatic stress, adverse childhood experiences, and in the time of menopause, it like comes to a head. 

I call like our pressure—you know, sometimes we have a pressure cooker of a life, and then the lid to that pressure cooker is progesterone. So you take off that lid of progesterone because progesterone is plummeting, you know, mid to late 30s and into our 40s and 50s, so that protective, neuroprotective hormone progesterone decreases. So now you’ve got like, that’s the lid to your pressure cooker. So now you’re just like exploding with emotions, hot flashes, all the neuroendocrine symptoms that our patients come to us about. 

Kalea Wattles:
Right. Well you mentioned that you started having menopausal symptoms when you were, I think you said 39, right? So there’s definitely this difference between physiological ovarian aging and pathological ovarian aging. Will you talk to us a little bit about when the menopause transition is considered healthy and when we might think, this is now a dysfunctional pattern? 

Anna Cabeca:
Yeah, definitely. You know, I think we were taught, you know, Speroff endocrinology, one of our OBGYN textbooks, that menopause age 52 plus or minus, you know, a few years. And in smokers it’s 42. And endometriosis, we know it’s earlier too. So in cases of inflammation, right, inflammation stress to our body, we’re going to see earlier menopause. That’s all pathologic, you know, and early premature ovarian menopause has that immunologic component to it. But I would say that we’re seeing, if a patient’s coming to you with symptoms anytime in their 30s and 40s, like that’s when you start acting, right? You start acting by detoxing their liver and empowering their adrenal gland so they can start using their hormones better. And like for me, it’s the keto-green lifestyle. You eliminate sugar, you intermittent fast, give your body time to heal itself. You alkalinize the diet and the mindset with oxytocin-increasing activities, the most powerful and alkalinizing hormone of our body. You do those four things, and then all of a sudden patients come back in within a few weeks and they’re like, “Doc, I feel 100% better.” And that’s because we’ve now empowered the body, supported the glandular system, supported the adrenals, supported the ovaries to do what it’s designed to do into our 50s.  

And as a result of my journey, that early menopause that I reversed in 39, I was great till about 48. And that’s when I experienced all those secondary, a second menopause. So weight gain despite not doing anything different. Let me tell you, my patients would come in and tell me that, I’d be like, yeah, sure you’re not. I’m sure you’re exercising less. Let me look in your purse. Is there a Snickers bar in there? What’s going on? And, but that weight gain without doing anything different, and the night sweats, the hot flashes, the difficulty sleeping, the loss in sex drive. So that hit me again at 48. And so that’s when I really dug into a ketogenic lifestyle and then recognized for women, we need the alkalinizing component, so hence my keto-green way of doing things. And it’s a lot of what I teach now as part of the lifestyle and the nutrition that is empowering in menopause and beyond. And that helps with the ovarian resuscitation. That helps with the adrenal gland resuscitation. So now we’ve just empowered our organs to do more of what we need to do. And then I use adaptogens. I use my Mighty Maca Plus, which has maca and 30 super foods combined, and we’ve seen improvements in DHEA and progesterone. So that’s an adaptogenic blend that works really well that we can do. And if we need to, further on, we’ll add progesterone, estrogen, DHEA, and those other additional hormones. But you’ve got to support detox, and you’ve got to support regeneration. 

Kalea Wattles:
I’m feeling very excited to take a deep dive into these nutrition and lifestyle interventions. But before we do that, I think if we’re seeing patients in the clinic, we might be wondering, okay, how do I identify the patient persona who maybe is losing some ovarian resiliency at an accelerated pace? So let’s talk a little bit about menopause-specific concerns. Because we have the vasomotor symptoms, and we have changes in mood and energy, and I think we might be able to anticipate some of those, but are there symptoms that are maybe less intuitive, or we might not initially associate them with menopause, but we should be thinking about this?  

Anna Cabeca:
Yeah, definitely. And it’s so funny because I’m, you know, I’ve been, you know, divorced for 11 years now. Again, I didn’t learn this whole cortisol-oxytocin disconnect thing in time. But that dating in my 50s and talking to other, you know, to my dates, and they’ll be, “Oh my, my wife was bipolar.” I’ve heard that enough times to recognize, they were not bipolar, they were hormonal. They were hormonal. So one of those symptoms are those definite, those mood swings. You have fatigue, you have mood swings, you have forgetfulness, brain fog, insomnia, heart palpitations, muscle aches, stiffness in your joints, bladder incontinence, decrease in orgasm, restless leg syndrome, hair loss, all of those are other symptoms that, especially the heart palpitations. I mean, how many of our patients have ended up in the emergency room with palpitations when it’s probably progesterone and magnesium? And when you add that back in, wow, it’s like, that’s such an improvement. So those are very common during this time. 

Kalea Wattles:
So with this huge variety and spectrum of symptoms that we might witness, are there some tools and biomarkers that you’re using to help your patients understand what stage of life they’re in hormonally? 

Anna Cabeca:
Yeah, absolutely. And I think that’s a piece of this. Like when we’re experiencing these symptoms is, you know, test don’t guess. What gets measured gets managed. In my book The Hormone Fix, chapter two is that: test don’t guess. So it has our inventories, the MSQ inventory from functional medicine, medical symptom questionnaire, my own hormone toxicity questionnaire inventory, also what key lab tests. So questions we answer, I always say treat the patient, not the labs, but those labs are really good markers for us. And I go through, you know, we can do a lot, we can spend a lot of money in functional medicine labs. I know y’all are like, “Yeah, we can.” And I’ve gone the gamut from, again, having very high-end clients that want everything done and then from having very economically restricted clients that we needed to just focus on what are the key things.  

And that’s where I really got thinking. What are the key tests that I need for this client to really motivate them to make changes and see changes very quickly? And it really comes down to four key tests that I want to look at and watch and monitor over time and the fewest that I can do. And of course, number one is a vitamin D 25-hydroxy. Without vitamin D, our progesterone doesn’t work well. Our oxytocin doesn’t work well. I mean, vitamin D is important in pretty much, you know, most of our hormone receptor sites. For our reproductive hormones to work well, we need healthy levels of vitamin D. And many of us don’t realize that as prescribers, it’s in the research though, and it’s been there for quite a long time.  

The second one I test regularly is an inflammatory marker, hs-CRP. Hs-CRP is a key inflammatory marker, so the highly sensitive or cardio C-reactive protein. And when I started checking this in my practice, it was crazy the things I would recognize. I mean, I would see clients would come in with an hs-CRP—I had one woman, she came in with a, complaining of everything, had been to her cardiologist, her internist, her family physician, her podiatrist, had all these other doctors. She came into me for, to see me for her pap smear. And she had all these symptoms. I said, “Well, let me, do you mind if I look at the labs you’ve had done?” And so of course they didn’t have hs-CRP, or, you know, many of the labs that we want. So I did one, and it was 111. And this woman, you know, was dead six months later. She had metastatic cancer. So did I do her a favor or not? I don’t know. But you know, if we found that earlier, man, we could have turned that around. We could have turned that around. So I think it’s really important to watch these inexpensive markers.  

The third test that I like to do is the DHEA-S, the marker of our adrenal status in the blood. Again, quick, inexpensive, and we can see how well our adrenals are working. We’re high under stress, often they’re very, those levels are very low. But we want to see what they’re doing over time. And sometimes they come in, and they’re way too high. They’re out of balance. But mostly we see them, and they’re way too low, especially in women over 40. And so we want to look at that level and see what we can do to optimize it. With the supplement I talked about, my Mighty Maca Plus, we’ll see a 70 to 200% increase in DHEA and adrenal function in two to three months. So we will see that improvement. And it’s important again, when you’re giving your client something they’re paying money for, you want to see those numbers improve.  

And the fourth test is the hemoglobin A1C. So of course we want to get that number as low as we can get it, you know, around below five, 5.0, 4.8. We want to see that good hemoglobin A1C drop, and we can actually see it drop very quickly. If you’ve got a cantankerous patient, and like, you know, two months out, you know, they’re not going to wait two months to see a change. You can actually, if you’ve, like we’ve put clients in the keto-green lifestyle rechecked in one month, and we’ve seen hemoglobin A1Cs drop from 6 to 5.4. I mean, technically, that’s unheard of, right? We always wait two months, but we’ve seen it over and over again. So I think those are four key markers. I’d probably add and give credit to Dr. Perlmutter, this fifth one, uric acid level. And I think many of us don’t realize, especially in doing a keto lifestyle, or keto-green lifestyle, or if we’re playing with carnivore or extended fasting, that those of us with a metabolic or genetic predisposition will make a lot of uric acid, and that puts us into a metabolic slowdown. So it’s important to watch that one too.  

Kalea Wattles:
Such good and helpful takeaways in terms of lab evaluation. So let me ask you this question. You’ve mentioned inflammation as a driver for a hormonal dysfunction. Let’s say a patient comes in. Their high sensitivity C-reactive protein is elevated. Do you find that when you start to address that underlying inflammation that their menopausal symptoms naturally improve? 

Anna Cabeca:
Absolutely, absolutely. So the two key reasons for over 90% of our illnesses are hormone imbalance and inflammation. You add in adrenal dysfunction, and you’ve got 99.9%. So address those three things, and you’ve empowered them to heal. And yeah, that’s powerful.  

Kalea Wattles:
Very powerful. You mentioned a DHEA sulfate. Is there a role for any cortisol assessment in this workup? 

Anna Cabeca:
Yeah, again, when you’re working with clients, I think it’s important to, you know, assess what they need at the beginning. Because again, like I said, I even created testing, full testing panels for women, including organic acids and essential fatty acids and ADMA. I mean, boy, we can get into it, right? And so, and believe me, I want to see all of that. So the four-point salivary cortisol is very beneficial. Urinary hormone testing, especially hormone metabolites to see, again, how that’s changing with time, especially if you’re manipulating their hormones. It’s important to look at those things too. And nutritional assessments, and, you know, of course digestive health and stool analysis are critical to the overall health of our patient. But you want to, again, figuring out. Because we just mentioned a couple thousand dollars’ worth of testing right there. You want to figure out, what do you need when? Like what are the biggest changes you can make now? What do you need to motivate the client? Where do you want to see them out? Where do you want to fine tune them next? I’ve made the mistake early on of like, think, okay, you need these 11 prescriptions or whatever, or these 11 supplements. It’s no better than prescribing someone 11 drugs, right? You got to balance that out with what you want to do. And sometimes we do have to be very aggressive very quickly, but oftentimes we can take, I say, the seasonal approach. 

Kalea Wattles:
I really admire this stepwise, like a first-tier lab ordering, and then we escalate from there. I think that’s really using labs diligently. One more question before we move on, because it’s just so interesting to hear your perspective. You said that a hemoglobin A1C is part of your workup. Are you finding that maybe your patients have had normal hemoglobin A1C their entire life, then they enter this menopausal transition, now all of a sudden they’re struggling with glucose regulation? 

Anna Cabeca:
Yeah, absolutely. Absolutely a part of this entire journey. And what’s interesting, when we look at the research published, looking at women who have had hysterectomies, and there’s a published study not too long ago, and it looked at women with hysterectomies and women who had a hysterectomy and their ovaries removed. So, you know, TAH-BSO, or you know, bilateral salpingo-oophorectomy, so immediate menopause. And what it showed that women who just average, no intervention, had, you know a, in menopause had a significant increase in risk of diabetes. But if you’ve had a hysterectomy, that risk was even higher. And if you’ve had your ovaries removed, your risk is even higher. So did a TAH, did a hysterectomy, and removal of the ovaries or, you know, cause that increase in diabetes, or was it the dysfunctional glucose regulation that caused the dysfunctional bleeding and the need for the hysterectomy to begin with? I would vote on the latter.   

So you fix that issue, and guess what? They don’t need a hysterectomy. And I did this in my practice. And so I was, you know, I trained at Emory, and I loved my training, and I loved surgery. I loved that quick fix. And as I got more in tune with, you know, hormonal management and functional medicine and integrative medicine, where I used to do two to three surgeries a week in doing this approach, which is called my keto-green, you know, approach, my detox, I went from doing two to three surgeries a week to needing to do two to three major surgeries per year. And those were usually in clients that came in and are too far gone, and I wasn’t able to reverse their symptoms or their pathology. But in general, I could reduce their need for a hysterectomy by over 90%. 

Kalea Wattles:
Well, I know everyone listening at this point wants to know more about this keto-green lifestyle. Will you tell us what that means? 

Anna Cabeca:
So the keto-green lifestyle, and it’s what I call it, right? Because when I was going through my second menopause, let’s say, at 48, and I gained that 20 pounds, that without doing anything different, I was terrified because I’d once been well over 240 pounds, had lost 80 pounds, and was pretty good at keeping that off, 70, 80 pounds off. And then I was, experienced that 20-pound weight gain. And anyone who’s lost a significant amount of weight, when you see that happening, you’re like, it’s not going to stop till I’m 300. What is going on here?  

And so I had a daughter. I have a daughter who has seizures. So I was already very familiar with, thanks to Dr. Catherine Willner, thank you, shout out to her epic history in functional medicine, but with the keto diet, so from early 2000s. And so I was familiar with it, and I used it in my neurologic patients. I used a modified keto approach in my Candida patients. And so anyway, so I’m using it myself at this point. I’m like, I’m not going to eat another carb. I can’t let the scale move up, you know, one more notch at all. And I felt like I hit a wall. I didn’t like how I felt, and I did what I tell my patients to do. Check your urine pH. And I was, my urine pH was as acidic as the pH paper read. So, and I think the minimum was five. So who knows? I mean, like I was peeing battery acid at that point. And that’s important, because men and women do keto differently. Men have 10 times as much testosterone, our anabolic steroid, right? Women don’t. And so, you know, we’re going to get into a catabolic state, a breakdown state, a lot sooner than men, especially doing keto. And so adding the, now the keto world says, okay, add minerals, add minerals. And so for me it was adding alkaline. This is back in 2014. I was adding alkalinizers. I was adding the greens, and the low carbohydrate greens like the kale, the beet greens, the sprout, the cruciferous vegetables for hormone balancing. And I started playing with the chemistry of food and working and trying to maintain that ketogenic lifestyle. And as my urine pH got more alkaline, and I stayed in ketosis at the same time, quite a challenge, which I challenge everyone here to do. And I, you know, I felt like, you know, it says in the Bible, the peace that surpasses all understanding. Nothing in my crazy outer world had changed, but I was better. I felt better. The weight came off. My moods were better. My memory cleared. I’ve since authored three best-selling books. Couldn’t have done that before this time. And that and this physiology, I can talk to you clearly, I can present, I can write. That keto-alkaline state is really important to bump into that on a periodic basis. So that’s part of the keto-green way with intermittent fasting.   

So I tell my clients, for women, I have recognized that it’s often, again depends, everyone’s different, and I recommend you try what works best for you and then keep changing stuff. So the, you know, breaking fast. So it’s intermittent fasting, breaking fast at 10 am, so approximately 16 hours between dinner and breakfast. Start at 13, work your way up to 16. And 16 hours of intermittent fasting. And then say, for example, breakfast is a smoked salmon with olive oil, onions, capers, some arugula, and you know, again, drizzled with olive oil. I mean, it’s just amazing. So, and some sea salt on there, that’s a perfect keto-green breakfast. And your blood sugar, and I wore it for my second book, Keto-Green 16, I wore in 2015, sorry, 2018, ’19. I wore a continuous glucose monitor the entire time. So I made sure that my blood sugar didn’t elevate with those, the new recipes I was creating as well as the old ones. And so, you know, you want to keep a breakfast, when you break fast like that, healthy fats, high quality proteins, low alkalinizing carbs, your blood sugar stays stable, and you’re not hungry. So you can have two meals a day. You can have, you know, two, three meals, no snacking, no more snacking for, you know, there’s very few reasons, if ever, to snack. Only if you want to. So, but physically for health, there’s very few reasons. So that’s part of the lifestyle.   

And you have a, I usually say an eight-hour eating window, but you can shorten it and extend it, again, to have that flexibility, that variety. And say dinner is a stir fried—some stir-fried vegetables with, you know, I like steak, so steak, or some seafood, or buffalo meat, and ground meat, and add in some great flavors. I use a lot of herbs and spices. Seven spices, allspice is another great, it makes everything taste better. And that would be a really healthy dinner. And then, you know, drinking in between your meals, not with your meals, so you don’t dilute your digestive enzymes. And then having a good evening ritual so that you’re, you know, really getting to deep restorative sleep at night. Part of the keto-green lifestyle is positive mental attitude, practice of gratitude, intermittent fasting, making sure you’re getting healthy fats, high quality protein, enough protein, and the alkalinizing vegetables and fermented foods to support your gut and detoxification pathways. And then enough time for your body to rest and digest. So that’s part of what is the keto-green lifestyle. 

Kalea Wattles:
Well, that sounds lovely to me. Are you using this plan mostly with women who are in their menopausal transition? I can see how there might be benefit for PCOS and other metabolic situations as well. What’s your ideal candidate for this type of nutritional plan? 

Anna Cabeca:
Well, I think the biggest thing is if it works for a woman in menopause, because we are difficult, it works for everyone. And that’s what we found. We’ve run groups. Dr. Angeli Akey out of Gainesville, Florida, has run since the, you know, 2020, like at, through, before, and through the pandemic. I think we had one keto-green group go before the pandemic, and then we were virtual after the pandemic started. But we were able to look at our two groups before the pandemic. So we’re able to look at labs and have people doing it together. You know, husbands, wives, families, all doing it together. And certainly, in my family that we’ve all done it, you know, most of us will stay, you know, bump in and out of it periodically. But all ages are, I mean, it’s again, it’s good, whole foods, and that is good for any age. And reducing sugar intake is really powerful. 

Kalea Wattles:
Well, as we’re talking about all of these lifestyle factors, we know that the incidence of early-onset menopause is increasing, and that there’s some thought and some research that’s pointing to endocrine-disrupting chemicals and estrogen mimetics. Are there some other precipitating factors that you’re thinking about? I feel certain that there’s a lifestyle component here. 

Anna Cabeca:
Oh yeah, absolutely. Certainly it’s the higher glycemic food, but the endocrine disruptors are huge, and many that we haven’t even had control over, what’s in our water, what’s in our air, what’s in our, you know, the umbilical cord blood during pregnancy. I mean, all of those things we have exposure to. It’s really important to understand that and to minimize, reduce exposure as much as possible in our food system, right? The food we eat, you know, it matters what they ate and how they were, what they were injected with, and how they were treated, all of those things. So we look at the life force continuum cycle. All that’s powerful. Stress is one of the biggest physiologic shifters in hormonal health that I’ve seen, though. 

Kalea Wattles:
Well, you’ve given us so many ideas to treat not only a menopausal transition that we would expect but also a premature hormonal transition. So my question, this is maybe the most loaded question of the episode, can we reverse premature menopause? 

Anna Cabeca:
I did for me. I did for me, and I have in several of my clients, and you know, I think, hopefully countless more. So in my community, in my Girlfriend Doctor community, we’ve had clients that hadn’t had a period for three-four years and start having periods again. And that’s a hallelujah moment. You know, once we rule out, like I’m a gynecologist, and once we rule out any endometrial issues, ovarian issues, we’ve done a pelvic ultrasound and an endometrial biopsy, then we can say hallelujah, we have just reverse-aged you a decade. And that is powerful. So being able to do ovarian resuscitation, I mean, this type of practice through diet and lifestyles and adaptogens and supplements, and maybe we’re using some peptides too. I mean these things can really, really help. And yes, I’ve seen it reverse. And we, you know, and we’ve seen, you know, spontaneous pregnancies in the, you know, in their later 40s when they weren’t expecting it. Some were very happy. I think most were. 

But you know, be prepared, right? You cannot… And so it’s fascinating, right? These things make a difference. And I’ll give you an example for the guys out there that are listening and are caring about their women’s health, but also just in general for male fertility factor. So we have a case where a guy was infertile for, you know, much of his adult life, went through fertility treatments, was told he had low sperm count, and you know, a single, enjoying his single lifestyle. And so he, during the pandemic, he’s like, “I’m going to get healthy.” He’s upping his vitamin D, his vitamin C, his zinc. And lo and behold, he now is a father of two children, and he is 48 years old. And he was for 20 years with diagnosed low sperm count. So the supplements that we do can really affect our fertility. And the lifestyle, right? Choosing to be healthy, choosing to pass the alcohol, you know, pass by the alcohol, pass, you know, really support our body’s own natural hormonal regeneration. I mean, that’s powerful for our body. So it’s something that should be done as part of wanting to age gracefully, so… 

Kalea Wattles:
Well, I think this really goes back, how you said, when we start optimizing all of our body systems, it gives us hope. We’re turning over stones that no one has turned over before. And I think that that’s a great example of that point. 

Anna Cabeca:
Yeah. And that gets me onto a tirade. Like what are you doing not using a condom anyway? And first of all, ladies, why aren’t you demanding it? And secondly, you know, do you really want to swap microbiome with someone like that? No. 

Kalea Wattles:
We’ll be careful who we share our microbiome with.  

Anna Cabeca:
That is right. That is right. 

Kalea Wattles:
Well, I think related to the functional medicine matrix, we talked about the center of that matrix, which is the mental, emotional, spiritual concerns. And during menopause, we’ve covered so many of the physiological changes, but there’s also this mental-emotional shift. And we mentioned at the beginning of the episode that sometimes that affects our sexuality, our libido, our arousal. You even mentioned our ability to orgasm. What are some of the underlying factors that might impair our sexual function, make us feel disconnected from our partner? 

Anna Cabeca:
Yeah, so that’s really great. Definitely the cortisol-oxytocin connection-disconnect, right? So when you’re in this state when, you know, like when cortisol’s high, oxytocin goes low. Because like when you’re in fight or flight, it’s not the time to, you know, stop and hug your neighbor, right? You’re not going to hug your enemy. You’re in this stressed state. Makes sense, right? Cortisol goes up, oxytocin goes down. That’s the hormone of connection. And when it’s up, when cortisol’s up for a long time, like our paraventricular nucleus in the brain will shut down that production of cortisol. So now you’re in this dangerously, this dangerous space where cortisol and oxytocin are both low. So that’s going to create that disconnect. Also that low libido, it’s not the time for reproduction. It’s, you know, more associated with infertility during that time. So you know, decreased fertility at least, right? And so that’s important physiologic… And as our, you know, progesterone starts to decline, that’s our mother hormone. So from there we’ll derive DHEA. And then from there, estrogen and testosterone, more of the reproductive hormones. When we’re in stress, we’re producing less of those reproductive hormones. So less desire, right? We’re in fight, flight, or freeze state. And I will say flight is that escape. I want to escape my work, I want to escape my family, I want to escape my country, whatever. When you’re feeling those things, that’s physiologic. And our physiology affects our behavior, our mental health and mental well-being.  

And in my, one of the areas, I lecture on sexual health all the time, and I say this low sex drive comes from really three areas we have to investigate. The first is desire. Why is desire low? And second is disconnect. You know that sense, it’s physiologic disconnect. You’re not connected. You’re not getting along. You’re not going to want to make love. You’re not going to want to have sex. When you’re in that disconnected state, you’re not going to want to do the things you enjoy doing. And oxytocin’s low. It’s actually the time when you really need to be doing those things. And the third is discomfort. If you have discomfort every time you do something, if you have pain every time you do something, why would you want to? Early in my gynecologic career, I had a patient come to me, actually back in 1999. So in the way back. She came to me and she said, “Dr. Anna, I have been diagnosed with ductal carcinoma in situ of the breast. My husband and I have been married for 28 years, and I am a woman of the 60s. I want to have sex. It hurts every time I do. I’m dry. No doctor will even give me estrogen, and I’d rather die than live this way.” And she’s like, “Help me.” And I was like, “Shit, I got to help you.” I was straight out of residency. I’m like, well what’s in my doctor’s bag? I didn’t have anything in my doctor’s bag. So that led me in this field of sexual medicine and understanding, well, what’s the research say? Yes, we can use vaginal and topical estrogen. Yes, we can use DHEA and testosterone. We should be able to use these things, because from safety profiles, and the breast tissue, it’s not going to—if anything, it will help not hurt. And then of course I’m like, I have to consent you out the yin yang. If you want to try this, you know, I’m going to consent you, and you’re fully owning the, you know, risks, and you know, potential risks and complications of this therapy as well as acknowledging that there’s going to be tremendous benefit.  

So that’s where I really started looking at androgen prescribing. And especially with DHEA, very safely. In the US, it’s over the counter. I created a cosmetic cream, so topical for clitoris to anus. Because people forget about the clitoris, and you cannot, because it is the number one pleasure area on a woman’s body, and it’s important. It will atrophy and shrink as we get older unless we keep it nourished and rejuvenated. And we do that with hormone and pelvic floor exercises and attention, right? So, and then all the way, the vulvar tissue and vaginal tissue, these topical hormones can absorb into the vaginal tissue because it’s so vascular. So we reverse vaginal atrophy. And I have a client who’s been using my product for a long time because when I stopped, when I closed my medical practice, I stopped prescribing. And then when I moved to Texas, I didn’t get my Texas license. I’ve been on a hiatus. But I wanted, way back in 2015, to create something over the counter that was better than anything I could write on a prescription pad. So women didn’t have a barrier to be able to use, you know, something like this. So I created the first vulvar cosmetic cream. And then don’t forget the anal tissue, anal fissures, hemorrhoids, very common. I see this often in the, my gynecologic practice. So, you know, being able to use it clitoris to anus is really very important. And so that’s topical DHEA. Very safe. The work of Fernand Labrie out of Montreal; he’s been studying this for two decades now. It’s really powerful, good and safety-studied. The work of Rebecca Glaser, some of her testosterone research was, you know, gave me some confidence to be able to play at least with DHEA, and then I added plant stem cells to my formula. But it’s important to use this. Because if you have pain every time you do something, why would you want to? As patients told me, “Dr. Anna, you know, I, you know, I just power through because I know I’m supposed to as a wife, or I’m supposed to enjoy it, or after, you know, like a few times or a few dates I’m drying up and it’s, you know, something wrong with me. Am I broken?” I’m like, “Oh, we can reverse that.”   

And I have a patient, as I started to mention, who’s been with me using my product since it came out, and she’s 67 years old now, and she’s like, she is very proud to tell everyone she has the vagina of a 25-year-old. And I say there is no better anti-aging marker than that. So pay attention. I mean, you can reverse that, the aging of that vaginal tissue. And with that, you’re going to enjoy sex more, and you’re going to have more oxytocin, more pleasure, less incontinence, be able to run, jump on a trampoline, enjoy activities, go out on a boat for six-eight hours and not worry that you’re going to have an accident. I mean, things like that that have limited the lifestyle of, you know, women through the ages, but especially menopause and beyond. And we don’t want to have limitations. We want to be limitless to the best of our ability. 

Kalea Wattles:
Limitless, really improving quality of life and letting your patients return to doing the things that they love and gives them meaning and purpose. I think that’s beautiful. So it sounds like you’re using topical hormones for the most part. And menopausal hormone replacement therapy I think remains somewhat controversial. Is there a role, or how are you utilizing oral hormones? Is that coming into play in your practice as well?  

Anna Cabeca:
Yeah, so, and this is an area too. You know, I really do think that hormones, you know, particularly progesterone with or without a uterus into, you know, post-menopause is a really important tool for us to use and not be afraid of using it. Progesterone is a neuroprotective hormone that topically or orally is not associated with any complications. You got to watch the dosages you’re using. I use topical progesterone pregnenolone in a lot of my clients, and definitely post, you know, post, during menopause and beyond. I think it’s key. Again, with or without a uterus, it’s so important to balance the hormones. And DHEA, testosterone, estrogen.  

Now the question is oral versus transdermal. And that’s a really good question. The safest route we go is transdermal. There are benefits early, you know, for oral estrogen. But you know, typically I don’t keep anyone on oral estrogen past age 55 because of its proinflammatory reaction. It’ll cause an increase in hs-CRP, and we’ve seen it. So switching to transdermal, you completely, you know, avoid that risk or complication at all. And so I think that’s where, like we have to get comfortable prescribing hormones, you know, post-menopausally. And I like to customize. So when I work or consult or do physician to physician consultations, we talk about customizing hormonal care. So using topicals or troches. Now troches, that’s that oral-transdermal. You know, you’re getting some orally with that troche. So you got to, you know, pay attention to that too. Watch the hs-CRP if you’re using a troche. The benefit of using the troche is that, so it’s like a lozenge that dissolves between the cheek and gum. And you can, you know, periodically, once or twice a week, use that same dose troche intravaginally and keep the, give that added boost to the vagina. So as physicians, you can prescribe that way. It’s like the little bonus from that troche. 

And then, and transdermal creams as well and being able to use them in different areas in your body, and you know, and customize that care. And I, you know, I’ve dug into this because I really work hard to empower my patients to take, you know, with the guidance of a good physician, to be empowered to make those decisions. What, you know, what’s the best diet and lifestyle? What’s the best, you know, workout regimen? And may have to change it up a few times, right? What’s the supplements that we need to use, or, you know, cycle in and cycle out of? And what’s the hormonal therapy that’s the best hormonal therapy? What else can I do to support aging gracefully that’s going to honor my body’s own ability to make hormones versus suppress them? And I think that’s, those are the key things that I want practitioners, prescribers to really recognize when we’re using hormonal therapies too, especially. 

Kalea Wattles:
Well, this is personalized precision medicine at its best. And now we’ve talked about lifestyle factors. We’ve talked about hormone replacement therapy. I cannot let this time go by without talking to you about oxytocin because you’ve mentioned this a few times, and it seems that this is a therapy that we can use to help ease the transition and really empower our patients and their sexuality. Will you just give us a brief primer of how you’re using or supporting oxytocin in practice? 

Anna Cabeca:
Yeah, certainly, the oxytocin is free. You make it naturally, and you want to keep making it, right? So, but this is the interesting—again, I have a full chapter on this in my book, The Hormone Fix. But the thing is, with oxytocin, so naturally you increase it by, you know, making love, having orgasms, hugging, kissing, laughing. So I always prescribe my clients My Big Fat Greek Wedding. That is like the best oxytocin-increasing movie there is, right? So something like that. You know, and then play, having a pet, playing with a pet, doing things you enjoy doing, gratitude, charity, giving, all of those things increase oxytocin. Sometimes when you’ve had post-trauma, when you’ve had trauma like I’ve had trauma, many listeners here, patients have had trauma, then you have decreased levels of DMT, you have decreased levels of oxytocin. So you want to really make the, when you don’t feel like making oxytocin, you need to make that a habit.   

So things that can help improve oxytocin naturally is certainly, you know, again, like for me that’s why the keto-green diet and lifestyle is built around certain foods like the fermented foods and things that we know that can help, you know, nourishing our body, our brain, et cetera, and possibly increase our oxytocin in those ways. And also things like, if we need to, prescribe oxytocin. Again, like anything else, if we prescribe it daily long term, you’re going to suppress the body’s own ability to make oxytocin. So we don’t want to do that. So prescribe it in a pulsatile, as-needed basis. But for many of my clients have burnout, exhausted. They’re struggling with work, and they’re coming home from work exhausted. I have an ER physician, and she would come home from the ER totally exhausted. Her teenage children, you know, like they, she said, “I had zero at the door. Opening the door, I had zero to give my children.” And so we worked on all of these things, but in the meantime, I gave her oxytocin. So I would prescribe it in a troche, and I would give it to her to have to take on the way home from work. So, and you know, to work on a meditation, listen to great music, do these other things to increase her oxytocin by the time she got to the door, as we worked on, again, decreasing cortisol. Because you can imagine how stressful an ER physician is, but so many of us experience it in other ways. And work to regulate her cortisol and naturally get her body to start making more oxytocin again too. So there are ways we can prescribe it and not to be afraid of doing it, but to pay attention to that. God, I can go, I can give a five-hour lecture on oxytocin. 

Kalea Wattles:
Well, I can sense your passion for this subject. And Dr. Cabeca, I just wanted to thank you so much for sharing all of these insights. You have filled our toolbox with so many strategies to support menopausal health, hormonal health, sexual health. We so admire your work. Thank you for spending time with us today. 

Anna Cabeca:
Thank you, it’s a pleasure. And I would just let a note, you know, that I will be doing a hormone replenishment certification program. Would love to be able to offer that to your listeners too. And definitely connect with me at DrAnna.com. 

Kalea Wattles:
Thank you so much. 

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Show Notes: 

Find out more about Dr. Cabeca and her work on her website: https://drannacabeca.com/