Ep #193: How to Treat Sexual Issues That Arise in Menopause with Dr. Anna Cabeca

By: Dr. Sherry Price

How to Treat Sexual Issues That Arise in Menopause with Dr. Anna Cabeca

Are you going through perimenopause or menopause and experiencing vaginal dryness? 

Decreased libido? Or vaginal changes?

If you’re looking for advice on how to manage symptoms ‘down there’, then this podcast episode is for you! 

This week, I am thrilled to talk with Dr. Anna Cabeca and have a powerful conversation about how women can take charge of their sexual health and master menopause!  This topic is near and dear to my heart (and the reason I launched my Mastering Menopause program).

Dr. Anna Cabeca is the best-selling author of The Hormone Fix, is triple board certified, and is a fellow of gynecology and obstetrics, integrative medicine, and anti-aging and regenerative medicine. She holds special certifications in functional medicine, sexual health, and bioidentical hormone replacement therapy. 

She is known nationally as “The Girlfriend Doctor” and hosts The Girlfriend Doctor Show. She has personally developed natural products to help women balance their hormones and thrive through menopause 

Join us as we discuss perimenopause, menopause, and three key hormones that are majorly impacted by menopause.

What You’ll Learn in this Episode:

  • The hormonal changes women experience in perimenopause and menopause
  • Common misconceptions around hormone therapy and what the latest research has shown to help women with this big life transition
  • The little-known relationship between cortisol and oxytocin and why these hormones matter 
  • How to increase your sexual health and intimacy during menopause and beyond 
  • Why balancing your hormones leads to achieving optimal health

Featured on the Show:

[00:00:00] [00:01:00] Well, Dr. Anna Cabeca, I am so honored to have you on the podcast as a triple certified physician master of menopause. And I’ve Been learning so much from you through A4M meeting and following you on all the platforms. And I just really want to thank [00:02:00] you before we get started and thank you for coming on the podcast today.

Oh, it’s my pleasure. You know, there’s a saying that your mess becomes your message. Yeah, I’ve learned a lot of what I know through my own messes and history. And so, you know, being here with you and to talk about this to your audience is truly an honor. Thank you. So I thought we would start, you know, I’ve read your awesome book and I highly recommend it to anybody who’s going through perimenopause and intermenopause called the hormone fix.

I’m holding it up right now. If you’re watching the video portion of this podcast, it really learned a lot. And I thought we can start with, you know, talking about that perimenopausal time for women, what’s going on in their bodies. We can dive into , menopause and what happens there. And then where I want to take this conversation after that is really looking at those three key hormones that you talk about and how they go awry.

And then we’ll go into other things from there, but really focusing [00:03:00] on first, what happens to our bodies during perimenopause and into that menopause and that transition time. Yeah, and it’s again there’s so much complexity to it and each woman is individual with based on what their stress level is, how well they’re sleeping, what hormone disruptors, what their genetics are, and their nutrition and lifestyle, all those factors come into play with how we transition.

But typically what we see is that. In our, you know, for both men and women, actually, in our mid to late 20s, we start to see a decline in 1 of the precursor hormones to testosterone and estrogen and that’s one of our adrenal hormones is produced 5050 in reproductive ages, 50 percent ovaries or testes and 50 percent adrenals.

But in our adrenals, our stress gland responders, you know, as our reproductive hormones start to wane, ovarian function starts to decline, we rely on our adrenal glands to make more of that hormone and from we [00:04:00] make testosterone and estrogen. So, with a declining, we start to see a slight, very slight dip in testosterone and estrogen, but in our mid thirties to, yeah, mid thirties.

To mid forties, late forties, we start to see a really rapid decline in progesterone. So, by, you know, from age 35 to 55, it’s estimated that we’re producing 75 percent less progesterone and. And that’s significant because progesterone is our mother hormone, and when we think of the hormone cascade, we make our hormones, our mother hormones, progesterone and pregnenolone, from cholesterol.

And so so as our ovaries start to decline in function, we start to make less cyclic progesterone. And again, our adrenal glands have to pick it up. And so midlife tends to be a. Perfect storm of things happening, you know, maybe we’re raising teenagers or just getting into empty nesting and maybe work has [00:05:00] more challenges while our bodies , is facing its own challenges to with these natural hormonal transitions.

So, working on those things can make a really make a big difference as our hormones are changing and then our estrogen and testosterone will decline and continue to decline. You know. through the rest of our life, but still be produced at some levels while post menopause. So as long as we can maintain healthy ovarian functions associated with longevity.

Yeah. And I think that’s really important for people to understand that this is physiologic, and what is actually going on in our bodies. So when I noticed a reduction in progesterone is that. I started to notice that I wasn’t feeling as happy. I wouldn’t say I felt depressed. To me, depression is more clinical.

I felt like just a little bit lost myself a little bit more blue or [00:06:00] a little more sad, or just feeling like a little off and maybe not as motivated to go to the gym or take care of myself or eat healthy. And I felt that, you know, Being put on progesterone really helped that. And then learning, you know, Oh, this is natural, right?

It’s not something that’s, a disease, right. But something that’s natural, that’s happening to my body. And I really like learning about how that wanes and just by giving back. A little bit of hormones can really help rectify some of those symptoms. What are other symptoms that you feel and you find that are common in your practice for women making this transition besides the anxiety and feeling a little blue?

So along with that is the difficulty sleeping. Right. We see that a lot difficulty sleeping and, you know, in for gynecologist, we see the irregular menstrual cycles, the breakthrough bleeding, the heavier than normal periods, the more painful menstrual cycles. [00:07:00] Those things are happening at the same time.

So those. Gynecologic issues are happening at the same time as the neurologic issues, like you said, the moodiness worsening PMS, anxiety, irritability, feeling more brain fog, less, you know, like I’ve lost my edge type of feeling. And until recently, really, Sherry, like one of the things that I didn’t recognize, I always look at the combination of Our hormones and our neurotransmitters like progesterone supports GABA, which is our hormone.

And I, you know, it’s like, think of GABA, think of the rock group ABBA, think of like just Mamma Mia musical and think, Oh, that feels good. Right. It’s a feel good hormone. And estrogen relates to serotonin, testosterone relates to dopamine or drive or drive hormone. And as like, you know, when you get into this fluctuation of what’s really happening, I realized that progesterone also supports tryptophan.

Which is a [00:08:00] precursor to serotonin, which is a precursor to melatonin. So affecting our sleep and during this time, if we’re not making enough progesterone, we don’t have enough circulating tryptophan. So less 5 hydroxy tryptophan and estrogen support serotonin. So, if our estrogens also declining, we’re making less serotonin.

So, so we’re having more anxiety, mood disturbances, less sleep. You know, bright colors and enjoyment in life, and that’s affecting our quality of life. So it’s coming at us from both ways, making less serotonin and then from serotonin, we make melatonin our sleep hormone. So in this cascade is there’s this function of like, I will say, you know, we have a bucket of hormones and in perimenopause and menopause, , we’ve got to fill back up our bucket, but we also have to plug those holes.

So, hence this whole rejuvenation perspective and where I like to say it takes more than hormones to fix our hormones because we got to keep our, we got to [00:09:00] plug those holes and keep our buckets full as, as long as possible, but that whole, you know, cascade between progesterone and tryptophan to serotonin, estrogen to serotonin and then melatonin.

If we’re just addressing , the end stream results, like we’re giving you anti anxiety hormones, or anti anxiety prescriptions like SSRIs, we’re giving you sleep meds. I mean, those are two of the most common prescriptions that are prescribed to women over 50. And add in the anti inflammatories and,, digestive support supplements or the antacids.

And so those are the 4 most common prescriptions. And if we never address the underlying reasons for those hormone imbalances, we’re just putting band aids on. And before, you know, people are on multiple medications, treating side effects of medications and never getting to the root cause. So, I think that’s the perspective that.

is critically important. Then from melatonin, one of the metabolites we make [00:10:00] is oxytocin. So, you know, it’s like creating that deep restful sleep, feeling connected beyond the insulin, cortisol, those other major hormones I talk about. This cascade also decreased sleep, more depression, feelings of isolation, you know, feeling like you want to create a smaller world, doing less of the things you enjoy.

Also, cause we’re making less oxytocin unless we focus on these major, you know making more oxytocin naturally our bodies and incredible pharmacy better than any drug store you can go to. So making our own oxytocin and supporting our bodies at the drain on our reproductive hormones from stress and cortisol.

Yeah, and I think that’s so important for women to hear, not that prescription medications are bad per se, and we’re not saying that, but, you know, you know, just throwing out a prescription for anxiety or for sleep you know, or for [00:11:00] an acid, because now you’re, you have got issues. And really not addressing the root cause.

And some women turn to alcohol, right? Because they’re feeling emotionally, not themselves. They’re not really understanding what’s going on with them biologically. And it’s coming and being expressed like emotional volatility., And they want to maybe isolate, like you said, because of all these changes.

And so getting to that root cause and really treating with something that’s going to help all of that. And getting to actually what is the root cause I think is so helpful. So I want to talk about why, we have been so fearful of hormones. I know I’ll bring my bias is that in pharmacy school, we talked about, you know, Hormones were dangerous.

Unless you’re just using birth control. There’s, you know, the side effects that we learned about that came out in the women’s health initiative. And of course that scared everybody, but looking at the reanalysis, I don’t think that’s gotten enough attention and enough press. And I love how [00:12:00] yourself and other Clinicians and practitioners and doctors are talking about, you know, the redo of that study.

I mean, the re analysis of it, and we were wrong about some of that. But I think there’s just widespread fear about hormones. And can you talk about any of that? And how you work with your patients to understand that bioidentical hormones. Can be a wonderful thing to add to a woman and helping them transition during this time.

Yes, absolutely. Because again, there was so much fear. I was early in practice. I trained at Emory University in Atlanta as a gynecologist and obstetrician. So I was like you said, brainwashed on, you know, the birth control pills and. Prim Pro, and then I started looking at some of the earlier studies, even as I was completing my residency on Prim Pro, because during my residency, I participated in an arm of the HIRST trial, which was the, you know, heart disease and estrogen replacement [00:13:00] study.

And I was looking at, okay, well, you know, an aspect I was studying and researching an aspect of that trial in communicating with physicians about hormone replacement and what your, Physician , what did they tell you about it? So it was really interesting. And so I started seeing, okay, well, you know, we’re not seeing great cardiovascular benefits, but like, this doesn’t make sense because by, you know, the hormones are designed to be neuroprotective, breast protective, bone protective, and so, you know, maybe it’s the type of hormone we’re giving.

And it’s also the root of administration. So those two aspects were, you know, in the forefront of my mind. Now I was a research scientist. Before I went into medical school, so I had this and I did exercise and respiratory physiology research. And so, you know, I had this, you know, I always like to understand the mechanism of action of these drugs and these medications.

What’s the mechanism of action? So, when the Women’s Health Initiative trial came out, , and in 2002, I remember the day, because I’m in [00:14:00] practice in Southeast Georgia, and, you know, like, you know, I just had to pause for a moment and look at the data. I went to the data, and I was like, okay, well, what’s going on here?

Okay, the estrogen only arm. looked at, did not have an increased risk of breast cancer, but is associated with increased risk of heart disease and stroke. Will oral estrogens increase inflammatory markers? And so that made sense to me. And then the progestin arm increasing the risk of breast cancer was like whoa.

What’s going on here? It’s not progesterone. Progesterone should be breast protective because it affects the P53 enzyme inducing apoptosis, which is natural cell death and , typically unhealthy cells. So what’s going on? And then, and so I really, I did an analysis of that and and also showed the protective effect on colorectal cancer and the estrogen arm as well as decreasing osteoporotic fractures.

I think we had all that in 2002. [00:15:00] And so that was fascinating to me and had to really look at what I was doing. I said, well, why don’t we use at that time we had prescription Prometrium. And I was just, you know, in 1999, I started working with compounding pharmacists to help with my breast cancer clients, looking at, you know, their, Ability to help them with, you know, sexual health issues and desire and vaginal dryness consequences, and the consequences that come from post breast cancer treatments in so many clients.

So I’d already started working with Bioidentical, but we had Prescription Prometrium, which is a bioidentical progesterone. And in 2005, Dr. Fornier out of France, published in the E three N trial, the bioidentical progesterone oral form compared with oral forms of progestins, including medroxyprogesterone, which is Provera, as well as nor, like for example, norathindro, norpregnane derivatives.

In other words, [00:16:00] different formulas, and this can be technical for people, but stay with me for a second. So we looked at, okay, well, these are not identical to what your body’s making. I think God has more wisdom. Mother nature has more wisdom. Then we do in general and understanding the nuances of the pharmaceutical preparations compared to what our body’s making naturally.

And so that E3N study showed, okay, well, biogenical progesterone did not increase breast cancer and the synthetic progestins, especially provera had a 4 times increased risk of breast cancer. And then the nor pregnant derivatives a little bit less. And, but they all had a significant increased risk of breast cancer compared to progesterone, which did not.

So, from there, 2005, there was like, no chance I was prescribing, with rare exception, any synthetic progestins because they don’t work. Well, plus my patients. would feel so much better when switched to a bioidentical form. [00:17:00] And that was, you know, that’s better than any study. And when your patients are coming in and say, Dr.

Anna, I’m sleeping better. My mood’s better. The world’s in technicolor now, instead of shades of gray, I’m just feeling so much better. You know, you know that you’re onto something, right? Because it’s just substituting one for another and they were doing better. And you know, that, that’s convinced me. And from there, formulating, you know, combination bioidentical hormones with testosterone and DHEA, using vaginal preparations for bladder health and sexual health and orgasm, it just seemed like, okay, well, you know, this is the safest way to go in optimizing hormone balance.

But the world was already scared of it at that point. And so you know, , through my own work and research and clinical experience, I started lecturing and writing about what I was finding and seeing. Yeah. And thank you for explaining the differences between the [00:18:00] progestin, which is not bioidentical, the MPA that was used in the Women’s Health Initiative, and the reason we saw some of those effects.

And why we’re proponents of bioidentical because they are safer and the natural type that our bodies produce. So thank you for separating those 2 out and discussing some of the history around that and where the fear came from. And so it’s understandable that if you haven’t been keeping up on the data or learning, in addition to what came out beyond the women’s health initiative, right? You may not know of these beneficial effects and not maybe every practitioner does and find finding 1 that can really help you get the resolution of symptoms that you need because you deserve it. And I want to talk about something that I feel you’re so versed in that I’ve learned actually the most from you is this relationship.

I knew cortisol, the belly fat you know, estrogen could come from belly fat and cause more visceral [00:19:00] fat, which is the most dangerous kind. But I wasn’t. So clear on the role of oxytocin. And I learned from your book and your lectures about, you know, when cortisol is up, oxytocin goes down and just how prominent, the symptoms can be of that and how to reverse that.

So can you educate my audience a little about this relationship between cortisol and oxytocin and then the benefits of oxytocin therapy? Yeah, and honestly, if it hadn’t been to my own person for my own personal experience, I wouldn’t have realized it myself. It’s not something we’re trained in or taught was never anywhere published per se and, you know, certainly not in women’s health at all in some trauma PTSD.

I learned from Dr. George Crusos who studied PTSD in children and their effect of you know, persistently dysfunctional adrenal dysfunction, as well as lower oxytocin [00:20:00] levels. And I started asking questions because one thing for me through my own personal journey and my trauma, and I write about this in my book, the hormone fix, I share that part of myself.

And I’m again, with gratitude for all my patients who have shared their stories with me as well. And I through our trauma, I had significant PTSD. So post traumatic stress disorder, combine that with Daily, everyday chronic stress, man, you’re in a, you know, I was in a perfect storm. And for my relationship with my husband at the time, we knew we wanted to keep our marriage together.

 But, you know, eventually it was like, you know, I know I love my husband. I don’t feel love for him. And I remember thinking that I just don’t feel love for him. I’m completely disconnected from him. I’m was burning out from my practice that I loved, you know, that I, built with my own two hands, practically.

I love my patients, but I just didn’t feel like going in anymore. I was burning out in so many ways in that physiology. So I’ve recognized that [00:21:00] when improved my stress response, when I empowered the practices that increase oxytocin, I felt better. I felt more connected and I didn’t learn that until after I was divorced, but this was that thing.

Okay. In the back of my mind, why did I feel such? Disconnect. I mean it was a tangible disconnect. And so, what happens is when cortisol goes up, oxytocin goes down, which makes sense because when we’re in that fight flight mode, when we’re in stress, when we’re, you know have an enemy that we’re facing, there’s no time to love and hug and connect and relate, you know, with that enemy.

, you’re not in that place. So oxytocin is low. And when cortisol is up for a long period of time, a protective mechanism in the brain says, okay, you’re frying me out. I’m going to shut you down. And so cortisol then gets suppressed. It’s not like the, you know, our [00:22:00] adrenals don’t fatigue. They get dysfunctional, but they don’t.

fatigue. It’s not like they’ve shriveled up died off, for instance. We don’t lose the cell mass of the adrenal glands per se but we get this suppression of cortisol because it is that, you know that, you know, you’re frying me out, but when cortisol is low and oxytocin is low at the same time, it’s that physiology of disconnect, that physiology of I’m going to talk to you today about the physiology of burnout, the physiology of divorce, the physiology of, I know I love my work.

I love my family. I just don’t feel love for them. And as I saw that, and I made that connection in myself, I started asking my clients and my patients and I would, you know, I remember a client came in who was a veteran from a foreign war and said to me, you know, I go into my, I go into my house and yeah, I know I love my family.

I just don’t feel love for them. Say the same thing, right? Say the same thing. So I started digging into low oxytocin, physiologies, like for [00:23:00] example, autism, low oxytocin, unable to make eye contact, can’t be touched. You know, you have that lack of intimacy and connection. In PTSD, there’s that disconnect, that withdrawal, that.

Loss of emotional intelligence or not intelligence per se, because the intellect is there, but the emotional, capacity. Thank you. And so, so we started, you know, looking at clients like that or someone with a post a very traumatic birth and feeling like I can’t connect to my baby.

You know, like this, you know, I had a stat C section, wasn’t able to breastfeed, you know, just don’t feel connected. And so we’re, as I started seeing this, like, you know, everywhere, and there’s a saying that we learned in surgery at Emory, it was the eyes don’t see what the mind don’t know. So once my mind knew it, I started seeing it everywhere and I started digging into the [00:24:00] research and finding, you know, more of the science of it.

And this really the energetic, that our hormones are energetic molecules more so than chemical molecules. And so we give off this energy when we have high oxytocin, good levels of serotonin, progesterone, we have this, you know, higher energetic vibration versus when we’re high cortisol. Low oxytocin is like stay away from me, right?

So , there’s an energy to this and so it started looking at the energetic medicine quantum physics and those components of, how that also is related into our energy, our sense of get up and go or enjoyment in life and joy. And so this whole process was really through my own struggles.

And then when I realized , when cortisol goes up and oxytocin goes down, we’re in this acidic state in our body and that’s like a catabolic state, a breakdown state. And we feel it. Our [00:25:00] hair gets weaker, our skin wrinkles. I mean, look at any president before and after term, they age rapidly.

And, but we’re in a high oxytocin state. Gosh, it looks like you had a great, you’ve had an orgasm overnight, great sex, for instance. You’re like, oh, I feel so much better. This is, you know, life is good. I have more joy, more connection, more vibrancy. see all of those that’s a high oxytocin, state it’s a more alkaline state.

It’s a more anabolic state because in a hierarchy of hormones, oxytocin is that crowning hormone. It’s the most powerful hormone in our body. It’s a rejuvenating, and anti aging and it’s alkalizing. And it’s, Supports muscle cell regeneration, supports our immune system. I mean, there are so many benefits to oxytocin.

So when we empower that, and again, we make it in our body naturally, sometimes I prescribe it. But when we can empower the practices that increase oxytocin, we’re in a better place. Yeah. Thank you [00:26:00] for explaining all that. What are some of the tips? I read some in your book, but what are some of the tips that you can share with the listeners that would raise oxytocin?

Yeah, great. And so the, we know with, for example, with oxytocin, intimacy with sexual touch with play with a hug and a kiss. We increase oxytocin with laughter. We increase oxytocin. So sometimes I’ll prescribe the movie, my big fat Greek wedding, you. Yeah, you will make more oxytocin with that. You definitely will.

And and things that, so things that make you laugh, people that you enjoy being with, having good community around you increases oxytocin. A practice of gratitude, meditation, and prayer decreases cortisol, increases oxytocin. Having a pet, I mean, gosh, when that pet greets you at the door and is like all full on love.

I don’t know. I’m not a cat person, but for dogs, for instance, they’re like full on love. And you’re like, okay, [00:27:00] yeah, that’s oxytocin. Those are some of the things that increase oxytocin. Of course, pregnancy and childbirth. I mean, many people don’t realize when, as an obstetrician, I give Pitocin, that’s oxytocin.

Your body is producing oxytocin naturally to stimulate contractions of the uterus to help you deliver this child. And then you’re imprinted to this child. You’re bonded. You feel love that as much as someone tries to explain it to you, never fully gets there because you feel this immense love for this child.

And getting over that part of a survival mechanism. Now I’m going to take care of this child at the sacrifice of myself. As a mother often does and, you know, but that’s oxytocin, the power of oxytocin while breastfeeding, we’re producing oxytocin, further bonding, further imprinting. And the same thing with sex, we produce oxytocin, whether we orgasm or not with intimacy and enjoyment, and that bonds us to our partner.

Now that’s a double edged [00:28:00] sword. If you don’t want that, you know, if you think, and I’m just going to play with this partner and not, you know, expect something long term and then all of a sudden you’re like, Oh, maybe I can make this work. Maybe oxytocin. Yeah, I remember holding my daughter I would have those like nightmares before you give birth.

It’s like, what if I don’t like her? What if she’s not what I thought, you know? And then when you hold your child, no matter what they look like, you just think they’re just amazing. And I just remember those first few moments with her in my arms, it was just so magical and it’s like the best day ever. So I.

totally felt the oxytocin flowing and coursing and still do when I look at her, which is amazing. Speaking of, so we’re let’s, dive into the topic of sex. I think you know, talking about what happens to our normal vaginal physiology, is important for women to know, right? Just to know what goes on and what to look for.

And when things [00:29:00] do get dry down there, as you wrote so eloquently in your book and you give so many strategies on how to help this, but let’s just talk about , you know, normally what happens to you know, we know the vaginal dryness, but more detail into that. And then we’ll talk about strategies on how to protect the vaginal.

Vault and that area. So women could continue to enjoy intimacy, even if it doesn’t look like traditional intercourse or orgasm. But like you said, just intimacy can have so many different ways that we could connect so we can get those advantages of oxytocin. Yeah, no, this is one of my favorite topics because when I talk about, you know, what leads into lack of intimacy, the disconnect between partners, I always say it’s three things, three Ds.

It’s issues of desire, disconnect, Or discomfort, those are the three D’s typically for the majority [00:30:00] of clients when the, you know, comes down to a lack of intimacy, what’s keeping you from being intimate, discomfort, desire, or disconnect. So those three areas, and just I mean, aging is a natural part of life and some, you know, times we age more rapidly , than others in our life, but just like all of us will experience laugh lines and smile lines.

Right on our face, or we want, you know, laugh lines and smile lines, not frown lines. I always teach my group to think of a word that brings a smile to their face because, you know, we don’t want those frown lines. And the changes that are happening here are happening down there, but they create consequences like incontinence, bladder leaking, right, that accidental, leak of urine when we cough or sneeze, the decrease in orgasm sensation, less clitoral sensitivity, vaginal dryness, discomfort, odor after we have intercourse, discharge or [00:31:00] discomfort afterwards or, frequent urinary tract infections.

Those are all a consequence of the aging of the vulvovaginal area. So, prevention of that is through healthy nutrition and lifestyle, you know, healthy mitochondrial, good cellular function, healthy. gut. An important part. I can’t get someone’s hormones balanced, but I don’t have a healthy gut to work with.

So I got to get the gut healthy first and sometimes, but this is where topical hormones can really benefit us. So those natural changes between thinning of the, vaginal walls, a loss of the elasticity, the normal flexibility, so we lose the rugation and the folds, and loss of the natural glandular secretions.

And as we age, the pH of the vagina designed to be acidic, so again, to fight off bacteria, , to be a Protect it for protection becomes more alkaline. So that fishy odor recurrent infections, etc. can become a [00:32:00] consequence, completely preventable and reversible. I think that’s so important to know completely preventable and reversible.

And you give so many tips in the book on how to do that. And I think a lot of people just think lubrication and I think lubrication is just one aspect. And I do want to call out that. The product that you’ve designed, Jolva. I would love for you to give a shout out to this and talk about this product and how it can help women.

And I’m holding it up again. If you’re watching the video version of this podcast, but what hormones are we talking about that would help rebuild and rejuvenate the vaginal vault in addition to, you know, this Jolva product that you’ve eloquently made. And I’ve used it and it works wonders.

Great. Thank you. Thanks for that. And so typically when we think about vaginal dryness or, you know, as we’re aging, the focus has been on vaginal estrogen because we have prescription formulas that are, you know, designed for just give us vaginal [00:33:00] estrogen. And sadly, those prescriptions have a lot of hormone disruptors in them.

And plus, if we’re having sex with a male partner, then oftentimes we’re getting transference of that estrogen to our partner. And, you know, Guys, for the most part, I’ll say for the most part don’t need more estrogen. Some may, but for the most part they don’t. Right. And so you’re transferring estrogen to them and estrogen works on the 1st layer of the vaginal wall.

That’s the mucosa. So, like, just like the inside of your mouth, the mucosa. The inside of the vagina is that moist, soft tissue. So estrogen does work for that, but again, it has the other consequences. And whereas DHEA and testosterone and even progesterone work on all three layers of the vaginal floor.

So the, you know, the subdermal layer the. to the muscularis layer. And that is really important because then all of a sudden you see those anti aging effects, the increase of the natural folds of the [00:34:00] vagina, the rugations, the glandular secretions, your pH becomes, vaginal pH becomes more acidic.

And, you know, and again, we have a lot of focus on the vagina, but. But you’ll hear me say clitoris to anus, the most important real estate of our bodies. When that area is not feeling good, nothing feels good. So from clitoral atrophy to urethral atrophy, causing incontinence and urinary tract infections to perianal atrophy with vaginal.

Fissures and hemorrhoids. , it’s not fun. And that creates susceptibility to yeast infections, bacterial infections. And, you know, if anyone’s had a yeast infection, you know, that kind of ruined your day. So and urinary leakage, right? So this is going to even help support the pelvic floor.

Yes, DHEA and testosterone really do help with that. And so in Jolva, I wanted something over the counter that patients could get economically without a prescription that [00:35:00] worked. And so in my years of research and working with clients and formulating prescriptions You know, compounded formulas I created which has, which is a precursor and works at the intrinsic cellular level to make to some testosterone and estrogen.

It works on all 3 layers of the vaginal wall and I combined it with plant stem cells from the Alpine rose, which is a. Beautiful. I mean, it’s a, it’s in high end cosmetics. It decreases fine lines and wrinkles, improves collagen production and, rejuvenation. And again, I have clients that have been using Jilva since I first brought it to market in 2016.

And I have one client who’s 65 and she’s like, Dr. Anna I have the vagina of a 25 year old. I love this stuff. And, you know, the and it looks that way and I, and again, I’m in clinical practice and I see the improvements that clients get as a result of that. I mean, you just can’t compare with [00:36:00] estrogen or lubrication only you really need to add these pro androgens.

Yeah. Well, thank you for creating this product. And I think it’s really important for women to know that they, you know, their sex life is important, right? It just doesn’t stop once we go through this change and have to suffer with these consequences of the loss of hormones and what it does and the downstream effects of them.

So I really liked that we talked about this. And so we educated, you know, people to know that this is. Temporary and this is reversible. Yes. And so many times I heard from my clients was that, you know, I’m just powering through for the sake of my husband or partner. I’m just powering through sex, checking that to do list off or whatever, but hold on a second.

You know, sexual health is necessary for optimal health. We get again through our pharmacy. There’s no other way we can make the amazing amount of chemicals that we do. Then in, in intimacy, but there’s, other ways to again, laughter, good life, [00:37:00] giving, living, enjoying, contributing to society. There are certain ways, but with sexual health , it’s for our pleasure and you know, it is.

So if you’re not having pleasure, those mirror neurons. That we have with our partners, they feel that too. So now we’re creating a disconnect. And oftentimes women are going through vaginal dryness symptoms at the same time, their partner, if it’s male, we’ll be having maybe erectile symptoms. And so now there’s even, you know, there’s, and again, reversible and treatable.

And so, you know, we work to address those issues. And all of a sudden the couple comes in and they tell me, Dr. You know, we were like, We’ve been roommates before and now we’re lovers and you know, again, and they’re just so much healthier. And that’s what we want. We want to support that type of connection.

And there are many factors in relationship disconnect, but if , dryness, discomfort, a lack of enjoyment with sexual health, with intimacy. and it’s [00:38:00] something we Used to enjoy. It’s really important to get back there. And I have clients who will tell me that, you know, they hadn’t had orgasms in years and they are again, they’re enjoying their sex life now more than they ever had.

And you know, this is well post menopause. So I love to hear that. Yeah, beautiful because we’ve learned from maybe the generation before us that didn’t talk about it. Or we hear maybe in some friend groups that we just have to suffer through it. Like you said, I know I was talking with one of my friends and she says, Oh, sex is starting to feel like razor blades cutting inside of me.

And I said, Oh, that is reversible. And when she found out and got You know, the proper help and put on the proper treatment. She’s able to enjoy that connection, that intimacy, and it leads to, you know, more emotional health, mental health. Right. And then you have more enjoyment with the, your partner, your lifelong partner.

And it just restores the relationship in a way that I want women to know that’s available. I love that. Yeah. So you mentioned [00:39:00] earlier in our conversation , looking at bioidentical hormones, but, you know, correcting hormones doesn’t necessarily fix the hormonal imbalance. What are some other tips that you use or can share with our audience?

You mentioned the microbiome, but other things that they should be looking for or maybe doing so that they are You know, really setting up a great environment internally for the hormones to be able to function and work properly. So one of the things is that, you know, again, it takes more than hormones to fix our hormones.

And when I realized that for my own health and journey, getting nutrition lifestyle dialed in was really key for the hormonal transition and beyond when our body’s shifting in each day. You know, in our production of neurotransmitters and hormones. So for me, I call it the keto green way or the keto green lifestyle and it’s a nutrition support with, you know, periodically getting into ketosis.

You don’t have to be there all the time, but periodically getting into ketosis, [00:40:00] the keto part of my keto green, that’s getting into ketosis, not just high fat foods and all this, you know, technical keto diet. you know, butter and bacon. Now it’s pushing our body into ketosis periodically because then we become more insulin sensitive with more insulin sensitivity, less hot flashes, less, you know, decline of our testosterone and progesterone, et cetera.

So we start to see more of a balanced hormones, less inflammation in our body, less risk for all these other cardiovascular diseases. So first part. getting more insulin sensitive. The second part is that green part, which is the alkaline part is what is making you acidic? Is it, the food you’re eating is very acidic.

, so which would affect the microbiome. If you’re eating the same thing every day, you’re going to decrease gut microbial diversity. And that , affects so much. So the alkalinizing part for me is the greens, the alkalinizers, the fermented foods, , the Detoxifying foods for especially for estrogen, like the cruciferous [00:41:00] vegetables, broccoli sprouts, one of my super foods and it supports healthy estrogen detoxification.

So, adding in those alkalinizes into your nutrition plan, bone broth, electrolytes, all those work at the cell membrane to support, , healthy transmission of energy across the cell membrane. So from there we look at what else creates acidity. And this I learned from my own study and my own experience in my programs.

I tell my clients, they have to check their urine pH and ketones and uric acid. So I have urine test strips I created with those three markers, but I want them to check their urine pH starting out with me every time they use the bathroom. Are you alkaline at certain times? What do you, what’s that associated with?

Are you more acidic at certain times? What’s that associated with? And when I was doing that in my own journey, I realized that the mornings that I would gratitude journal and or walk on the beach, you know, I had more, [00:42:00] I was more alkaline all day. Then the mornings I, hit the ground running and I was more acidic all day.

And so that’s when the study of cortisol, I dug more into cortisol and cortisol actually increases hydrogen ion secretion across the renal tubules. In other words, it makes you P acid, it makes you more acidic. So by regulating, by recognizing that and regulating cortisol, so decreasing cortisol, increasing oxytocin, it was able to have, and the practice of gratitude and, You know, being out in nature, doing things you enjoy with people you enjoy doing them with shifts your physiology.

 So that perspective came into that alkalinizing approach and managing insulin and cortisol and empowering oxytocin. All our reproductive hormones get better balanced as a result of that. So that piece of it , was eye opening for me and what we know from studying urine pH, and there’s many scientific articles on this, that the more acidic your urine [00:43:00] pH, the more at risk you are for all diseases of inflammatory diseases of aging.

The more alkaline your urine pH is, so seven being neutral, so seven or greater, 7. 58 on a regular basis. The less risk you are for all those inflammatory diseases of aging, so cardiovascular disease, cancer, osteoporosis, and in general, you feel better. So you’re more empowering a optimum physiology that way.

So that was so eye opening for me at the time. Again, if I hadn’t lived it, I wouldn’t know it. Yeah, and I like how you were talking about all these it comes back to like lifestyle habits, right? Habits that you can stack on each other, the gratitude, the getting out in sunlight, the regulation of the sleep, you know, you’re diversifying your microbiome.

All these habits that we can incorporate into our lifestyle. That’s going to keep our health functioning. Lead us to have that longevity, [00:44:00] regardless if you’re on bioidentical hormones or not, right? These are practices we should be embodying because we know that they help so much of our body, right?

From preventing disease to helping the vaginal, um, area and maintaining that pH. I did want to talk about if people don’t want to go on bioidentical hormones, you’ve created an awesome product called Mighty Maca, and I’ve been using it for a little bit now, and I’ve never liked Maca in the past.

It’s always had this awful taste. Even when I put it in smoothies, it couldn’t seem to cover it up. But I’d like you to talk about why you developed this and all the benefits that I was reading about in your book. Yeah, thank you. So I, you know, again, part of my personal journey when I was 39, I was diagnosed with infertility, failed the highest doses of infertility treatment, 6 rounds of injectables, then diagnosed with early menopause, told I would never be able to have another child.

And that was devastation on devastation for me [00:45:00] and my family at the time. And I took a sabbatical from my medical practice and literally traveled around the world. And I was part of my healing journey. And when I was in Peru, they would say, well, if you’re infertile, drink Maca. And if you’re tired, drink Maca, , then they would elbow my husband and say, it’s the Peruvian Viagra.

And you’re like, okay, we’re going to drink some Maca. Right. But I couldn’t stand the taste of it. So I was like, humph, this is a super food. You know, this has potent ancestral origins. I mean, it’s reported , the ancient Incan warriors would drink maca before they went into battle to give them more stamina and drive and resilience.

Right. And so like, okay, well, what else is there? And I started adding different. You know, superfoods as I learned and traveled and compiled all these and to make it taste good because I’m from a family of gourmands. I mean, you know, like, it’s got to taste good. Right? And so, and I feel very strongly to about that.

Medicinally, like, if we have an aversion to something that’s supposed to be good for us is, [00:46:00] you know, is it really that good for us? So. I wanted to enjoy it. And so that’s where I started working on adding the different superfoods. So my Mighty Maca Plus formula has 30 superfoods combined.

So with mangosteen, with acerola cherry, with cat’s claw herb, which is a potent anti inflammatory, with turmeric, quercetin, resveratrol, potent immune stimulants, and adaptogenics. And so I started adding all these great ingredients into it and to make it. taste really good. I mean, my granddaughter’s been drinking it since she’s been just over a year old.

 And what we found is an improvement in DHEA levels, improvement in progesterone levels, improvement in blood sugar regulation, appetite control, craving reduction, all of those things that my, you know, and I had formulated this, and I wanted to keep using this for my patients. And all these great other benefits came about and part of my [00:47:00] journey was that, you know, it reversed my early the combination and grace of God reversed my early menopause diagnosis.

And then I naturally conceived my child. I was told I would never be able to have and at 41 years old. So. So it was really so powerful and, you know, it really made me open my eyes. My doctor’s bag has, you know, is, it was pretty empty, you know, when I finished residency and it’s, and I’m always learning, right?

Like, what else can I do? What’s natural? How is it supporting me? What’s that mechanism of action? How do they work together versus the pharmaceutical approach? One drug, one action. And And so, you know, this is why I created Mighty Maca and we’ve had great benefits. So clients, for example, if they weren’t candidates for hormone therapy and the history of breast cancer and hot flashes and vaginal dryness can give them Mighty Maca and their hot flashes go away.

They improve their energy. [00:48:00] And again, it’s a diverse ingredient. So it supports gut microbial diversity. And that’s where we make serotonin and detoxify estrogen. So, very supportive in those ways. Yeah, and you made it delicious. So thank you for that. You’re welcome. It’s gotta be. Yeah, I will say when I put it in water at the 1st time, it’s really a dark green color.

And I’m like, oh, I’m not going to like this, but I was pleasantly surprised and I do feel better when I drink it. So thank you for that. I’d love to ask a question and I know it’s kind of controversial. And if you don’t feel comfortable talking about it, , we can just say skip on this question, but I know some of my listeners have written into me and asked me, Hey, I’m 10 years out post menopause.

And you know, I think I missed the window for bioidenticals. And we talked about other ways that people can support their hormones when they feel out of the window. Would you like to comment on people who feel that they are Beyond that [00:49:00] window of 10 years out for menopause and should they be looking at bioidentical hormones?

Or do you want to comment to those individuals that may be listening? Yes, absolutely. So again, it takes more than hormones to fix our hormones. And I’ll also say I don’t discriminate based on a patient’s age. I want to optimize their health, create bodies, you know, inhospitable to cancer to create resilience and improve longevity.

And so I want to optimize nutrition, lifestyle, movement, sleep, circadian rhythm, all of those mindset, like, come to me with a positive mindset. And I know, you know, you’re gonna do well, right? And so I want to optimize those things and then. I would use, and I do use transdermal bioidentical hormones or vaginal.

I don’t like to use oral estrogens post menopause. Well, post menopause, because of the risk of increasing inflammation and inflammatory markers stroke, for instance. So, but [00:50:00] transdermal, I can get great results. With that, and using a combination progesterone testosterone, DHA, you know, estrogen, I like to use a 2, 3 combinations.

And so, and this is where again, working with clients since 1999 with customizing. Bioidentical hormones, you know, what makes you feel best, you know, how is it working with your body? How like, let me support your, you have to support your detoxification pathways and, you know, if someone’s coming in though, and they’re driving through, you know, fast food for all their meals and, .

, they’re not a candidate at that point. I’m like, okay, there’s a lot more we have to do here. I like to give the story, Sherry, about my father who, when he was 79 years old, this is back in 2005. So when he was 79 years old, he came to visit and this was many years after my mom had passed.

And my dad was, you know, born in 1926, World War II. He was in the U. S. Navy for 20 years and a naval attache, basically meaning a [00:51:00] spy. He could get anyone drunk and tell him anything. Right. And so he had that personality. I never heard him say a negative word about anyone. And so at 79, he had come to visit from Philadelphia, flew in, had to be wheeled back.

through the airport because he was having trouble walking. He was on over seven medications at the time and 120 units of insulin. And he was just irritable and short tempered and snapping. And I was like, dad, what’s going on? He goes, you know, Anna, I just don’t feel good. I said, you want me to call your doctor?

And he said, please. And so , I got on the phone with his cardiologist who I’d known for many years. And I said, you know, Hey, Dr. B , dad’s having all these symptoms, blah, blah, blah. And he said, well, you know, Anna, your dad’s 79. He’s lived a good life. And I waited for him to say something else and he didn’t.

And I was like, Oh, so in my mind, I could just see himself wiping his hands of my father. Right. He’s 79. He’s living a good life. He’s outlived most of, you know, the rest of his cardiac patients. Right. So, [00:52:00] and so I said, okay, well, do you mind if I intervene? There’s some things I’ve been doing, studying, blah, blah, blah.

And so he said, sure, just let me know what you do. And I go back to my dad sitting on the couch still. And I say, dad, you know, are you done living? Cause your cardiologist is done with you. He has written you off. And he said, he laughed and he said, you know, I’d like to see 80. And I was like, okay, he goes, Anna, I really, you know, anything you say I’ll do it.

So in 30 days, a 79 year old man written off by his cardiologist said, you know, lost 30 pounds, went from 120 units of insulin a day to 20 units of insulin a day at 79. And I was able to take them off three of his medications. I put him on some testosterone, some, you know, supplements and nutrients.

and by the end of those 30 days, he was out on the tennis court playing with the kids. Wow. And not only did my dad make his 80th birthday, but he made 91 good years. [00:53:00] Wow. So it’s such a good story. And I have clients in their eighties, you know, I don’t have anyone currently in their nineties or, greater right now, but , it’s never too late.

It’s never too late to optimize your health and wellness. And so I say that story to really emphasize that point. Our body has this pharmacy within us has this great rejuvenating, regenerating capacity. And when , we get , the right nutrients in the right amount, the right chemicals in the right amount with a good positive mindset, , I see miracles.

And so, yeah, that’s a beautiful story. And I love that story required. Almost no pharmaceutical agents. Right. And actually you took away pharmacy. I took away three. I added testosterone a little bit. And you came down on the insulin. So I mean, you know, yeah, huge from 120 units to 20 in a 79 year old.

I mean, who does that? Right. Right. It just shows you the power of these habits and keeping, you know our bodies [00:54:00] well fueled through diet, exercise, sleep all the mechanisms that you say that really support the body to go back to homeostasis, because that’s where the body is. It doesn’t want to be ill.

It doesn’t want to be diseased. And so it will work hard if you support it, right. And detoxify it so that it can go back into that state of homeostasis. I love that story. And I love the age too, because I see so many women say, Oh, I’m too old, or this is going to be too hard, or it’s going to take too long.

I mean, even in your story, you said 30 days, how much transpired for you. I’m going to say, give me 16 days and you’re going to be feeling like a, you know, much better version of yourself, healthier, happier. I mean, really, again, what the gut mucosal lining is regenerates in 72 hours. I mean, our body is constantly regenerating.

So when you now bathe it in positivity and alkalinity and, you know, [00:55:00] nourished, and, you know, you’ve got more oxytocin on board when you’re focusing on these things. I mean, it really is transformative. Yeah. And you know, coffee, not that coffee’s bad in itself, but coffee makes us more acidic. Alcohol makes us more acidic.

I have to say that being on this podcast and, you know, a lot of ladies, you know, think, Oh, there’s no harm to drinking a couple of glasses of wine, but that does make us acidic and there is harm to the microbiome ultra processed foods, very, you know, disrupted to the microbiome. And so clearing these things out of our diet.

So, you know, our bodies can be fueled and, you know, You know, our gardens grow inside of our, we can really support detoxification and serotonin to be produced. And that happens relatively quickly, like you said, 72 hours, right? Just start seeing some of those beneficial effects. We don’t have to wait as long as many people think we have to wait.

No, right. And on this alcohol subject, especially alcohol and perimenopause and menopause, I mean it’s [00:56:00] an issue. It’s an issue for a lot of women. And if you think about it, if our progesterone levels are declining, that’s neuroprotective. Progesterone is neuroprotective. So now we really have less protection on the nervous system and then we’re drinking alcohol.

And you know, for for a momentary improvement, alcohol always disrupts our sleep. Less deep, according to all sleep studies that I’ve reviewed less deep sleep, less REM sleep, you know and more waking, wakefulness, also getting up to use the bathroom at night. Alcohol disrupts our microbiome, like you mentioned, also increases uric acid.

So it creates you know, a metabolic imbalance that leads to weight gain. Brain fog, irritability, mood swings, less serotonin production and, so where this research came, I always like to think again I’ve traveled around the world. I love international medicine. I have family around the world and I think, okay, well, , like Sardinia, for instance, they drink wine every night.

And to [00:57:00] their hundreds, right? And but are they drinking it alone? No, they’re drinking it in community with friends and family and laughing and storytelling. Well, that’s oxytocin, baby. Yes. Oxytocin. So you really have to look at the situation and there was a time and I’ll share this with you sharing your audience is that where I was drinking a lot of alcohol, I was drinking at least one or two glasses a night.

And , I was recognizing that it was. I was not serving me. I was recognizing it was not serving me, but it would took a really long time to convince myself to do anything differently. And as you improve your physiology, those cravings go away. Those cravings for sugar, cravings for alcohol, cravings for whatever things that no longer serve us go away because we’re radiating and a and we don’t want anything to bring us down like that.

And alcohol is a natural depressant. And so. So when they looked at those [00:58:00] things and as I work with clients in perimenopause and menopause, it’s always a question, you know, like, you know, share with me, you know, what is your alcohol consumption? How often are you alone or in company? And because it becomes this self medicating in a way.

And so you heal your physiology and. Your cravings, change. Yeah. And I know a lot of people are in disbelief, but when you live it and you experience it, you’re just like, wow, it wasn’t as hard when you go about doing it the right way of cutting back that your body just feels better.

And who doesn’t want to operate in a body that feels better? Right. Exactly. Yeah. Thank you so much, Dr. Anna Kabeca for coming on the podcast and sharing your wisdom with my audience. I really appreciate it. I just want to tell everyone, I read your book twice because it was so good. Not that it’s hard to understand, but it’s so good.

You give recipes, you give a 10 day plan in here to follow to alkalize your body to get it [00:59:00] healthy. So many great tips. So I recommend anybody who wants to. Really learn about changing their habits. Changing their health is to pick up your book, but also can you share with my audience where they can find you and learn more about you and your products?

Yes. Thank you. So thank you so much for having me, Sherry. And you can find me@dranna.com, so D-R-A-N-N a.com, dr anna.com and on social media at Dr. Anna Quebeca, or at the girlfriend, doctor. Wonderful. And thank you so much for educating everybody and really turning the tide on hormone therapy and really being a champion for women’s health.

Appreciate that. Thanks Dr. Hannah. 



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