Getting Nerdy about Hormones – Topical, Transdermal, Oral, Oh My! with Dr. Anna Cabeca, DO

Dr. Jessica Drummond 00:00:03 Hi and welcome to the Integrative Women’s Health Podcast. I’m your host, Doctor Jessica Drummond, and I am so thrilled to have you here as we dive into today’s episode. As always, innovating and integrating in the world of women’s health. And just as a reminder, the content in this podcast episode is no substitute for medical advice, diagnosis, or treatment from your medical or licensed health care team. While myself and many of my guests are licensed healthcare professionals, we are not your licensed healthcare professionals, so you want to get advice on your unique circumstances. Diagnostic recommendations treatment recommendations from your home medical team. Enjoy the episode. Let’s innovate and integrate together. Hi, and welcome back to the Integrative Women’s Health Podcast. I’m your host, doctor Jessica Drummond, founder and CEO of the Integrative Women’s Health Institute. Today, I’m excited to introduce you to a dear friend of mine, Doctor Anna Cabeca. She is a triple board certified physician. She and I both trained at Emory Medical School. She’s board certified in ob gyn, integrative medicine and anti-aging and regenerative medicine.

Dr. Jessica Drummond 00:01:32 What I love about Doctor Cabeca is that she really is a hands on physician. She’s been working with women in midlife, hands on as a gynecologist for several decades, about 25 years now. And she’s really specialized in midlife for at least the last ten, 15 years. And so she’s a New York Times bestselling author. She’s written several bestselling books on menopause and utilizing the full holistic strategy that we teach at the Integrative Women’s Health Institute. We’re looking system by system, right? We’re not just adding hormones, and we’re going to talk about why and some of the challenges of that. But we’re looking at gut health. We’re looking at detoxification health. She talks in this interview about the importance of doing physical exams, even post-menopausal, even if you’ve had a hysterectomy, to reduce the risk of cancer. And so I think you’re really going to learn a lot of clinical pearls in here. Because here’s the other great thing about Doctor Rebecca. She is a product formulator. She’s formulated Mighty Maca which is a really excellent greens powder that combines greens to support detoxification with other adaptogenic support of the hypothalamic pituitary adrenal axis Access, giving women more stress resilience combined with detoxification capacity of the gut and the liver.

Dr. Jessica Drummond 00:03:05 And so you’re also going to learn some really nitty gritty clinical pearls around topical DHEA, topical estradiol, whether or not to use topical or oral progesterone. What the difference is also the difference between, you know, why use vaginal lubricants and not just topical vaginal hormones? Do we use both? Do we use one or the other? What are the indications? This is a very technical conversation around things that she and I have seen, both of us having well over two decades of experience working hands on with women, transitioning through the perimenopause to menopause period, and utilizing all of the tools we have available to us, but not forgetting the foundational health needs of these women. So if you were in clinical practice or you or yourself are transitioning, you’re in the ages of 35 to 45 and older. You are going to love this episode. I guarantee you’re going to learn something. If you don’t, you can email me, but you will learn something. So let’s enjoy it together and I’ll see you on the other side.

Dr. Jessica Drummond 00:04:21 Welcome back everyone. Hi there. I’m Doctor Jessica Drummond and I’m excited to introduce you to Doctor Anna Rebecca. Welcome, welcome.

Dr. Anna Cabeca 00:04:30 It’s so good to be here with you, Jessica. Thanks for having me.

Dr. Jessica Drummond 00:04:33 Thanks so much for coming. So we’re going to talk today about some of those nitty gritty details around hormonal support and especially involving topical solutions. Anna was one of the real pioneers in developing an over-the-counter DHEA support for vaginal dryness and vaginal health. So knowing that we have lots of questions about these details, let’s start with your story. What inspired you to create so many products specifically in support of perimenopause and menopause, and what was the process of doing that?

Dr. Anna Cabeca 00:05:12 Yeah, well, it’s been a long journey, but it really is my own story with in 2006 being diagnosed with early menopause and infertility and then reversing early menopause and naturally conceiving at age 41. The child I was told I would never be able to have, like I’d failed six courses of infertility treatments. You know, I’d taken a year sabbatical, studied medicine around the world, serendipitously met with some of the most amazing healers of traditional medicine, as well as some leading practitioners around the world that was outside my scope.

Dr. Anna Cabeca 00:05:46 You know, I trained at Emory University, where you did as well. I trained at Emory University and gynecology and obstetrics, and so I thought I had pretty full doctor’s bag, but I quickly realized I did not, and I didn’t want to follow the path that my mother went down with. You know, medication after medication after medication and polypharmacy really contributing to her early demise and years of years of struggling. So I always had this kind of holistic approach, okay, what can we do? How can we empower the body? God gave us the best pharmacy in the world inside us, right? Like, how can we empower body to resuscitate itself, to repair and rejuvenate itself? And so as part of my journey, I really realized it takes more than hormones to fix our hormones, right? And my first book, The Hormone Fix, goes into this multi-pronged approach that I take with my patients foundationally because we need a good vessel, a good vessel for when and if we are using hormonal therapy.

Dr. Anna Cabeca 00:06:45 And then as a surgeon too. And being an OBGYN, common surgeries were incontinent. Surgery and hysterectomy. Uterine surgeries. Ablation. hysterectomy, and I wanted to empower my patients to be in the best physical shape, honestly, before surgery, even more so to avoid surgery if necessary. And so this approach really helped me working in this area. I went from doing 2 to 3 surgeries per week to needing to do 2 to 3 major surgeries per year. So that’s how well the body repairs. And one specific area is in vaginal health and incontinence issues. There’s a couple areas here that clients deal with. First of all, I 100% insist that vaginal health is necessary for optimal health. Without a doubt, right. And vaginal health goes beyond sexual health. And when I say vaginal health, I really want to say vulva vaginal health. That entire vulva is critically important for overall health and longevity because we have from the clitoris to the urethra to the vaginal opening to the anus and the tissue around they have.

Dr. Anna Cabeca 00:07:53 We have problems. Their life is a mess, right? And so one of the common things I saw with clients was vaginal dryness issues and incontinence issues and recurrent urinary tract infections, as well as vaginal infections and cervical dysplasia. So I wanted to, for incontinence, for instance, get the best surgical results that I could possibly get. So I started using DHEA testosterone because they work on the muscularity levels and the fascia. And then you get good tissue. Estrogen works on the mucosal layer. So you know it doesn’t work as well as DHEA and testosterone. DHEA converts to testosterone and estrogen at the intrinsic area. So I had clients use this pre-op say, you know, like, let’s start this for two months before your surgery date, come in for your pre-op and then, well, we have your surgery date scheduled. So I started getting better and better, refining my compounds. Patients would come in for the pre-op. And like Doctor Ariana. I have been the best orgasms. You know, I’ve been running five miles and no, I didn’t even need to use a panty liner.

Dr. Anna Cabeca 00:08:57 I’m jumping on the trampoline with the kids. I have no more incontinence issues. I’m like, darn, I have to cancel surgery. Right?

Dr. Jessica Drummond 00:09:05 And you were doing at the time, like, bladder slings and things like that.

Dr. Anna Cabeca 00:09:10 urethral slings.

Dr. Jessica Drummond 00:09:11 You know, kind of getting into the tissue a little bit. I think it’s really interesting that you were talking about the clitoris and the urethra, and then, of course, the muscles and the kind of collagen supportive facial tissues of the pelvic floor almost need the hormonal support of estrogen and testosterone distinctly. So testosterone for the myofascial piece and estrogen for the mucosal layer. Is that what you found?

Dr. Anna Cabeca 00:09:36 Well, I definitely found that using the pro androgen form like DHEA, you’re getting the benefit of both okay.

Dr. Jessica Drummond 00:09:44 So you’re seeing then better support of the urethra, better support of the clitoris and even like the innovation, the tissue that innovates, the tissue that brings the circulatory supply, and you’re actually having more stability of the pelvic floor. Now, I know since that surgical time, you’ve worked with a lot of pelvic floor physical therapists.

Dr. Jessica Drummond 00:10:05 How are you seeing that pelvic floor rehab combined with DHEA supports the tissue. Like, what are you seeing clinically?

Dr. Anna Cabeca 00:10:13 Oh my gosh. It’s exponential improvement. So I think pelvic floor physical therapists are some of my biggest fans in this area because they get better results. And you can work on the pelvic floor better and get the results you want, whether it’s relaxation or it’s tightening, strengthening. And the combination is really critical. You get healthier anatomy. And so I find it’s a powerful combination. The other thing too is, you know, I have clients now who’ve been using my product for a while, which is DHEA and plant stem cells from the alpine rose, the combination of which is exceptional for collagen production and the pelvic floor. And I have clients in their 60s and 70s that are like, I have the vagina of a 25 year old, you know, and it turns back the hands of time. We don’t get that with estrogen alone, because we’re increasing the blood flow and the glandular secretions of its natural secretions, and we’re improving the collagen fashion muscle layers.

Dr. Jessica Drummond 00:11:13 And so is there a reason that a clinician would consider using topical DHEA like Jehova instead of oral DHEA? When are you making those decisions about delivery method? How are you making those decisions?

Dr. Anna Cabeca 00:11:29 So you have to get really high doses of oral formulations with consequential side effects to get improvements on the pelvic floor. So we don’t see significant improvements with estrogen. And again, with testosterone we need higher levels. We can see improvement in clitoral size and everything with these higher physiologic doses of testosterone. Local always works, local always works. And then, you know, again, sometimes we need to go higher. We need to go international with suppositories, etc. but often because the vulvar vaginal area is so vascular, it’s designed with incredible good muscle and facial flexibility and incredible blood supply to expand to allow the birth of a baby. So yeah, topical works really well, and it works at the intrinsic level so that we see great results with negligible side effects for the most part. Like for example, if you’re using testosterone injections of, say, 15mg weekly, I am intramuscular versus eight milligrams topical, we see great results with the topical.

Dr. Jessica Drummond 00:12:41 With less impact potentially to the metabolic system, some of the negative side effects of higher doses.

Dr. Anna Cabeca 00:12:47 Of acne. Hair loss? Yeah.

Dr. Jessica Drummond 00:12:50 So if we think about topical DHEA for the pelvic floor and vulvar vaginal tissue, the only kind of downside I’ve ever seen clinically using that in our communities with people who have potentially like vulvodynia or other tenderness. And so we’ve talked in the past about putting that topically on the inner thigh, kind of getting the tissues more used to it. Any other sort of troubleshooting tips? If people do have any irritation when they first start using a topical DHEA?

Dr. Anna Cabeca 00:13:27 Yeah. Have to be careful, especially if you’re going from the Sahara to the Amazon. Let’s say you’re getting natural glandular secretion. Then we have dormant yeast. And so with like lichen sometimes in vulvodynia there’s that coinfection that could be under the surface dormant. And so you want to make sure you’re treating those issues as well. Takes more than hormones to fix a hormone. So it’s nutrition lifestyle. All of those things low glycemic diet, removing food sensitivities and vulvodynia, lichen sclerosis, hyperplasia, vulvar vaginal hyperplasia, things like that.

Dr. Anna Cabeca 00:14:02 You really need to address the core issues. And I always say, you know, it starts with the gut the mucosa. Vaginal mucosa is an extension of that. So what else is going on there. So we need to address those issues. And in those cases too with like Vulvodynia looking at do we need trigger point injections with lichen. Do we need LDN. What are some of the other things. But nutrition and lifestyle is key to help with decreasing inflammation in any mucosal surface of our body and making sure we have good bacteria. So as we age and this is really important research, you know, as we age, we go from a less diverse vaginal microbiome to a more diverse. And so we’re the gut. We want more diversity. Right. We want great diversity. Biodiversity of our gut microbiome. But in the vagina we want predominantly Lactobacillus and predominantly Lactobacillus. So as we age, the pH increases. So hence the bacterial vaginosis the fishy odor more infections. And that goes leads into bladder infections too in cystitis.

Dr. Anna Cabeca 00:15:08 So you’re getting, you know, a higher vaginal pH where we want to drive it down. And topical hormones help drive that down. Again DHEA more so than estrogen. And we want to populate the vaginal microbiome with Lactobacillus species. So oral Lactobacillus vaginal Lactobacillus status. That’s critical because if we’re not doing that we see an increase in pH and increase in diversity and an increase in pathology. HPV cervical dysplasia and cervical cancers. So you have to address it again. This is why it goes beyond sexual health.

Dr. Jessica Drummond 00:15:48 Right? And even just chronic UTIs related to this, I talk about that as a longevity issue because the number one killer of women over 85 is hip fracture. So if they’re chronically dealing with urinary tract infections, that the infection itself could actually be a killer of women in their 80s and 90s, but also if they’re having this chronic bladder irritation, feeling like they have to go to the bathroom all the time, they’re getting up, they’re falling, and that hip fracture is really problematic. I think it’s like a 50% mortality rate over the age of 80.

Dr. Anna Cabeca 00:16:24 Yep. Within one year. I mean, it’s insane. And it is. It’s getting up at night needing to use the restroom, tripping, falling and breaking a hip. And we want to avoid that. So again, there’s no age limit on this. And I think that’s really important to understand. Also the number one factor that breaks the caregiver’s back is the incontinence issue. So when your elder is having incontinence issues, it’s like, okay, well, you know, I can’t handle it. I need to put you in a nursing home. And then the loss of mobility in general, it sets them on a negative path. I read a study this morning that said, okay, well, if our average age of longevity for women is 80 to 82, it’s estimated that 20% of that time is in a disease state. So we had to avoid that. Healthspan is so much more important than lifespan. So these are things we can do for quality of life. And the other area especially with vulva vaginal is using, you know, the concept of laser vaginal laser therapies and different things we do.

Dr. Anna Cabeca 00:17:25 Acog American College of OB gyn had come out with a statement several years ago that said, well, it’s good in the premenopausal or premenopausal individual, but post menopause, we’re not really seeing any significant benefits. The caveat to that is if you treat the vaginal area with hormones ahead of time, and then you get excellent results. So now patients can get their own vibrating wand with infrared light. And that’s very therapeutic. I have a client in my girlfriend doctor club and she’s 75 years old now. And she was struggling with, you know, in common symptoms. We’ve had her using Java. Then we added on the infrared light and she’s like her symptoms have completely gone away. Completely gone away. Those are huge wins. Those things make me very happy.

Dr. Jessica Drummond 00:18:14 And so essentially red light therapy that is a hot new topic of using red light therapy in general. You know, we use it for inflammation, for endometriosis, for chronic pain. You know, there’s a lot of indications even for skin. So if we think about like the vulva, vaginal tissue ultimately is a, you know, mucosal and skin layer.

Dr. Jessica Drummond 00:18:37 And then you’ve got the musculature. It’s right there to, you know, just underneath. And so if you’re not watching this on YouTube, if you’re listening, I’m just kind of showing the schematic, the model of the vulvar vaginal tissue in the pelvic floor. I’m really encouraged. There’s not a ton of research yet on red light for those kind of mucosal layers so directly. But what you’re saying, I think, is that essentially it can approximate having to go in for laser treatment because you’re kind of having a similar mechanism. Is that right?

Dr. Anna Cabeca 00:19:11 Yes. And it can prevent recurrent lasers too. I mean, because, you know, like after one year they’ll come in again, but you can prolong the time in between. Certainly with laser therapy you’re getting more deep, penetrating light, but it’s also more painful and longer recovery time. With the red light, we know we’re improving vascular parity and blood flow and circulation. And so then like with use of topical hormones, you can drive those ingredients in deeper that way too, to compound and beneficial result.

Dr. Jessica Drummond 00:19:44 So if we’re thinking about vaginal health for a woman, it sounds like it’s best if we start this topical DHEA kind of as soon as someone needs it at all. So in their late 30s to early to mid 40s. Similar to like the sooner we bring in estrogen in early to mid perimenopause rather than waiting till there’s more severe symptoms, you don’t have that period where everything gets dry and you actually have almost like injury to the tissue for a while, then you have to recover the tissue and then you’re a bigger risk for having yeast infection or bacterial vaginosis. Instead, if we want to almost connect, you know, like go right from pre menopause to keeping those tissues healthy rather than having to like wait till they’re declining and then come back in. I mean, obviously it’s never too late to start for this. So first we want to get the topical DHEA as quickly as possible as women are starting into the perimenopausal transition. So we don’t wait till the tissue is injured. But unlike the kind of conversation about the estrogen window, when we’re talking about internally absorbed either topical or oral estrogen, adding transdermal or estrogen, but adding topical estrogen to the vulvar vaginal tissues can start at any age, which I think is a really important point.

Dr. Jessica Drummond 00:21:19 Any thought about timing?

Dr. Anna Cabeca 00:21:22 You know, I would say, you know, when you start thinking about fine lines and wrinkles and you want to do something about them up here, face laugh lines and smile lines you want to be addressing down there, you know, when do you start doing your pelvic floor exercises? You know, right from the right right away. Prenatal visit. Right. Right. Yeah. So you want to maintain that strength and structure and the healthy ecosystem there within the vulvar vaginal area. You want to maintain that? And it’s definitely better than after the fact.

Dr. Jessica Drummond 00:21:53 But there isn’t a time when it’s too late. Is that right?

Dr. Anna Cabeca 00:21:57 No. Definitely not.

Dr. Jessica Drummond 00:21:59 Because obviously when we’re thinking about adding internal estrogen, we do have to consider the estrogen window and the impact to the vascular system. But topically it’s not really getting systemic. So that doesn’t play as big a role.

Dr. Anna Cabeca 00:22:13 And when we think about it because, you know, with topical so much, you know, this is an area that I think, you know, we do hear a lot about vaginal estrogen.

Dr. Anna Cabeca 00:22:22 But if we have a male partner we have to worry about timing, right? That’s just one more thing to decrease intimacy in my opinion. I’ve done exams and this made me research it early on in my career when I would do a patient’s annual exam. and they have cream or an ovule still, or a tablet unresolved within their vaginal tract of estradiol. Yeah. Estradiol. And so you’re like, okay, well, you know, how long ago did you use this vaginal ovule or this? Two days ago. I’m like, okay. Then I look at the research and they say, well, you know, on average seven hours, but the postmenopausal vagina has got to absorb it less quickly, so much more slowly. And so then okay, just that’s just one more thing. And guys don’t need more estrogen, right? None that I know. Well, maybe there’s 1 or 2, but but you can safely use DHEA even during sex. And so that they can do and we look at the hormonal curve in our fluctuations.

Dr. Anna Cabeca 00:23:16 Our DHEA levels start to peak in our 20s and then start to decline. Add in healthy doses of life stress. They decline even more. And then we get more into the decline of progesterone and pregnant alone, and then testosterone and estrogen. I follow that physiologic flow when I’m using hormonal therapies and I’m always working on, I say I do hormone replenishment, not replacement. I work on creating a body that’s producing your hormones, resuscitating your ovaries and adrenal glands, producing more of your own hormones naturally. And you do the same thing. I mean, detoxing the receptor sites or your body’s using them well and eliminating the metabolites well. And so that’s the concept of hormone replenishment versus replacement doses. Because my birth control pill is suppressing your body’s own natural production, high dose hormone replacement. And again, not like in super physiologic doses is doing the same thing. So we don’t ever want to negatively impact our HPA axis.

Dr. Jessica Drummond 00:24:20 Yes for sure. Now briefly I want to ask you about because I know you developed a Java for the lips.

Dr. Jessica Drummond 00:24:27 It’s been a bit of a hot topic to kind of put your vaginal estrogen on your face. You know, you mentioned the when you start getting the fine lines and wrinkles. What are your thoughts about that? Risks. Benefits? Does estradiol versus estrogen matter? Is DHEA better? Like what’s the perspective? Because I have to admit, sometimes I do mix my job with my just regular face cream.

Dr. Anna Cabeca 00:24:50 Yeah. Yeah, totally. And my balance cream, which is progesterone and pregnant alone, use it on the face and neck and décolletage. I’ve been doing that for decades now. It does make a difference. So progesterone pregnant. Now. Yeah I get the fat of estradiol and estrogen. And like sometimes we’ll compound estrogen with methylene blue and a facial topical. It’s kind of fun. But some people will get melasma and get darkening of their spots. But with the combination that I did with, you know, again. I know because I’m a doctor of woman and I am a woman, and I’m 59 this year.

Dr. Anna Cabeca 00:25:23 So like, I pay attention to this stuff, and I know that if I’m using something for cosmetic purposes, I’m going to use it more regularly. And if it’s good hormone balancing, going to help you bounce. Help your brain. Yeah, but you know, going to reduce my wrinkles, reduce my sunspots and age spots. You know, I’m a sun worshipper. We worshiped in the sun together. And so if you get those benefits, you’re more compliant. Consistency pays off in the long run. So yes, we definitely see that. But I see increased benefits with progesterone and pregnant alone basically in the neck. We always hear the neck tightening with that. And then the Kiss formula that I did is the DHEA formula in an ointment base with a little mint. And it helps those fine. And it has the alpine rose plant stem cells too, which helps with collagen linking and improving your collagen production. So you reduce those fine lines and wrinkles of the lips because things that age us. So you get a little benefit.

Dr. Anna Cabeca 00:26:19 I’m like, okay, better than swallowing my DHEA. I’m putting it on my lips and getting that absorption and the cosmetic benefit as well. So you can see that too. The one thing that I hear, I see patients here in Dallas, and I had a client recently and she’s been on different hormone creams and I’m like, where are you playing it? She’s on the back of my knee. I’m like, why are you using it on the back of your knee or your inner arm? I mean, this is a great cosmetic benefit for these hormone creams. They do have benefits. So yeah, I think it’s good to.

Dr. Jessica Drummond 00:26:52 Like, you could just use it. Rotate, rotate in the location. Okay. So we don’t really have like strong research that’s saying, you know, we have to kind of think about what the person needs internally. You know, we really have to personalize this. Not every woman over 50 should be putting ashtray all on their face. Not every woman over 50 should be putting progesterone in their face.

Dr. Jessica Drummond 00:27:12 But there could be a really good benefit to doing that depending on what your body needs. And I think that’s where we kind of don’t have the depth of research, but we have our depth of experience as practitioners ourselves. And our 5060 70s are doing this and have been doing this, and we gained that experience.

Dr. Anna Cabeca 00:27:33 Yeah, definitely. And you know, of course, client experience and over time and personal experience as well factored in, but also safety studies. I’m always looking at safety studies and we’re using something topical with it. You know estradiol in it. How are we detoxifying it. How are we detoxifying DHEA testosterone. What’s our body doing with that. Even though it’s transdermal it’s usually safer than oral. But how are we detoxifying it. And that depends on our epigenetics. So that needs to be factored in. And this is all part of daily nutritional hormone detox practices that we have to incorporate into our life. And those are the things that make a difference. And the most significant longevity hormone and rejuvenating hormone is oxytocin.

Dr. Anna Cabeca 00:28:19 So how are you playing? How are you laughing? How are you loving? How are you giving? You know, how are you connecting? So that is for me, like that’s always part of all my plans and all my programs that daily oxytocin increasing practices because we know that improves muscle, improves immune system. It’s part of our long Covid protocols for so many factors. We have clinical research showing the benefits of oxytocin. And then again our body makes this hormone. So it’s the practices that we do versus the pills that we take that can really supplement the quality of our lives.

Dr. Jessica Drummond 00:28:59 Now it’s very hot topic for every woman over 45 to be on the right, personalized dose of medical hormone therapy, and certainly almost everyone to be on some kind of vulvar vaginal hormone support every woman. But I think we are missing that conversation because I rarely hear kind of social media gynecologists talking about, are your clients client’s having a really good bowel movement every day. Are they sweating? Are they hydrated? Are they urinating? Because you’re exactly right.

Dr. Jessica Drummond 00:29:39 I think without thinking about how the body is able to metabolize the hormones, we can end up with some of those more side effects, or even the true risk factors of why women were scared of or originally recommending against using hormones. Because there are those cases where hormones can increase, whether it’s breast cancer or cardiovascular risks in individual women if they’re not metabolizing them. Well.

Dr. Anna Cabeca 00:30:08 Exactly, exactly. And I say I can’t fix someone’s hormones without fixing their gut. You know, with my functional medicine background, it’s like stool test, you know, functional. And there’s so many varieties we have now compared to what I had 20 years ago to use for clients. But I’ve been doing this for over 20 years looking at stool analysis, urinary metabolites, Tablets. All different, all different thing. If you’ve got a body fluid, I’m going to check it over. That’s all I can say.

Dr. Jessica Drummond 00:30:32 Right.

Dr. Anna Cabeca 00:30:33 Now. The vaginal microbiome. You know, this is really critically important for quality of life and longevity and gut health.

Dr. Anna Cabeca 00:30:40 You know, how are we digesting? Are we having a couple good bowel movements a day. You know. And I think of this I had a client recently. She said I she marked that no issue with constipation or once in a while. And I said, well, how often are you having a bowel movement every day? And she goes, oh, you know, maybe 2 or 3 times a week. I’m like, that is severely constipated. Yeah. And that is bad. That is really bad. You’re going to feel so good when you’re going every day.

Dr. Jessica Drummond 00:31:04 Yes. And the problem is, is that’s not like you said. Sometimes we have to really, really explain it. Like really just, you know, 1 to 3 bowel movements a day is ideal. What do they look like? You know, and people don’t talk about that very much, you know. Are you are you dealing with pebbles or are you having diarrhea. Like what does diarrhea mean to you? What does constipation mean to you.

Dr. Jessica Drummond 00:31:27 So for our practitioners, I think really kind of slow down for a minute and ask women how they are detoxifying. How hydrated are they, how much water are they drinking? Is it being absorbed? How is their gut health? Do they have any digestive symptoms. So all of that as you say, you cannot optimize hormone health by just supporting hormones directly. We really have to start with the gut, with the lifestyle, with stress management, all of those pieces.

Dr. Anna Cabeca 00:31:58 So yeah, and I would add just, you know, like that dark brown banana, it’s really good visual dark brown banana stools. Right. Like no residue. You don’t have to wipe five times. Those are signs that there’s a problem. There’s inflammation. We need to fix that. And you know again if there’s a problem in the gut, likely we’ve got problems elsewhere in the body. And definitely with hormone metabolism and detoxification, you know it’s important to have that conversation. I would add in how often are you grounding outside Getting into nature.

Dr. Anna Cabeca 00:32:27 Catching sunrises and sunsets. How often are you sweating? You know. Are you doing lymphatic brushing? So these concepts are all part of the wellness plan. And then I would add to Jessica, because I had a friend of mine, a colleague of mine who was 72 years old. I wasn’t her physician. She was getting hormone therapy, works out at the gym best, you know, nutrition, all this stuff. And she was getting all this hormone therapy and she was having bleeding, spotting. And then she called me and I said, well, what did your pap smear show her? Endometrial biopsy. So the doctor said it was just because they changed her dose of estrogen pellets. I hate estrogen pellets and women with uteruses. I don’t use them anyway. And so they changed her dosage. And I said, well, you need a pap smear, an ultrasound. And so she continued to have spotting breakthrough bleeding for three months. She went in finally and asked for an ultrasound and a pap smear.

Dr. Anna Cabeca 00:33:21 And she had stage four cervical cancer. Answer. So women after menopause aren’t getting offered pelvic exams. Women being treated remotely and virtually aren’t being offered pelvic exams, the pap smears, the vaginal microbiomes not being addressed. And it has to be to protect us from an unnecessary and completely preventable disease.

Dr. Jessica Drummond 00:33:46 Yeah, absolutely. I mean, I think that is one of the things that there’s this double edged sword going on with more awareness around hormone therapies, more access to hormone therapies through digital options. But I think you’re exactly right. I think women and practitioners have to have resources for regular in-person checks. You know, especially when you’re symptomatic. You know, this is another place that I think pelvic floor rehab professionals, occupational therapists, physical therapists, nurse practitioners, Nurse midwives can be really valuable support in menopause and the perimenopause transition because they’re so used to seeing visual changes, feeling, you know, palpable changes. Knowing what symptoms are not normal. And I think that’s a really important point for our practitioners who are seeing people in person to really keep in mind, because they might be the only person on that person’s healthcare team that is seeing that patient in person.

Dr. Anna Cabeca 00:34:57 And to advocate to ask the question, when was your last pap smear? And people say, well, I had a hysterectomy. They said, I didn’t need any more. I diagnosed two vaginal cancer, one vaginal, one boulevarde cancer, my first year in private practice for women that were told that very same thing. And it is preventable. And so advocate for your patients to get that. Even Medicare will pay for a pap smear every two years.

Dr. Jessica Drummond 00:35:20 So that’s great. That’s really good to know. So any new products on the horizon, or let’s talk about some of your other products you’ve been using for the last 15 plus years.

Dr. Anna Cabeca 00:35:35 So we have the Jehovah and we have like for your practitioners, we can send Java trial samples. We also have for our wholesalers the Java Pro which is higher concentration plant stem cells, higher concentration DHEA. And it’s in a maxi oil base. So it’s really good if they have scar tissue, lichen, etc. it’s a little, but you want to start them every other day, the first week and then daily and then of course Java.

Dr. Anna Cabeca 00:36:01 We have my gold standard for energy, libido and hormone detox, right? So it’s the mighty Mocha Plus with 30 superfoods my balance cream, which is my progesterone and pregnant alone with tri peptide.

Dr. Jessica Drummond 00:36:16 And let me talk about that for someone for one second. So topical progesterone or pregnant alone versus oral progesterone. How do you make that decision?

Dr. Anna Cabeca 00:36:27 Well, you can definitely use both together that you get a longer lasting effect with topical oral progesterone metabolizes pretty quickly and 90% of it. So, for example, a 100 milligram oral progesterone is equivalent to a ten milligram topical progesterone, for instance, because you bypass liver hepatic metabolism. So 90% of oral progesterone is metabolized. And we want those metabolites for the pregnant bone derivatives because that helps promote Gaba and deeper restorative sleep. You get a little bit of that with transdermal, but not as much as you do with oral.

Dr. Jessica Drummond 00:37:05 So for sleep issues, oral is where you might want to start.

Dr. Anna Cabeca 00:37:09 Yep, exactly. And the benefit of topical progesterone and pregnant alone is that you are absorbing that a lot of times.

Dr. Anna Cabeca 00:37:17 Like, what I like to do is I use my balance cream is part of my. And this is when I work with patients to like what makes it easy. It’s part of my morning routine, so I got good brain. I’m focused today with our conversation. No, but in general and oral progesterone at night. As a gynecologist woman with a uterus, if you’re on estrogen, you need at least 100mg progesterone daily or 200 cyclically minimum to get the impact on the endometrium. If you’re, you know, clients on hormone therapy, periodic ultrasound to help guide your management is really essential. You don’t want to wait till they’re having post-menopausal bleeding to know that you don’t have them on enough progesterone.

Dr. Jessica Drummond 00:37:59 So you want to be watching for endometrial thickening things like that.

Dr. Anna Cabeca 00:38:03 Yeah.

Dr. Jessica Drummond 00:38:03 Yeah.

Dr. Anna Cabeca 00:38:04 So the combination is really, really nice a lot of times early like in PMS symptoms topical progesterone and pregnant line worked really, really well in early perimenopause. It works really really well. I always use progesterone and pregnant alone together because the steroid pathway is pregnant alone, and progesterone in clients who you give oral progesterone to.

Dr. Anna Cabeca 00:38:26 And then they’re like, oh, I can’t sleep. I’m wide awake. They’re pushing that cortisol pathway because you’re metabolizing progesterone into the cortisol pathway. Pregnant alone will go to the DHEA testosterone and estradiol pathway. So you get more of that direct route without that negative side effect. So again transdermal you’ll have less of that cortisol push unless you want it. And in those clients where you know you are using oral progesterone and they’re getting that side effect, just have them take it in the morning. So pay attention. Work on the vagus nerve stimulation. Work on the parasympathetic works on increasing oxytocin to manage cortisol versus all the stress management techniques that stress me out.

Dr. Jessica Drummond 00:39:09 Yeah that’s right. Yeah, I think that’s a really important point because well, thank you for that kind of perspective on progesterone Own oral versus topical. All of our clients, you know. We start with having them track stress HR v. Just being aware of when their body is physiologically stressed. Because sometimes women go for decades without really knowing when they’re stressed, like their body is stressed, but they don’t feel stressed or they’re like, oh, I just pushed through it, or I’m not stressed, I’m fine.

Dr. Jessica Drummond 00:39:45 But when you layer on things like, oh, you need to start a meditation practice or you better go to yoga, like it’s like more to do. So talk about some of the ways you talk with your patients about bringing in that. Essentially the antidote to HPA axis stress and overwhelm, using oxytocin, using nervous system regulation. Like, what are some of the clinical pearls that your clients like the best?

Dr. Anna Cabeca 00:40:13 Even part of my programs, like my Magic Menopause program, I have them choose a cheer word to say throughout the day, a word that brings a smile. So I think of my granddaughter. Think of the word smile. But think of a word that leaves you with a smile because you think like you know the American hello does not leave you with a smile is going to give you wrinkles. The Australian hey mate, it leaves you with a smile. Right? So you want to activate that. We know it activates the serotonin the dopaminergic pathway. So smiling. So what brings a smile to your face.

Dr. Anna Cabeca 00:40:45 And use that microdose that I call these are part of oxy increase microdosing oxytocin throughout your day. So your cheer word and gratitude you know practice of gratitude. What you’re grateful for. Thankful for this moment. Thank you for this moment before I do these things, before I even open my eyes in the morning because it was so critical to turn my health from PTSD and deep depression to positive view on Rose la vie en rose type outlook. You know you need to empower oxytocin. So. Gratitude. Journal. Prayer. Meditation. Thinking about what’s good, what you love. Focusing on beauty. Creating beauty in your life. Things that make you smile. Playing with pets. Getting out in nature. Doing hobbies that you love with people you love doing them with. Laughing. What brings you laughter? You know what’s funny? What can you look at and laugh about? I mean, to really to restore that is the best effect. Sometimes I’ll prescribe oxytocin in certain ways and individuals, but it’s really a crutch to get you over a hump.

Dr. Anna Cabeca 00:41:49 But when we start doing these practices very quickly, it’s more alkaline izing to our body. So we’re more in a, you know, anabolic state instead of like with cortisol and acidic catabolic state. So we want to increase oxytocin throughout the day. So doing those things I was thinking about that this morning. You know gosh do I know anyone who’s dog has a little litter of puppies or a litter of kittens? I mean, like something really, really juicy. Like, I’m seeing my granddaughter at the end of this month. I can’t wait, you know? And so you think I need an extra dose. And those are things that when you focus on those things, what brings you laughter? What brings you joy? What are the feelings of love manifesting the feelings of love and healthy relationships and positivity versus negativity. And it’s hard when we’re stressed because our focus can be on the problems. So we have to look instead at the blessings. And I’m telling you, working with clients. I had one client and she was 38 years old and she was really struggling with anxiety and depression.

Dr. Anna Cabeca 00:42:53 I’m like, well, what are you doing for fun? And she’s like, well, can I take care of my kids and do this and that? I’m like, yeah, that sounds really fun. And I said, well, think of something, you know, like, is there something you loved doing, you know, in your youth? And she said, I love dancing. And so I saw her back and she was like a whole nother individual. She said, I started dance classes and just doing something like that is better than anything I could write on a prescription pad. So that’s that piece. And, you know, again, support your adrenals. Like the adaptogenic blends, I use Maca and Kirstyn turmeric. It’s all in Mighty Maca plus. So I use those support factors. But also what else do we need to support the adrenals and our body’s natural production and detoxification of hormones. And none of our hormones work well in a vitamin D deficient environment. So paying attention to that too.

Dr. Jessica Drummond 00:43:44 And I think really optimizing it like, you know, getting it to the higher ranges, especially now for immune support, you know, 90 vitamin D I like to see people pretty high up there. Would you agree?

Dr. Anna Cabeca 00:43:57 It depends on the individual because there’s an epigenetic issue. So if we know their status for some clients we need twice a day dosing instead of once a day dosing. And we always D3 with K2 combinations. But I look at you know, what’s the ethnicity? What are there other markers? How do we need to optimize their vitamin D levels and, you know, other immune factors going to drive up. But definitely if they’ve had a history of breast cancer, if they have an autoimmune disease, I’ll get it up typically 60 to 80 range.

Dr. Jessica Drummond 00:44:29 Yeah. Yeah. All right. This is so good. So many clinical pearls, so many thoughtful benefits around not just layering on hormones at the very top of the iceberg, if you will, but thinking about helping the body produce its own stress buffering hormones, its own pleasure hormones, and keeping its resilience.

Dr. Jessica Drummond 00:44:56 Anything else you want to add before we wrap up?

Dr. Anna Cabeca 00:44:59 Yeah. Speaking of pleasure, you know, I have a new product coming out and it is called velvet, and it is a personal lubricant specifically designed for the postmenopausal woman really Specifically formulated. It is paraben free. It is clean, you know. So I say safe for oral sex. I look at that with the tube and clean enough to eat, and it’s really helped to support a positive vaginal microbiome. We can use it on the infrared wands. We can use it with condoms. You know, and I get this question, where are we getting great vaginal health with Java, for instance, our hormones, for instance, when would we need a lubricant. And like, well, you know, if you’re using condoms and sometimes to enjoy longer lubricants are fun and 60% of people, you know have wanted a lubricant to and say that improves their pleasure and experience during sex. So got a good clean one that will support the vagina, not work against it.

Dr. Anna Cabeca 00:45:56 So that’s coming out. So gel for everyday and velvet for play.

Dr. Jessica Drummond 00:45:59 Oh I love it. What a great great tagline. And that’s so true. We have data that actually shows that as you said, basically everyone should use lubricant all the time, whether you sort of quote unquote need it or not. Because in every case, all the research shows it improves pleasure. So if ultimately the core hormone we want to be optimizing is oxytocin, then vulva play. Love that. There you go. Excellent.

Dr. Anna Cabeca 00:46:29 Yeah I’m excited to bring that out.

Dr. Jessica Drummond 00:46:31 All right. Looking forward.

Dr. Anna Cabeca 00:46:32 To that. I’ll send you.

Dr. Jessica Drummond 00:46:33 Yeah. Thank you. All right. Well, thank you so much for being here today. Doctor. Anna. Rebecca, where should our audience find you? If they want to learn more about your products or support their patients with them?

Dr. Anna Cabeca 00:46:46 Definitely. So at Doctor Anna. Com. So Anna is my website and our team. We do wholesale and affiliate accounts for our products and programs. And speaking of programs, I do have my Magic Menopause Coaching certification program coming up for practitioners and coaches.

Dr. Anna Cabeca 00:47:04 So I’m excited about that. And social media. The girlfriend doctor. And you know I have a great customer service and support team too, and we are here for you, so don’t hesitate to reach out and let us know how we can help.

Dr. Jessica Drummond 00:47:16 Excellent. Thank you so much. Thank you for being here and I’ll see you next week. I hope you enjoyed that as much as I did. I’ve been using myself and with my clients, Jehovah and Mighty Mocha for gosh, almost ten years now. And I really appreciate the thoughtfulness that Doctor Rebecca puts into formulating her products. We talked a lot in this episode about clinical pearls, about risks, benefits, decisions between different available tools, some of the new and up and coming red light. We’re going to have to do a whole episode on red light. I’m so excited about red light. Red light has so much to offer us. But what I want you to do today, after listening to that episode, there was probably just 1 or 2 clinical pearls that you were like, oh, this client could benefit from this, or I could benefit from this, or I still have a question about this, right? That 1 or 2 things down and put it into action in your practice, in your educational materials for yourself.

Dr. Jessica Drummond 00:48:25 And if you do have questions, please reach out to me at support at Integrative Women’s Health Institute. Let me know which products you are interested in you’re more curious about. You want to learn more detail about. And we’ll keep going deeper in this conversation, because I think one of the things we often get on social media, like we briefly discussed in this conversation, is like, oh, everyone should be on vaginal estrogen, but when estrogen, when testosterone, when DHEA, should everyone just be on these topical medications? Or should we first think about their gut health, their detoxification, health, stress and social support. What about oxytocin? What about insulin? And I think on a podcast is where we have the opportunity to go deeper with some of these things that are really just headlines in social media. So reach out to me, let me know what your questions are, and we will continue this conversation, because getting into the details is how you, among all of our certified specialist health coaches, are going to be the most sought after health coach.

Dr. Jessica Drummond 00:49:39 This is why we train in specialization, because not only do I want you to have good marketing skills, I want you to be excellent at your knowledge base, at what you do, how you integrate this within your practice, whatever your scope of practice may be, if you are focused on learning a deep specialization. That’s what we do at the Integrative Women’s Health Institute. No question is off the table. You are going to be in the top 1% of excellence. So consider joining our Perimenopause and Menopause certificate program. If you want to get to that top 1% level, we go deep every single week discussing complex client cases. I would love to see you there. All right. See you next week. Enjoy your week. Thank you so much for joining me today for this episode of the Integrative Women’s Health Podcast. Please share this episode with a colleague and if you loved it, hit that subscribe or follow button on your favorite podcast streaming service so that we can do even more to make this podcast better for you and your clients.

Dr. Jessica Drummond 00:50:58 Let’s innovate and integrate in the world of women’s health.