Women’s sexual health with Dr. Anna Cabeca: Mast Cell Matters

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Jill Brook: Hello, mast cell patients and wonderful people who care about mast cell patients. I'm Jill Brook, and today we have an episode of Mast Cell Matters, Deep Dives on Mast Cell Activation Syndrome or MCAS, with our amazing guest host, Dr. Tania Dempsey, world renowned MCAS expert, highly sought after physician,

educator to other physicians, researcher, and all around incredible person. Dr. Dempsey, thank you for being here today. And which of your illustrious colleagues did you bring with you?

Dr. Tania Dempsey: Oh, I am thrilled to have Dr. Anna Cabeca here with us today. Dr. Cabeca is a bestselling author of The Hormone Fix, and Keto Green 16, and MenuPause. Dr. Anna is triple board certified and a fellow of gynecology and obstetrics, integrative medicine, and anti-aging and regenerative medicine.

She holds special certifications in functional medicine, sexual health, and [00:01:00] bioidentical hormone replacement therapy. She lectures frequently on those topics and shares the secret behind the ebb and flow of intimacy as she demystifies the fascinating hormonal changes over time. She will help you discover how the love hormone oxytocin can breathe life into your relationship and how cortisol can take it away, and how the delicate balancing act of those hormones can reignite your libido and support a healthy relationship,

most importantly, the one you have with yourself. She's sassy, blunt, speaks from the heart and has a wonderful sense of humor, and that is why we called her the girlfriend doctor, because everyone needs a friend like her. She's personally developed natural products to help women balance hormones and thrive through menopause, including the highly acclaimed Julva cream for the vulva,

and Mighty Maca Plus, a powerful superfood blend. She lives in Dallas with her daughters, [00:02:00] horses and dogs. Dr. Anna, thank you so much for joining us.

Dr. Anna Cabeca: Well, it's great to be here with you. Thank you so much for having me.

Dr. Tania Dempsey: So, so let's, you know, let's dive right in. Our audience is really, really interested in hormones. We've been talking, we've had, we've done quite a few podcasts now about hormonal imbalances. We've talked about perimenopause and menopause. I'd love to hear a little bit maybe about, let's talk about your journey first.

If you can tell us sort of what got you to this point in your career, and then we can talk more about the hormonal pieces.

Dr. Anna Cabeca: Well, you know, they say your mess becomes your message, Tania. And so that's definitely the truth for me. So true. I mean, like here I was at this, you know, a point in my life when I was in my thirties and I was Emory University trained and as a practicing OB/GYN. You know how the, the thriving solo practice,

a med spa, [00:03:00] was a mom and a wife, and all these things going on. And then I was diagnosed with infertility at age 38, and then early menopause. And I was told I would never be able to have another child. And that devastated me. That devastated me. I couldn't understand how this could, you know how this could be my story.

And that was it. I went through, I had gone through six rounds of infertility treatments. Six rounds. And so anyone who's gone through fertility or you know, been trying to have a child, have a child, and that negative pregnancy test comes up or your period comes up, it is loss after loss after loss. Grief after grief after grief. And a result of that

experience, you know, I took a sabbatical from my medical practice for a year. And I always knew travel, my mom would say travel's your best education, travel's good medicine. And so I really went around the world and I always [00:04:00] joke Tania, to be honest, I say, I went around the world to learn that everywhere you go there you are. Which is so true, which is so true. But as a result of that journey, I learned about medicinal foods, traditional practices, other healing modalities, and, and as a result of that, and with the grace of God, my early menopause was reversed, and I naturally conceived the child I was told I would never be able to have.

And she, by the way, she's now 17, I'm 59 this year, so she's 17. And let, let me tell you it, it, it is like, it is like such a blessing. Time goes by so quickly. Time is just the blink of an eye. So, so, and there's the reason I am in Dallas with horses and she, she's competitive in the rodeo.

So here I am as her mom and I get in that old dude truck on the weekends and haul those horses in that big old horse trailer. That is what I'm doing at 59 years old. So,[00:05:00]

so it is, and you wanna have the energy to raise a teenager, let alone in your fifties and your forties for sure. So you've gotta, you've gotta have the energy.

And so when I came back into my medical practice and I just started using these medicinal herbs and then combined them into my formula Mighty Maca Plus, started really digging even more deeply into restorative and regenerative medicine and functional medicine, and understanding root cause more. I said, look, if I, you know, I had these diagnoses, I mean, I'm a physician, I'd like you get that diagnosis,

that's it. Infertility, early menopause, whatever it may be, diabetes, heart disease, cancer, and you get these diagnosis, let me tell you, your diagnosis is not your destiny. And these are reversible diagnoses in many cases. So, so that's been, that's what brought me here and creating my method and creating my modalities and processes to help people restore their health,

'cause within us, we are tremendously [00:06:00] powerful.

Dr. Tania Dempsey: Absolutely what, what a journey you've been on and, and, and thank you for helping so many people because of your journey, right? That's, you know, that's the the unfortunate thing is you have to go through that, but look how many people benefit.

Dr. Anna Cabeca: And that keeps me going, you know, hearing from people that my work has helped and products have helped. I mean, it really does keep me going too. So, and that's part of it, right? That's in, in Biblical too, to give is, you know, is a, a great gift.

Dr. Tania Dempsey: So, so let's talk about perimenopause, right? Because, you know, we can talk, I wanna talk about menopause too, but I think perimenopause, there's so many misconceptions about it, when it starts, how to identify it, how women feel, the symptoms they're having that are very confusing, the medical profession that doesn't really want to recognize, right?

So, so what's your approach? What, what can [00:07:00] we share with women today so they can understand this better for themselves?

Dr. Anna Cabeca: Absolutely. First of all, terminology is terrible in medicine. Like I just think of this room of white-haired people, guys, you know, creating all these, these diagnostic terms, you know. I mean, seriously menopause. I mean, it's one day and that's it. And then you're post menopause. So, then what? You know, and then you know, pre menopause should be everything before menopause.

Post menopause should be everything after. And then perimenopause, where is that? It should be the time around menopause. It would make more sense, but it's the time leading up to that diagnosis of menopause. Then you're in the post menopause. So menopause is when, I mean like that's like madden you in some ways.

I mean, it's maddening to me.

Dr. Tania Dempsey: Yeah, yeah, yeah, yeah. It doesn't even make sense, right? But, but of course, you know, we know who created that, the terminology. So.

Dr. Anna Cabeca: Oh my gosh. Yeah. And so speaking of having a pregnancy, you know, in my forties and you know, I was labeled as elderly, multi gravita. I mean, let's [00:08:00] talk about this terminology. I mean, I can go off on it. But, so, so, this concept though, perimenopause is the time leading up to menopause, and it's this, when your periods are irregular or not, when you're symptomatic, what's happening is your hormones are starting to fluctuate.

I consider the perimenopause timeline typically on average between age 35 and age 50, 35 to 55. Perimenopause. The average age of women going through menopause is around 51, 52 years old. However, perimenopause can start in our thirties.

So, and in smokers, menopause is 10 years earlier, at age 42 on average, and also in clients with history of endometriosis.

They have earlier menopause. We look at these times and, and pay attention to that. The symptoms associated with perimenopause beyond the irregular cycles, heavier than normal bleeding, more painful periods. There's the PMS symptoms or [00:09:00] anxiety or depression a week before or two before your period, feeling inability to sleep, difficulty concentrating, and I always tell my clients, if you only hate your partner two weeks out of the month, it's more likely your hormones than your partner. If it's only two weeks, it's only those two weeks. So we, you know, it really, physiology affects our behavior. It affects our perception, how we feel in our body, how we show up for ourselves, how we show up for others. So that perimenopausal transition is really associated, we've used the term estrogen dominance, but it's really progesterone insufficiency,

as progesterone levels start to decline. And this is key because we need progesterone from cholesterol, we make progesterone and pregnenolone these two neuroprotective, anti-inflammatory hormones that are so good for the brain, for our mood, for our cognition, for our drive and desire, and [00:10:00] all of those things.

These hormones are are key mother hormones. But from progesterone, we make cortisol or stress hormone. Now, show me a woman in her thirties and or forties that's not under some significant increased amount of stress, right? I mean, like, if you're having to fill the cortisol bucket, progesterone levels can decline even more.

And, and that progesterone insufficiency, that loss of this neuroprotective hormone that's so important for production of our neurotransmitter GABA, which is our anti-anxiety hormone, our neurotransmitter. You understand okay, now I see why there's more anxiety, more difficulty sleeping.

Progesterone helps us get good restorative night's sleep, and it's like, it's like that protective cushion that we've had in our lives. And now we hit this perimenopause journey and it's like all [00:11:00] of a sudden the lid to our pressure cooker comes popping off and everything that we've been like shoving down in us for so long, all of a sudden I would say it this way, gets the opportunity to express itself.

Dr. Tania Dempsey: And then, and then, yeah, then, then it's sort of like I think about it like all hell breaks loose, so to speak. Right?

Dr. Anna Cabeca: It absolutely can. I mean, it can lead to divorces, mood disorders, multiple diagnoses, medical condition, if we're just like bandaging it. But we know when we get to root cause medicine, get to functional medicine principles and address the underlying, underlying reasons, all those symptoms go away, all those symptoms go away even before prescribing anything.

And like I like to say, you know, menopause is natural and mandatory. Suffering is optional.

Jill Brook: That was gonna be my question because I feel like, so I'm 52 and I'm at that age where I'm getting all this messaging about how miserable I should expect to be and I should expect to gain belly fat and have [00:12:00] trouble thinking, and, oh, the one today that I didn't know about was incontinence. I didn't know that was part of it.

And so like, I feel like, and my own primary care physician had mentioned that there's nothing that they would normally do for any of this. And so it's like, I feel like I was set up to just expect to suffer for a while. And I'm wondering what you think, like how much should a woman suffer before she takes steps to do something about it?

Dr. Anna Cabeca: She shouldn't. Right? She shouldn't. If we are, we, the earlier we can start being proactive, we don't have to suffer. Right? We do not have to suffer. So understanding what's happening at the physiologic level and understanding the natural hormonal shifts and while our reproductive protective anabolic hormones are starting to decline,

insulin and cortisol are increasing. So what happens is we can gain weight, have blood sugar issues. That's why we catch up to men and heart disease. [00:13:00] So we need to create insulin sensitivity and we need to manage as a priority, you know, our, our stress, for instance. And I always like I say that, but it, it's, I am very strongly an advocate for optimizing oxytocin.

Like, okay, all this stress management stresses me out. So let's just focus on things to increase oxytocin, the counter antidote, the antidote to stress, right. The antidote to cortisol, oxytocin, the most powerful hormone in our body, the life-giving hormone, the joyful hormone, the hormone of gratitude and compassion and kindness and love. Like that hormone oxytocin is an, you know, is a

immuno supportive hormone. We've studied, there's so many aspects of it. So we look, Jill, as you're going through this now, it's like, okay, how, how much are you playing each day? Are you laughing? You have such a great sense of humor, I can tell already. So it's like, you know, those, those are, that's good ways to self-medicate.

Like focus on what increases [00:14:00] oxytocin. This transition should be a time of rebirth into the second spring of our lives. And so there's some challenges around any kind of rebirth that recognizing this is happening and optimizing our journey through it. That is key. And the sooner we start the better, right?

So in my methods that I write about and I teach in my programs, it's the like creating insulin sensitivity, optimizing oxytocin, working with our body's physiology to empower it to heal itself, and then all those symptoms go away.

Dr. Tania Dempsey: So a lot of what you're talking about women have some control over, right? What you're saying is that there are things they can do even beyond medication.

Dr. Anna Cabeca: Absolutely.

Dr. Tania Dempsey: I think that's powerful.

Dr. Anna Cabeca: Yeah. I mean, lifestyle medicine is 90, is lifestyle and nutrition is over 90% of it. And I say 90% 'cause I'm still an egotistical physician and I wanna claim [00:15:00] 10% you need me to write you something on a prescription pad or fax something in.

So you know, I mean, it's true. But it's really 99.9%. So then there is the bioidentical hormones that come in now, you know, and Jill, you mentioned incontinence, like I'm a gynecologist. Vaginal health is necessary for optimal health, and so many women don't get treated, get mistreated, you know, are even going through very expensive surgeries,

bladder incontinent procedures and vaginal rejuvenation procedures without ever being hormonally optimized in that, that vulva vaginal area, which is key, which is, you know, like I originally launched, a lot of what I do in sexual health and sexual medicine is paying attention, because yeah, you know, I might get laugh lines and smile lines, but down there they cause problem. Wrinkles down there, loss of collagen down there, you know, decrease in moisture down there. Anything like, no. Not having it.

Dr. Tania Dempsey: And by doing that and [00:16:00] being, and being proactive, right, you can reduce the symptoms that doctors say are inevitable, right? I think that's not acceptable in modern medicine. We can't just say this is inevitable and just, you know, deal with it, right? We have solutions. You know, it sounds like you have you, you know, you have your solutions.

I have mine. Many of, of what we, much of what we do overlaps of course. So I think that's, that's, you know, we have to give women hope because there is so much, there's so much that we have, you know, at our, at our, at our fingertips.

Dr. Anna Cabeca: Right. Absolutely. And, and like this, it's hope and empowerment, right? It's hope and empowerment to be able to say, okay, you have control. You have a choice. And in every, you know, in every, everything you do, in which way are we going towards health or are we going towards disease? We make that choice every day.

And so I think that conscious [00:17:00] knowledge that, okay, if I make this choice every day that I'm going to be a healthier me, I'm gonna be a more balanced me, a stronger me every day in that day as well as, you know, decades from now.

Dr. Tania Dempsey: So, so what is your approach? So if you have to use medication and you have to treat and you have patients who have symptoms, let's say they need various hormones. They're having problems you know, let's say the hot flashes are hard to control. They have decreased libido and it's impacting their relationships.

They have vaginal, vulvar problems that are making, so aside from the libido, they, they can't engage in, in sexual relations because of the problems they're having. So, once you've tried to optimize through lifestyle, then where do you go?

Dr. Anna Cabeca: Yeah, so, so this is key. We look at what's the underlying, underlying cause of what's happening. [00:18:00] So hot flashes can be estrogen insufficiency, but I would be doing a disservice to my patients if I didn't optimize insulin sensitivity, because insulin resistance is one of the number one reasons for unrelenting persistent hot flashes post menopause.

So you wanna optimize insulin sensitivity. You know, I, I have clients check urine pH for alkalinity 'cause we know that's associated with decreased inflammation, improved bone health, improved cardiovascular health and metabolic health, all those things. And so when it then, you know, and, and support their detoxification pathways.

Make sure they're having regular bowel movements each day, supporting healthy hormone detox, because anything I add to their bucket that they're already like overwhelmed in toxins or having struggle with constipation or IBS is just maybe contributing is, is a crutch. Or contributing to the problem depending on their epigenetics.

And so my approach is always support [00:19:00] those pathways and use bioidentical hormones and you know, around menopause and for, you know, post menopause, I will, I will, you know, take my progesterone pregnenolone cream, it's my balance cream, I will be using that till I die. I guarantee you. That is my mind memory, mood, magic, right?

I will be using that. And, and, and you've come across and I do, I had an old patient when I was in Georgia and I had retired my practice and I start up practice here in Dallas, Texas. So she's long history back with me and I had her on compounded hormones. So she's 65, she's a, she's a MD, so she's a bright, incredibly bright woman and she's like, well, you know, I can't write my own hormones, but my gynecologist,

she said I'm 65 and she's not gonna continue me on these hormones. She's like, prolonged it for like a few months, but that's it. She says after age 65, there's no research. I'm like, wait, did she not read the 10 million women study? I mean, [00:20:00] wait, that was in post-menopausal women. Would we take away your thyroid medication at a certain age would we take away your insulin at a certain age?

I mean, it's ridiculous.

Dr. Tania Dempsey: No, but, but thank you for bringing that up because that is something that is spoken about a lot in conventional medicine, that there's something about this five years on hormone thing that keeps being thrown out. My patients come in and they say, you know, yes, you know, they, they wanna go on bioidentical hormones, but their internist or their OB GYN,

somebody has said to them they can only go on it for five years after menopause. Is there research on that? Is there actually like a study?

Dr. Anna Cabeca: You know, like this is where the concept of the estrogen window came into play, and like the benefits versus the risk. With oral estrogen, the older we get, the more risk of stroke we have with oral estrogens. Now with post [00:21:00] menopause, I don't typically use oral estrogen. I use transdermal estrogen typically, or you know, or I will use trochees sometimes, but I watch those inflammatory markers if I'm prescribing a oral lozenge, 'cause some of that will be swallowed and I wanna see if they're increasing any inflammatory markers. Oral estrogens cause inflammation.

So I think a lot of that was looking at the mode of delivery versus the optimal mode of delivery for those individuals. What the 10 million Women Studies show, this was published in July, it looked at Medicare users. So again, that's what the majority would be over age 65 that were filling hormone prescriptions.

And they looked, they broke it down into different types, topical, oral, the different forms, and they found that women classically on transdermal estrogens did better than those who were not. Like lower morbidity and [00:22:00] mortality in our hormone users. And progestins, we know that's a bad idea since 2002, actually since the Hers Trial published in the nineties, we've known oral progestins

are a bad idea. Bioidentical, oral progesterone is very, very safe. So I get confused with that. All of a sudden, okay, you've been on, you have this five year window, and then what you're, then you can have dry vaginal tissue, you can have incontinence issues, you can have hippocampal brain shrinkage and memory loss.

I mean, then, I mean like, does that make sense? I mean, who does that make sense to? Wait, wait. It may make sense to the guys naming these conditions.

Dr. Tania Dempsey: I know. No, I know. I don't mean to laugh, but it, it is just doesn't, it doesn't even make sense. And the reality is that. People are living longer and we don't wanna just live longer. We want to live healthier. [00:23:00] And so hormones have to be a piece of that, of that puzzle. Otherwise, right, it doesn't make sense.

Dr. Anna Cabeca: I think so in our current environment. Health span has to equal our lifespan, right? Health span has to equal our lifespan. Living out years in hospice or in a, you know, a nursing home or something that is not, that is not optimal. But we want optimal. If we have a choice, we can create optimal for ourselves.

And then this is the, the contradictions to some of what I'm saying is my own, you know, my own issues, 'cause I was a debater in high school and college, so I, you know, had to argue both sides of an argument. So I say, okay, well look at the, look at the Blue Zones. Here we have people in the Blue Zones , you know, the populations with the highest concentration of people living over a hundred, and they're not on handfuls of supplements and they're not on a, you know,

tons of prescription medications. I mean, they're not. And so we look, we have to look at that and say, okay, well what are the factors we know that [00:24:00] are common in these groups? And they're out in nature. They have good organic food sources. They're eating from nature. They have good community and friendships, and a faith, that's oxytocin.

Dr. Tania Dempsey: That's right.

Dr. Anna Cabeca: That's oxytocin. So those are really powerful. In today's environment, we are exposed, we've been exposed, at least as American woman to so many toxins in our water. Fluoride opposes and kicks out and blocks the iodine receptors. And we need iodine at every receptor for actual good hormone optimization.

So we've been drinking fluorinated water, fluoride tooth paste and killing our hormones. So we've had, again, that's just one example of many. And so we have all these hormone disruptors, so we have to keep, you know, emptying our toxic bucket. We have to keep emptying and open our detox pathways and supplement with optimizing our body's own natural hormone production.

And that's, that's the way I practice and [00:25:00] it's where I see clients really thrive as a prescriber. When I'm prescribing, I'm looking at all these factors. Right. I'm looking at all these factors to maintain and optimize health. The other really big areas, women who've been diagnosed with breast cancer. I mean, they're not given any options, but why ?

Dr. Tania Dempsey: Yeah.

Dr. Anna Cabeca: Why? If we use bioidenticals and we support, figure out why did they get breast cancer to begin with, address those issues with epigenetics and therapeutic lifestyle changes, management, sub targeted supplementation, and hormones. We're optimizing their quality of life and creating bodies

inhospitable to cancer, and that's what we wanna do. So I started in 1999 doing this work with bioidentical hormones. Because I had a patient who was 63 years old, she had come in to see me, 63-year-old, five foot 10, silver hair, black horn rim glasses, [00:26:00] you know, 150 pounds, very intimidating.

This very confident woman, she was the president of a biotech firm. And she said, Dr. Anna, I was diagnosed with ductal carcinoma, in situ, that, you know, 10 years ago at Emory, at my alma mater, and they said they won't give me hormones. I have no sex drive. It hurts to have sex. I love my husband. I'm a woman of the sixties, and I'd rather die than live this way.

Help me. And that's how I got into it. I looked in the research. Well she didn't have breast cancer, but what if, what's the research regarding breast cancer and estrogen vaginally or testosterone or DHEA? And so I started customizing, you know, her hormones and prescriptions, and then other patients as well.

And I tell you again, I had her 83-year-old follow-up many years ago. She just published her memoir. She was still very active in advocacy on Capitol Hill and you know, she was thriving brain, [00:27:00] body, mind, relationship intact.

Dr. Tania Dempsey: So we learn from our patients and we have to continue to sort of, you know, change the paradigm.

Jill Brook: Well, Dr. Cabeca, you had mentioned a little while ago that you sometimes prescribe oral

bioidentical progesterone. But then I think you had mentioned that there's also a cream, and I guess I was wondering if you could just kind of talk about like the different options and when would you do one or the other, or do you do 'em both together or like how does it work and can you talk more about, about your products?

Dr. Anna Cabeca: Yeah, yeah, definitely. So I started to get into more of the transdermal products for safety, for efficacy, and for the slower half-life that lasts longer. We're using something transdermally. And oral progesterone for sleep is excellent. So that's a great thing that can typically, it's a you know, a max 18 hour.

It's gone in 18 hours, is pretty much gone for your system. Seven hours [00:28:00] it's peaked, 18 hours, it's gone. If you're taking it at, you know, 10:00 PM you're completely crashing somewhere midday. And so, so that was one reason. And again, I've, I've been my own best test subject too,

but as well as working with patients. Transdermal progesterone, we can get a lift. And when we use oral progesterone, they can make us sleepy 'cause they're converting 90% of an oral progesterone is converted through hepatic metabolism to its metabolites, allopregnanolone. And that can help, that produces GABA.

From there, we produce GABA, that helps us get a good night's sleep. That's why it's such a good, a good form to take to help, especially in perimenopause, to help us get a good night's sleep. And, and during that luteal phase of the cycle are trying to time it. So, and certainly it's brain food post menopause.

So I started using early on transdermal progesterones, especially in my breast cancer patients, [00:29:00] and and more complicated clients. I started really compounding different forms of progesterone and I added pregnenolone because of the neuroprotective effects of pregnenolone .

From pregnenolone, we make DHEA, and from DHEA we make testosterone and estrogen. So the combination worked better than the single by itself, and I could use it during the day without getting sleepy, have good memory, good focus, and good mood. And we just help kind of support that bucket, 'cause you know, we're going, I'm, you know, you we're moms and we have a job and we've got all these things that we've gotta do.

We've got all these things we're juggling. And so that, that added support. And so what I found is that you know clients do really, really well. So if we're not on oral progesterone for whatever reason, there is the option to do transdermal progesterone and pregnenolone, and that's why I created my [00:30:00] Balance Cream.

And then I added tripeptide to it, which is a natural ager to reduce fine lines, wrinkles, and the combination reduces sun spots and age spots. And this is what I know about women being one, and having had a med spa, is that if if we're using something, oh, this is great progesterone for my brain,

but I've had that, you know, tripeptide in and I'm like, oh, it's gonna reduce your wrinkles and firm up your skin and all that, your neck, et cetera. Then they're using it, right? Then they're gonna use it regularly.

Dr. Tania Dempsey: That's the compliance part. So are they putting, so they're putting that progesterone, pregnenolone, tripeptide cream on their face?

Dr. Anna Cabeca: Yeah, and this again, benefits. Like I always kind of get irritated when I hear someone's using a testosterone cream on their inner arms. I'm like, use it on your clitoris. Hello? Like, where do you want me, you know, put a little sometimes here, you know, like that, that, that's good stuff. That's magic stuff. So, for the Balance [00:31:00] Cream,

i, and, and this is true, men can use the topical progesterone too. I mean, it helps them sleep, helps with anxiety, helps again, fill their, I mean, it's a neuroprotective hormone. So, I have clients using it around the temporals. So to we say thin skin, where it's well absorbed versus fatty areas like our buttocks.

So we wanna put on thin skin where there's veins and you know, we wanna get good results. You can rotate sites too. You can use it on the vulvar vaginal area too, and get that benefit in, in that area as well. The vulva vaginal area is very vascular and absorbs ingredients very well, so it's another way to kind of rotate and support

that area. I created another cream Julva specifically with DHEA and plant stem cells from the alpine rose to help with vulva vaginal atrophy to help with clitoral atrophy, to reverse those changes too. So it's like, it's a nice a, it's a nice addition.

Dr. Tania Dempsey: So, so a [00:32:00] combo, right? A lot of women would use both.

Dr. Anna Cabeca: Yes.

Dr. Tania Dempsey: And, and does that product sort of help women not have to use estrogen vaginally, or do they sometimes have to use estrogen products as well.

Dr. Anna Cabeca: So, the majority, the Julva is sufficient because DHEA at the cellular level converts to testosterone and estrogen. And initial research looking at intravaginal DHEA showed it works at the intrinsic cellular level. There's very little systemic absorption. And it, it works on all three layers of the vaginal wall, from the mucosa to the, to the muscle.

So, and then we see that, like basically the hands of time reverse. We see tissue, and I see this all the time in my practice, go from atrophic thin tissue to, you know, flexible, naturally moist, healthier tissue. And so we see that vaginal [00:33:00] estrogen works on the mucosal layer, so it helps with moisture, but doesn't reach the deeper tissues.

On occasion, some women will need an added estrogen or added testosterone.

Dr. Tania Dempsey: No, that's, that's really, really helpful. So how do you approach libido?

Dr. Anna Cabeca: Oh, absolutely. It's a seven hour discussion. This is when it happened. You've, you, you've done your annual exam, you've talked with your patient, you're like, okay, I'll see you next time. Is there anything else you want to ask me? Well, Dr. Anna, I don't really, you know, haven't had much of a sex drive.

I really, you know. I kind of miss it. I'm like, okay, that's a seven hour discussion. So I actually created a whole program called Sexual CPR, that's a five week program as a very holistic way to kind of, get to the, to, to help women feel empowered and revive their libido, hence the CPR part, Sexual CPR.

So it's a very holistic program. I am the women's sexual health, not technique or relationship expert. I do [00:34:00] have to give that caveat. But when it comes to that whole issue of desire, and I've studied this, i, I created my program Sexual CPR in 2011. And so what I really narrowed it down to, the majority of issues come down to three main causes.

They're issues of desire, disconnect in the relationship or with yourself, with your own body, and discomfort. 'cause if it hurts every time you do something, why would you want to? So that discussion, I mean that it really is one of the first things that clients get when they do my Sexual CPR program is a, you know, it's a three page questionnaire.

It's understanding, because we look at, okay, is there medical issues, are there relational issues, are there spiritual issues or held beliefs? Is there, anything related to physical pain, episiotomy, you know, pelvic trauma, pain symptoms, what's going on there? Are there, you know, so [00:35:00] there's hormonal issues.

Other medications that could be inhibiting their ability to orgasm or causing them dryness. Antihistamines and steroids can dampen your libido and orgasm.

So you kind of, there's so many aspects. What could be, what could be this woman's cause for a low libido and how can we get around it? And so that's a, a big part. And then part of my formula, my foundations is my Mighty Maca. Mighty Maca is a known aphrodisiac. It's been studied and used for centuries for this specific thing.

And the reason, they call it the Peruvian Viagra for a reason here, but I wanted to study, I was a researcher before I went to med school, so I wanted to study, well, what, what is this Maca composed of? Like, what makes it work this way? And so it has specific proteins called macaene, and it's rich in arginine,

which produces nitric oxide, which is how Viagra works, right? Increases blood flow. So I was like, oh, [00:36:00] well there's some, maybe there's something to this. And it's certainly the combination if you get rid of inflammation, helps support detox and improve your body's energy and hormone balance, that naturally helps revive the libido.

So the combination in Mighty Maca Plus has been really, really good to do that. But maca in and of itself, a well known aphrodisiac.

But again, we know like testosterone, we can use testosterone for women with low libido. We sometimes we need estrogen. When we need estrogen on board for receptivity and testosterone for drive. And, and so, but we know from clients who have been on even pellet therapy for so long, really high levels of testosterone that works for a while, and then they're back to no libido. Always, right, address the underlying root causes.

Dr. Tania Dempsey: So they're not detoxing or they're not clearing, or their receptors are overwhelmed or, right. So there's some, so many things that you have to consider. But again, I go back to what we said [00:37:00] earlier. There's hope and there are things that, that can be done. The main thing is just for, for, for women to hear this and to understand that they can

and should look into it. Find somebody like you or like me or you know, or one of our colleagues, who can work with them to address it. It's not something that they need to suffer in silence on. I feel like, like women are sort of, I guess subtly or maybe not so subtly made to believe that it's not important.

Dr. Anna Cabeca: And that's heartbreaking. That is. Because when you see the light turns on in someone's eyes that believed that, that they were just maybe like dead from the waist down or, or that hey, this is just how they have to power through life. And they get that twinkle and energetic spark. I mean, it's powerful. I mean, it is, is game changing and you know, and I reflect back to when I was, you know, diagnosed [00:38:00] with early menopause and infertility and that pathway that I was going down towards diabetes and heart disease, like my parents before me, right? That was at that time now to be 59. This year I celebrate my 59th birthday. To think, okay, well I walked a hundred miles on the Camino de Santiago last year.

How am I gonna celebrate this year? Like I gotta keep challenging myself, right? Like to keep living and plus I gotta get in the back of the truck to connect the trailer, so I gotta stay active, right? Like and having people that you can look at and look up to, and recognizing that, no, no, I'm not accepting that.

Women are really powerful and intuitive, and when you hear that voice inside you, you know, just like with that little spark of hope, and I hope that's what this conversation gives to everyone listening today, is that that spark of hope, there's always one next right step.

Dr. Tania Dempsey: So what, what else do you [00:39:00] think we, we need to teach women about? What, what is one of the things that we don't talk enough about?

Dr. Anna Cabeca: Yeah, definitely the vaginal health is necessary for optimal health. And this is something I'm speaking about at Harvard at the end of the month, teaching on. Yes, and I think it's so important to get this into mainstream because even as gynecologists, we don't really understand the vaginal microbiome.

We're not trained. I mean, I didn't know anything about it. I've had to learn on my own all these years, so much of this work. But the research is there. The vaginal microbiome is key to optimal health. We know through the vaginal birth canal, baby's first seeding of a protective microbiome is through the mom's vagina.

And we as OBs, I mean, we created such a sterile environment and you know, really have industrialized OB and I witnessed that three years ago, actually just recently, just exactly three years ago, when I delivered my granddaughter in a birthing center in the middle of the pandemic. And [00:40:00] so walking in a bath and, and, and as an OB, I mean, I delivered babies in very dim light and I labored my patients and all that.

I thought it was really good. But working with midwives in a birthing center outside of a hospital setting, let me tell you, I was humbled. I was like, oh my gosh. Incredible. And women are so powerful to be able to do this. And seriously, it was the best delivery of my life.

Dr. Tania Dempsey: Wow. So you, you've, you've mentioned insulin resistance a, a, a few, quite a few times, and it's, it's one of the things that I talk a lot about. So I'd love to hear your approach, 'cause there's no question in my mind that insulin resistance is like

the evil root cause of a lot of things that we're seeing in terms of, you know, chronic diseases in terms of the aging process, you know, overall. So I'd love to hear what your approach is to, to that part of that.

Dr. Anna Cabeca: Yeah, so insulin sensitivity is key, and and everything we can do to [00:41:00] optimize insulin receptor status, et cetera. But where it is built into my method, and I call it my Keto Green method, and this is what I write about and teach about. Not keto in the sense of bacon and eggs, but keto in the sense of low glycemic with incorporating healthy alkalinizers, medicinal foods to help with detox.

I say medicinal foods like turmeric and cinnamon, garlic and onions, tomatoes, and, and, you know, cabbage, broccoli, I mean, those are medicinal foods to be honest. So we look at these, so I created recipes that are very low glycemic so that we can start to be insulin sensitive and incorporate intermittent fasting into this mix.

I mean, even just 13 hours of intermittent fasting is enough to get us to a nice baseline glucose and helping to support insulin sensitivity. So those are some of the key things that I do with clients as a rule to help stabilize, you know, to balance [00:42:00] hormones.

Dr. Tania Dempsey: I, I think it's, I think it's critical. I think diet is underrated in a, in a lot of ways. And I think that everyone has to personalize it for themselves, right? There are, I think that there are, you know, foods that maybe some people do better with than, than others. You know, maybe cabbage isn't great for one person 'cause it's too high in FODMAP or, or whatever it is.

Right. But I think generally speaking, we can use diet to control a lot of this, this issue that is really an inflammatory state. Insulin resistance equals inflammation. I think that's the driver of, of all the stuff we're talking about.

Dr. Anna Cabeca: Exactly. And then we can use supplements too. I mean, like, again, medicinal food, cinnamon helps with insulin sensitivity. So cinnamon's a great one. And then berberine, you know, is, is well studied at improving insulin sensitivity. One of the best insulin sensitizers is something we get for free as [00:43:00] soon as we walk outside in the sunlight.

Right? Vitamin D. Vitamin D, or supplementing with it, is a huge insulin sensitizer.

Dr. Tania Dempsey: That's my number one,

right? That's, that's my, I always tell everyone, you know, if you can just, if there's only one thing you will take, please take vitamin D. Right? Because it's an insulin sensitizer. It's an immune modulator. It's a hormone itself, right? So it interacts with all these other hormones.

Dr. Anna Cabeca: Yeah. None of our hormones work well without it, in low D, vitamin D deficient states. Exactly.

Dr. Tania Dempsey: Well, this was just wonderful. I, I, I, I know that you're busy and I really appreciate your time. Any last words and then where can people find you?

Dr. Anna Cabeca: Yeah. Thank you. Well, thanks for having me. I mean, I think that it's like, you know, one thing that I've learned the hard way is that, you know, it is always just one next right step at a time. And so, you know, being able to have supportive communities and, and collaboratives just makes all the difference.

[00:44:00] So, to find me, I'm at dranna.com . I have online virtual programs that help you, you know, like guide yourself through these hormone optimization methods like the Sexual CPR, my Magic Menopause, my Free Breeze through Menopause Program. So I've got ways for people to connect with me. And then please connect with me on social media too at thegirlfrienddoctor, on YouTube, on Instagram, and Facebook.

Dr. Tania Dempsey: You've got wonderful content. I've heard you speak a number of times. I think you have so much to offer and I really appreciate your time today.

Jill Brook: Dr. Cabeca and Dr. Dempsey, thank you so much for all this great information and I just have to say to listeners that if they haven't already listened to our previous podcast about the hormones, this one is such good news, especially in the context of what Dr. Dempsey taught us before about progesterone also helping to control mast cells.

And I know that for me, I don't, I never do this, but I have to [00:45:00] say that progesterone changed my life and Dr. Dempsey like literally saved me. But I started taking it for mast cell control and I ended up getting all these benefits that you spoke about today, Dr. Cabeca. So now this is starting to make sense, and I'm one of those people who had tried everything and so there's probably a lot of, you know, people listening saying, okay, well this is one more piece,

and I'm saying, at least for me, it was a huge piece and I've been trying everything for years. So, this is really exciting to know. There's like still big things out there that can make so much of a difference.

Dr. Tania Dempsey: Right. Exactly. And that's the thing, there's always something out there.

Dr. Anna Cabeca: There's always hope. Yep. There's always something. One next right step.

Jill Brook: So thanks a million to you both and okay listeners, that's all for today. We'll be back soon with another episode, but until then, thank you for listening, remember, you're not alone, and please join us again soon.