Ep. 317 Perimenopause Wisdom: Dr. Cabeca on Ovarian Health, Menopause & More!

Today, I am delighted to reconnect with my friend and colleague, Dr. Anna Cabeca. She was with me before on episodes 94 and 202.

Dr. Cabeca is a triple board-certified physician in gynecology, integrative medicine, anti-aging, and regenerative medicine. She is also an authority on functional medicine, sexual health, and bioidentical hormone replacement therapy.

In our conversation today, we dive into women’s health care. We explore the impact of COVID and COVID vaccines on ovarian health, methods for measuring ovarian health and supporting fertility, the significance of oxytocin, the role of oral contraceptives, and navigating perimenopause and menopause. Our discussion also extends to alternative hormone replacement therapies, using pellets and bioidenticals for hormone replacement, the benefits of hormone holidays, pregnenolone use, and detox support. 

You are sure to gain from the insights and expert information Dr. Cabeca shares with us today.

“When we look at the hormonal hierarchy, oxytocin is the most powerful hormone in our body and it is the most alkalinizing hormone.”

– Dr. Anna Cabeca

IN THIS EPISODE YOU WILL LEARN:

• How COVID and COVID injections have impacted women’s health
• Improving ovarian function and fertility through detoxification and lifestyle changes
• The role of oxytocin in fertility and regulating hormonal balance
• The negative impact oral contraceptives have on cardiovascular and breast health
• Dr. Cabeca recommends a simple, pain-free, and non-hormonal IUD for birth control 
• Dr. Cabeca and I share our opinions on using pellets for hormone replacement therapy
• The potential risks of high-dose hormone replacement therapy
• Why is it important to give your body a hormone holiday?
• Why is it essential to use only natural and clean skincare and dental health products and avoid everyday products containing heavy metals?
• How mold toxicity affects the body

Connect with Cynthia Thurlow

• Follow on Twitter, Instagram & LinkedIn
• Check out Cynthia’s website
• Submit your questions to support@cynthiathurlow.com

Connect with Dr. Anna Cabeca

• On her website
• On social media: @the girlfriend doctor

Previoius Episodes Featuring Dr. Cabeca

Ep. 94 – Reclaim Your Vibrancy, Sexuality, Health and Happiness! – with Dr. Anna Cabeca

Ep. 202 – Healing Your Hormones and Becoming Empowered with The Girlfriend Doctor

Transcript

Cynthia Thurlow: [00:00:01] Welcome to Everyday Wellness podcast. I’m your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent, is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

[00:00:28] Today, I had the honor of reconnecting with my friend and colleague, Dr. Anna Cabeca. She has been on with me before in Episodes 94 and 202. She is a triple board-certified physician in gynecology, integrative medicine, antiaging, and regenerative medicine. She is also an expert on functional medicine, sexual health, and bioidentical hormone replacement therapy. Today, we spoke at length about, well women’s care, the impact of COVID and the vaccines on ovarian health, ways to measure ovarian health and support fertility, the impact of oxytocin, the role of oral contraceptives, and perimenopause and menopause as well as alternatives, hormone replacement therapy, pellets and bioidenticals, the role of hormone holidays, the use of pregnenolone as well as detox support. I know you will love this conversation as much as I did recording it. 

[00:01:30] Welcome Dr. Cabeca. So good to have you back. Definitely a fan favorite. Everyone always enjoys our conversations. 

Dr. Anna Cabeca: [00:01:37] I am so glad to be here. I’m so grateful to be spending time with you. It is a gift. It is a gift for sure.

Cynthia Thurlow: [00:01:44] Yeah. So, I know that you are back in clinical practice and I would be curious to know in the interim in which you were not seeing patients formally, has anything changed in terms of, well women’s care for women in perimenopause and menopause? Any different concerns or do you feel like there’s a greater emphasis on women’s health post our childbearing years?

Dr. Anna Cabeca: [00:02:07] Where do I begin? Oh my gosh. [Cynthia laughs] I mean, seriously, there is so much to talk about here, especially a sharp contrast from when I retired from my practice around 2015 and since I was just doing physician-to-physician consults regarding patients and seeing patients back in practicing and really digging into what some of the underlying issues are has really changed. And COVID and COVID injections have had a lot to do with it. So, women in perimenopause a lot sooner, with irregular cycles, with earlier diagnosis of menopause, multiple miscarriages after conceiving normally without difficulty. I’ve seen so much like that. Definitely hormonal issues for sure, hormone imbalance issues and ovarian dysfunction where when we do a workup and we’re looking at fertility, longevity of fertility, or even again, which is ovarian function is a marker of quality of life and longevity.

[00:03:09] So, when we’re looking at that, we really have to look at one hormone called AMH, anti-Müllerian hormone, which measures the fertility perspective or possibility based on ovarian function through the entire feedback system of our hormonal communication. So, AMH is an important number. So, seeing clients in their 30s, mid to late 30s, 35, 37, 42, 44, all with very low AMHs. So that makes them, first of all, not good fertility candidates. They’ve been diagnosed with early menopause, put on birth control pills, and this is with some of the best and the brightest we have here in Texas, and told we’re sorry and that’s not okay. So, just even working– So there’s so much to that and there’s a lot we can do to revive ovarian function. And I’ve been able to do that and see that happen, clear some of the hormonal balances caused by the spike protein. And that was not part of my experience before. 

Cynthia Thurlow: [00:04:16] Yeah. And I think I’ve been pretty open with listeners. I did get vaccinated. I do a tremendous amount of travel. And so that was the greatest concern that I had was just at the height of the pandemic, and I bled for six months as a menopausal female, six months. And I remember every GYN I saw because we were in the midst of relocating from one part of the state to another, they just said, “I can’t tell you how many women we’re seeing,” women who are 10, 15, 20 years into menopause that are bleeding. Women who, as you mentioned, have never had issues with miscarriages, having miscarriages. So, I don’t think we fully appreciate as clinicians the net impact of the spike protein on ovarian reserve, ovarian function, what’s going on between the brain and our ovaries.

[00:05:01] So, it’s going to be interesting to see how things evolve over the next 10, 15, 20, 30 years. Obviously, the AMH test that you’re talking about is one that I probably have not talked about on the podcast. For listeners benefits, can we explain a little bit more about what that is and what is a normal value? What would you want to be seeing in your 35, 40-year-old females as a function of ovarian aging? 

Dr. Anna Cabeca: [00:05:29] Yeah, so that’s a great question. So, what we want to see optimally, especially for fertility is greater than 1.7. So, these numbers are really small. So greater than 1.7. And what my one client who’d had two miscarriages after having a healthy, normal pregnancy, she came in with an AMH of 0.03. And in just one month, we were able to improve that– About four to six weeks, we were able to improve that to a 0.5. So that’s like over 10 times improvement in just one month. We’re not where we need to be. But that was very hopeful, very hopeful because again, she’d been seen and said, “Oh, we just need birth control pills, or you’re not a good candidate for in vitro, you’re not a good candidate for egg retrieval, and things like that.” But there’s still more we can do. Still more we can do.

Cynthia Thurlow: [00:06:25] What are some of the things, if someone is listening to this podcast and they’re in those circumstances, obviously work with your physician, work with your healthcare practitioner, but what are some of the high-level concepts of things that can help improve that metric? 

Dr. Anna Cabeca: [00:06:39] So, definitely, number one, is removing toxins. So, detox. So, for my clients, first step is from my book, The Hormone Fix, start with the 10-day Keto-Green hormone detox. We add in Mighty Maca because it has so many superfoods and antioxidants to help decrease inflammation, support detoxification safely, and because we’re being aggressive, we want fertility, and we want to detox, and we want to move things quickly I add in our Keto Detox supplement, which supports phase 1 and phase 2 detox. So, from the liver support, to help with releasing toxins and eliminating them safely and Omega-3 fish oil and optimize vitamin D [laughs] and optimize progesterone, which is a potent anti-inflammatory too. So that scores, cleaning up the diet, working on detox, and also part of that detox is lymphatic drainage. So dry brushing and I know you love doing that, Cynthia.

[00:07:41] I love dry brushing. I have one in my office and one in my bathroom, and I’m just like, “Okay,” sometimes during the day, I’ll just wake up with a good dry brush. So, it’s important to do that. Move the lymphatics, infrared sauna. And for this client, because we do want fertility. And as soon as possible, we’re doing IV ozone. So, IV ozone, which that’s a process when you remove blood, put it through an ozonator, it gets extra oxygenated or ozonated, which also is killing off bacteria, toxins, it’s filtering as well. And then we reinfuse that blood back into the individual with maybe some additional vitamins and amino acids. So that’s supporting detoxification and revitalization at the same time. So, I like to do that at least once or twice a week if possible. 

[00:08:31] And if it’s not possible, it’s fine with what we’re doing supplement wise as well as lifestyle. So also with lymphatic drainage, it means– so the infrared saunas, you can hot/cold shower, alternate dry brush, get on a power plate or one of the vibrating plates or rebounder, go for long walks, definitely destress. And that’s probably the big part of it is decrease cortisol, increase oxytocin, because if there’s one hormone that can do the most powerful healing in the shortest amount of time, it is oxytocin. So, working on that to empower her own production of oxytocin as well.

Cynthia Thurlow: [00:09:06] I really love that because it’s a very comprehensive mind body spirit perspective as it pertains to fertility. I think in many instances, and I’m someone that went through infertility treatments to get pregnant with both of my children, not realizing that there were fundamental underlying issues related to luteal phase defects. Not enough progesterone, which was probably driving a great deal of it, that piece of it was missing. And I think for a lot of individuals that are struggling with infertility or struggling with some of these specific challenges that we started the conversation focusing on is understanding that there’s a lot more than just giving medications. There’s so much more to this fertility journey.

[00:09:46] I’m so glad that you brought up oxytocin, because I started the conversation with you before we started recording, saying, I don’t think we’ve had an oxytocin slanted conversation on the podcast. And yet it’s such an important hormone that in many ways acts as a neurotransmitter. So, let’s talk about oxytocin. What is its role? I think a lot of people associate it with bonding with our babies and breastfeeding. And yes, it’s that wonderful bonding hormone, but it’s a really powerful hormone and one that I think is particularly important for women as they’re getting older because of its effect on cortisol.

Dr. Anna Cabeca: [00:10:20] It’s so true. It’s so true. And there’s a yin and yang to oxytocin and cortisol as well. Now, I will just with your infertility journey, that was mine too. I had been diagnosed at 39 with early menopause and irreversible infertility after failing six rounds of the highest doses of fertility meds and not getting any ovarian response. So that was what took me on this journey around the world and learning about indigenous medicines and traditional medicines and Eastern medicines and lifestyle hacks that as a result of that, naturally, after failing that, getting that diagnosis, and this is why I will say your diagnosis is not your destiny. But getting that diagnosis, I was able to, with the grace of God, God’s hand has been in my life every step of the way. So, with the grace of God, was able to reverse the early menopause diagnosis, started having my period again, and then I naturally conceived the child I was told I would never be able to have when I was 41 years old. And so now, at 57, I’m like, okay, we’re going to balance those teenage hormones because she’s 15 right now, so working on that too. 

[laughter] 

Cynthia Thurlow: [00:11:27] Well, what an incredible story. I think it’s particularly helpful for listeners to understand that many of us that are in the health and wellness space have struggled with infertility. I certainly didn’t go to the point of being using IVF, but went through Clomid, went through IUI. I was told, there’s no way you’ll ever get pregnant on your first cycle of IUI with Clomid and I did. I have an 18-year-old and then with my other son, it took a lot longer, but I remember being so very grateful that I was in a position to be able to get pregnant and to stay pregnant. But I think for a lot of listeners, it is such a blessing to be able to get pregnant.

[00:12:06] And your story of being diagnosed with early menopause, how many women, if they didn’t know as much as you did, would have just said, “Okay, I’m just not meant to have another child?” And yet you persevered. And so that’s such an inspiring story and one that I know that many listeners will be able to associate with. So, when we talk about oxytocin, it’s more than just this bonding hormone. Why is oxytocin so important and so special and unique?

Dr. Anna Cabeca: [00:12:33] So, when we look at the hormonal hierarchy, oxytocin is the most powerful hormone in our body, and it’s the most alkalinizing hormone. So, what I like to say, Cynthia, is that if you consider all the hormones, we have hundreds of hormones in our body, and like estrogen, progesterone, testosterone, DHEA, melatonin. I mean, even these are minor hormones. And I consider, I like to make the analogy of, say, for university. All our hormones are like students at a university. They’re gifted, they have a specific purpose, direction, plans to make, etc. And then the professors of the university are other major hormones that regulate the minor hormones. And these are insulin and cortisol and adrenaline, but insulin and cortisol mainly. And if we can get insulin and cortisol in check, then all those other hormones play better. 

[00:13:25] And if they’re not, that’s the example of– say, for example, your professor comes in hungover or high, and he just turns out the light and plays a movie and lets the classroom be chaotic, there’s chaos. And that’s so true. When insulin and cortisol aren’t well regulated, there is chaos. And then the overarching, say, the principal or the president of the university, is oxytocin. So, a good oxytocin, benevolent, kind, compassionate, good boundaries, firm, grateful, generous, all of those characteristics lead for better morale, better teamwork, better connection, and community within the entire university setting. And the opposite is true. If there is no oxytocin or oxytocin is very, very low, deficient, there’s anger, there’s hate, there’s the iron fist, there’s greed and prejudice and racism and all of those things. And that does not lead to good outcomes for anyone. So that’s where we have oxytocin. 

[00:14:30] And the most important thing is to understand that when cortisol goes up, when we are stressed and cortisol goes up, whether it’s physical stress, whether it’s emotional stress, relational stress, environmental stress, everyday stress, or posttraumatic stress, when cortisol goes up, oxytocin goes down. And when cortisol is up for a long time, the paraventricular nucleus, the area in the brain, will suppress cortisol. So, now it comes down, and now you’re at this dangerous state where cortisol and oxytocin are both low. And that’s the physiology of burnout, the physiology of divorce, the physiology of feeling like, “I love my partner. I don’t feel love for them. I used to love my work and my colleagues, I don’t feel love for them anymore or I used to love painting or going for walks or hikes and I don’t feel like it. I just don’t feel like doing that anymore.”

[00:15:25] All of those are symptoms of this dangerous physiologic state where oxytocin is low, you’re out of balance, and when you’re in this state, it increases inflammation in your body. So that keeps cortisol, which is your natural anti-inflammatory, keeps it trying to pump up and push out, and that increases glucose. So, now you’re becoming more insulin resistant and there’s more chaos amongst your hormones. So, that process is just a nasty downward spiral. And we do in medicine, I have focused on the adrenals for so long, I focused on our reproductive hormones for so long and that’s why I say it takes more than hormones to fix our hormones. 

[00:16:03] But when it came down to that, when I realized that physiology, “What is wrong with me? I know I love my husband. I don’t feel love for him. I wanted our marriage to work. Like, what is this disconnect?” And it’s when I realized that this physiology, I had to search in the literature, it’s nothing I was trained in, but I had to understand this physiology as I started to learn more about, “Okay, well, what do I need to do to increase my oxytocin?” Playing with my pets. We have horses, getting out there with the horses. And horses can sense when you are frazzled. So, being able to force your stress level down so that you can be calm and present. And of course, things like sex, orgasm, positive touch increases oxytocin and gratitude. So, my prayer practice, my spiritual practice, and the practice of focusing on in the very present moment, what am I grateful for?

[00:16:59] So, those things naturally increase oxytocin. And yeah, we can prescribe it, and I do sometimes for a short while because it’s also, again, the power of oxytocin. Do you know that it can be used to help clear COVID spike protein? [laughs]

Cynthia Thurlow: [00:17:13] No, I did not know that.

Dr. Anna Cabeca: [00:17:15] A remedy to COVID is to get happier. But yeah, I was looking at some of the research because looking at the areas where too, COVID had higher prevalence or higher illness versus lower and oxytocin rich areas. So, I started looking at oxytocin and virus, the effects on virus, and it can definitely boost your immune system and suppress virus replication, which is really critical to hear that.

Cynthia Thurlow: [00:17:44] Yeah, I think it’s such an important discussion to be had because I know that when I trained 1000 years ago now, oxytocin just wasn’t emphasized. We were familiarized with Pitocin used to induce labor in pregnant women. It was something that we really just didn’t focus in on. And yet when I hear you describing how critically important it is to having a happy, healthy, balanced body, it makes complete sense. So, you mentioned some of the signs that we can look out for. It can be just being irritable, it can be being angry, aching muscles, poor sleep. I mean, to me this describes in so many ways perimenopausal, menopausal women have low oxytocin. So, when you are working with your middle-aged women and you’re talking to them about oxytocin, and maybe they’re not in a relationship. 

[00:18:35] And my understanding of oxytocin is that it has a very short span of action. So, when you hug your loved ones or you hug your pet, or you have an orgasm or you’re cuddling or you get a good massage, the effects are short lived but still significant. So, throughout a given day, how many times do you feel like it is most therapeutic in a given day or over the course of a week, to really be looking for those oxytocin hits? 

Dr. Anna Cabeca: [00:19:04] So, this is what I say, that as a practice, a good benevolent practice. Just a couple more benefits of oxytocin helps with muscle regeneration, antiaging. So, it’s very antiaging in that way too. So that muscle rebuilding, muscle growth. And that’s part of, again, it’s an alkaline hormone where cortisol is acidic, cortisol will break us down, oxytocin will build us back up. But I also want to make this important connection with the neurotransmitters as well, because this is, we don’t realize. So, in our mid 30s or 40s, patients will come in with worsening PMS, anxiety, and we realize, okay, well, they’re low on serotonin. So, the Western way is to prescribe selective serotonin reuptake inhibitor, an SSRI or combination thereof, to block receptor sites, not actually helping make more serotonin. 

[00:19:57] But this is important to note because that’s one of the first signs of hormonal imbalance, because serotonin levels drop. Because serotonin is derived from tryptophan via 5-hydroxytryptophan which we can supplement with B6. But look, tryptophan stays active and available with healthy levels of progesterone. If we don’t have healthy levels of progesterone, as those progesterone numbers start to dip in our 30s, tryptophan breaks down, we get more degradation of tryptophan, so there’s less of the precursor to make serotonin. If we don’t have enough estrogen, serotonin breaks down. So that increases serotonin degradation or we’re not producing enough serotonin, so we decrease estrogen and now serotonin breaks down. And then what happens? We make melatonin from serotonin, so we have that deficiency in sleep. And from there also oxytocin. Oxytocin is one of the metabolites.

[00:20:54] So we can think of it from that pathway too. So there’re multiple pathways where oxytocin comes into play. And if you don’t have enough vitamin D, oxytocin is not going to work well. Progesterone is not going to function well. So that’s an important piece to remember. So, during the day, I say what we need to do is microdose oxytocin. [laughs] So microdosing, you think, oh, microdosing mushrooms, microdosing something else, I don’t know. But microdosing oxytocin [Cynthia laughs] with little hits of laughter, play, being present, being grateful, little hits throughout the day. And I call this OxyPlay. And also, foreplay is part of OxyPlay [laughs]. So, foreplay can start with coaching your partner to bring you coffee in the morning or whatever it may be. Those acts of kindness or speaking your love language.

[00:21:43] So OxyPlay is what I want everyone to incorporate throughout their day to microdose oxytocin, to give yourself these little hits of oxytocin. And it really does have to be done on a daily basis, even if we just start. And my practice is, before I open my eyes in the morning, I focus on where did I see love? Focusing on love increases oxytocin. Where you see it, where did you feel it and really remember that. Feel that in your body. What are you grateful for? Increases oxytocin. Where did you see it? Where did you feel it? These also reduce cortisol. Then where did I laugh? Or could I have laughed at myself more and laugh at that? I always think there’re so many ways I could have laughed at myself yesterday and I take myself too seriously sometimes.

[00:22:27] So, in those three things, starting your day with an oxytocin hit is really powerful. It changes your physiology. And you can measure that by checking your urine pH actually seems very bizarre, but it’s so true. And because oxytocin is very alkalinizing, if you’re waking up and you quickly turn to an acidic urine or you’re waking up in an acidic state, you really have to focus on, again, empowering oxytocin, empowering your diet, your micronutrients as well. And those things will help.

Cynthia Thurlow: [00:22:57] I really love that you can literally from your bed before you even let your feet hit the floor you can be in a position where you are receiving the powerful benefits of oxytocin without having to jump on, I think for a lot of people. I’ve been guilty of this in the past. Your phone, your tablet, your computer, before even thinking about your day, honor yourself by supporting your body in a very beneficial way. Now, I’d love to pivot just a little bit because you touched on this earlier, but it is a question that comes up with some regularity from listeners. Why are we prescribing oral contraceptives for women in perimenopause and menopause and calling it HRT? Now that may not be your practice, but I’m sure you have women coming to you that are on oral contraceptives and they either think it’s HRT because they’re hearing that or they’re being given oral contraceptives as a way of fixing whatever symptom they’re experiencing.

Dr. Anna Cabeca: [00:23:57] And that is a really good point. I see it all the time. And it is not the right way to honestly practice perimenopausal or menopausal hormonal support. It’s pregnancy level hormones with a synthetic progestin that has negative cardiovascular and breast effects. So that should never be designed for hormone replacement, especially, when you don’t need it for birth control. If we need birth control, I like the ParaGard nonhormonal IUD. Let’s just do that and cover birth control with a nonhormonal IUD. It’s simple. Patients have had a painful experience with it before. You won’t with me or the way I recommend doing it. I give clients a suppository made with Cytotec and lidocaine to use the night before and morning at least 4 hours before the procedure. So, their cervix is soft, open, and they’re numb and then I can just insert the IUD.

[00:24:50] Always did it in my office, typically without any problem. And I’ve had three myself, so I’m very sensitive to no pain for this procedure. I don’t want any pain for this procedure plus for my daughters too. So that’s a nice easy way to do the IUD. And you can do it without pain, even if they just do a lidocaine suppository vaginally and that can really help eliminate the pain. Many doctors don’t know to prescribe that vaginally or nurse practitioners either. So, a compounding pharmacy will make that compound for a vaginal just like we numb our gums before we get an injection in our teeth, if you got a nice dentist. So, the same thing we do with the vagina. So, we can do that with the cervix. So ParaGard IUD, nonhormonal. 

[00:25:38] I have this discussion all the time, but birth control pills for hormonal management is not optimal for so many reasons. Another thing that I see clients coming in with is on estrogen and a Mirena or Skyla progestin IUD. And if you’re going to get an IUD, first of all, get the ParaGard IUD. If you have trouble with pain and cramping, we can fix that. We can definitely address those issues through all the things we do to balance inflammation in our body. So, it’s really important. But the Skyla is a progestin IUD. Sometimes, we need to, with dysfunctional bleeding, that can help, but you still need bioidentical progesterone, and you want to be on a bioidentical estrogen combination. And, of course, have DHEA and testosterone addressed.

[00:26:23] I’m also seeing people on way too much testosterone and that will suppress your body’s natural ability to make testosterone. And so that can, coming off of that for men and women, can cause depression, suicidal ideation, and that’s not where we want, and our body has to recover from that. So why don’t we just replenish and support our body’s natural hormones as much as possible as a practice? And that’s the way I practice. 

Cynthia Thurlow: [00:26:50] It’s so common for women to share with me that they had these really horrific experiences with IUD insertions. I love that you proactively are saying to women, listen, “I’ve had several. I do think they can be painful. Let’s proactively address the pain issue so that we can comfortably insert this.” What I’m starting to see is a lot of women that are going through pellet mills and I’m just going to call it that. I think there are many practitioners who are doing a really nice job, the majority of whom are doing a nice job. But there are these antiaging pellet centers where women are getting super physiologic doses of testosterone. Sometimes, they’ll come to me and they’ll say, I think my testosterone levels are low. So, we’ll look at their labs and it’s not. They are super physiologic.

[00:27:35] So, for listeners above a normal range for where a woman should be, they’re at levels that are close to where a man should be, and it puts them at risk. I actually was listening to a lecture from Dr. Pam Smith who works with A4M and she said she’s starting to see women in their 30s and early 40s that are having early myocardial infarction, so early heart attacks because their testosterone levels are so high. So, you want to work with a practitioner that will replace if it’s needed. And some women, even menopause, make enough testosterone, but many do not, I’m one of them and so will replace what you need, but do it within a therapeutic range that is not going to harm you. 

[00:28:14] And I’m sure you probably see that that clinically women are coming to you and saying, “I had an estrogen and testosterone pellet put in. I felt good for a week and now I don’t feel well”. What are your feelings about pellets? Whether you’re pro or anti, what has been your clinical experience? Or do you prefer utilizing different forms and routes of administration for hormone replacement therapy? 

Dr. Anna Cabeca: [00:28:34] Yeah, it’s a great question. I’ve used pellets on patients since the early 2000s. So, was using bioidentical hormones and pellets in a very judicial way. Like for me, it’s the amount that matters. I never use estrogen pellets or under rare, extreme circumstance would I temporarily use estrogen pellets. Think again, too high. They also fade out at a different time than testosterone. And then you got to manage it, especially if a woman has a uterus. It just can cause a lot of problems. So, number one, no estrogen pellets. Testosterone pellets can have a benefit, especially that perimenopause. When you can’t remember anything, you’re like, “Can’t take a pill, can’t do–” [Cynthia laughs] And I’ve been there.  It’s been, “Life’s been crazy. Give me that pellet and let me not think about it for four months.”

[00:29:22] And at a physiologic dose, but you will get a peak and then a gradual decline. And sometimes, that peak, we have to know testosterone converts to dihydrotestosterone and/or to estrogen. Estrone specifically can be toxic level, can add toxic levels to our system and cause breast tenderness, can cause increased risk of cardiovascular disease and cancer. So, we want to look at where, when we’re using hormones, always start low, go slow and look at where are those hormones going. So, where is that? How much of testosterone is converting to estrogen and how are the estrogen detoxification pathways. And we do that typically with urinary testing.

[00:30:02] You can also do it with blood, but it’s looking at 2, 4 and 16 hydroxy and methoxy estrogen metabolites, which is part of our Dutch test or if we’re using Humap, that is so critical to look at your hormones that way. And again, optimize hormones. And when we’re using pellets, that is when we are suppressing our ovarian and adrenal natural production of testosterone, because we’re getting those high levels and we’re never getting a break. So, you have to really work on resuscitation of the adrenals, resuscitation of the ovaries. For short term, I think there can be a place for it, but in long term and too high doses, we’re just not even getting measured. And every three, four months, getting pellets in seeing patients with hoarseness of voice, which sometimes is not reversible, clitoromegaly, facial hair growth and acne and weight gain. 

[00:30:57] And so those are things to remember. And then you just stop. And if you’re not tittered off of it, then depression, even to suicidal ideations. And that’s not talked about, but it’s a real consequence. There’s published literature on it. 

Cynthia Thurlow: [00:31:12] It’s quite significant. I mean, for full disclosure, the first time I did HRT, I was working with a practitioner who lives in Texas. And it’s not anyone I’ve interviewed on the podcast. I’ll just preemptively say this. And this individual had me on estrogen, testosterone, progesterone, and DHEA, but it was too much for my body. And so, when I stopped, I stopped abruptly because I was then transitioning to working with someone that was more aligned with the direction I wanted to go in and I had probably two weeks. I’ve never been clinically depressed, but I had no motivation to get off the couch, I had no motivation to go to the gym, although I acknowledged that would be good for me. The clinical depression that I experienced coming from being way too high super physiologic to having none, was so significant. 

[00:32:00] I recall, I was going to one of our events that was for the mastermind and I got on a plane and I got in the wrong seat, not once, but twice. I got off on the wrong floor in my hotel, not once, but twice. So, our good friend Roseanne actually walked me to my room. [Dr. Cabeca laughs] She just said, “This can’t happen.” And it was all an effect of this significant reduction in exogenous testosterone use. But for me, that left me with an indelible impression and one that, as I’m hearing you talk about that I can really understand. And we think about– most of our discussion is about women, but you think about this epidemic of low testosterone in men and why we’re seeing a lot of mental health issues related to the low testosterone, which I know is a tangential conversation, but one that I think is significant- 

Dr. Anna Cabeca: [00:32:47] It is important. 

Cynthia Thurlow: [00:32:48] -worth of addressing. Absolutely. 

Dr. Anna Cabeca: [00:32:51] And looking at where that’s coming from. Why was your testosterone low? How was your DHEA with your cortisol pattern? What are we doing to boost that up? I’d have you on doses of Mighty Maca and start with pregnenolone and progesterone and additional DHEA if needed, and see what that did while we’re boosting, getting you a good night’s sleep is going to improve your testosterone, your workouts, and you do that regularly, your testosterone should be good. What’s going on? Where are they’re hormonal interference as far as endocrine disruptors or toxins that are causing that testosterone to be low? And we’re in front of the computer a lot. You and I both should have blue light blockers on right now. We’re in a lot of light, but we want to look good too. So having blue light blockers on, blue light decreases testosterone.

[00:33:36] So paying attention to, “Okay, well, why don’t I have enough?” And I don’t like to give it in anyone less than 40 at all. Certainly, you want to figure out why it’s low and work to resuscitate the glands to support them. And if we do, let’s not do it in suppressive doses. But testosterone can be, I mean, it’s a beautiful supplement. It’s definitely beneficial postmenopausally and perimenopausally if needed, but all those things have to continually be addressed.

Cynthia Thurlow: [00:34:09] Yeah, I think the lifestyle piece is so important, and you mentioned a hormone that maybe listeners are not as familiarized with, pregnenolone, which is very important for memory. I attended a lecture last year and the first thing I did was I went to my functional medicine doc and said, “I want to test for it” because I know my levels of pregnenolone should be greater than 50 to help support memory. Mine were 35. And so, I’ve been taking pregnenolone for the past year and I think it’s really been an important adjunct to everything else that I’m doing. Are you routinely utilizing– I would imagine, yes, utilizing pregnenolone in your perimenopause, menopausal females. 

Dr. Anna Cabeca: [00:34:49] So, my balance cream that I created is both progesterone and pregnenolone and tripeptide. So that’s the combination. I find the combination works better than the individuals by themselves. So, I’ve been using it for two decades now. When I look at the research, actually I was lecturing in, I want to say, 2007 or 2008 with Italians for a regenerative medicine conference that they were having and one of the speakers, oh, God, I can’t remember his name now, but a colleague of Dr. Francesca Moretto, who is this tremendous Italian physician, was speaking, and he spoke solely on pregnenolone. It really opened my eyes to all the benefits and the brain benefits of pregnenolone for memory, for cognition. 

[00:35:39] And if you consider our hormonal hierarchy is cholesterol, pregnenolone, progesterone. And from pregnenolone, we’re going to make our DHEA, testosterone, estrogen, and from progesterone we’re going to drive to cortisol and also make DHEA, testosterone, and estrogen. So, we need to consider that whole pathway. So, the benefit of pregnenolone and I like to use it transdermally. Sometimes, I’ll prescribe it orally as well, but always try to bypass the liver. The liver has enough to do. [laughs] So, we try to bypass the liver and use transdermal. So, that’s hence my balance cream. And for both men and women, pregnenolone is a really good thing. For women who can’t take progesterone, they have sensitivity, and I’ve done some videos on hypersensitivity to progesterone. We can start with pregnenolone. And again, just in a little bit goes a long way, but the benefits are tremendous. 

Cynthia Thurlow: [00:36:33] Yeah, it’s such an important hormone and one that I don’t think we’re talking enough about. Now something that I learned from you, so I want to give you credit, is doing a hormone holiday. So, can we talk a little bit about, if you are on some type of hormone replacement therapy, why it’s important to give your body a rest? Again, not medical advice. We’re doing a high-level discussion, but why is it important to give those receptor sites a break?

Dr. Anna Cabeca: [00:37:00] Yeah. So that whole piece about replenishment, not replacement. Replenishment and not suppressing our body’s own ability to make and utilize hormones. Let’s give the example of, and again, this work, this area is very much in its Infancy as far as do we take a day off? Do we take a hormone holiday? Do we take drug holidays, vitamin holidays, all of that stuff. And I’m like, there are seasons for a reason. Just to me, it’s Intuitive and it makes sense. But let me tell you some of the science behind it. So, if we consider selective serotonin reuptake inhibitors and what we do, we block receptor sites with those. So, what happens is the receptor sites often can get damaged. So, you need to block more and more receptor sites as a function to get a therapeutic effect or an increase in serotonin. 

[00:37:51] So that’s a problem with the receptors. And also, receptors, many of them contain iodine molecules, need vitamin D as part of it, are catalyzed by magnesium. So, all of those nutrient factors have to be in play. And anytime we’re using any hormones, any supplements, there’s a metabolic pathway that has to go through. So, we’re using other nutrients too to get the results that we want or to break it down to be usable sometimes. So, when we give our body a holiday from that, number one, it can help clear the receptor sites so they’re natural, clearing, or detoxing and also can reset the HPA axis. So, okay, wait, I’ve got to make some more. I’ve got to pick up my own function. I got to start making some. 

[00:38:39] So, if you’re constantly, just like when we microdose, say, like we microdose oxytocin throughout the day, we can pause periodically or seasonally our hormones and especially true with progesterone, because it is one of the mother hormones, progesterone and pregnenolone, not so much with estrogen, testosterone and DHEA, but definitely with progesterone and pregnenolone. I tell my clients who are postmenopausal or have had a hysterectomy, one to two days off per week or three to five days off per month. And that helps because in our menstrual cycle in general, if we’re menstruating, usually you’ll use progesterone the second half of your cycle. You don’t want it to interfere with ovulation. If you’re using progesterone every day in a progestin in a birth control pill, you suppress your ovarian function, you suppress its natural response and we don’t want to do that. 

[00:39:28] We want to maintain our healthy response. We want to support our glandular production of hormones because that’s a marker of longevity. The longer we can produce our own hormones, the longer, higher quality of life that we live. So, I think the pauses, micropauses in hormone replacement is important and vitamin pauses. I definitely do that periodically and rotate what I’m taking or pausing what I’m taking when I go on holiday, and especially if I’m going somewhere sunny and warm, that’s all you need is being out in nature. Nature is the best medicine. So, when you can get a bunch of that, a good dose of that, that’s really powerful. So, you don’t necessarily need the crutches we’re on.

[00:40:12] And when we look at the longest living populations, they’re not on hormones, they’re not taking handfuls of supplements. They’re living in nature with lots of oxytocin, good community, good friendship, good loving. So, that’s really powerful. So, we don’t want to ever suppress our body’s own ability to make our natural hormones. So, for me, that’s common sense. And I do get into very good debates about this. That’s where I’m at with it. And then also actually Dr. Pam Smith had alerted me to a legal case where I think it was in Florida, the physician was sued for prolonged high dose progesterone supplementation without a break, disrupting the hypothalamic-pituitary-adrenal axis.

Cynthia Thurlow: [00:40:56] It makes a lot of sense and it’s interesting. I can take a break with any of my hormones, but progesterone is the one that I notice the most because, and we’re still trying to find my happy spot in terms of dosing, usually a starting dose is 100 mg, maybe 150. That same physician who started me on supratherapeutic doses of estradiol and testosterone, also started me on 200 mg of progesterone. And so, it has taken a bit of time and finesse to get me backed down to 150 mg. But it was one of those conversations that I had with our friend Aaron, who prescribes all my stuff now. And he was saying, “I don’t want you on that much, and let’s talk about why.” 

[00:41:37] So, I think that it’s important to make sure that we’re on the lowest therapeutic dose for our bodies, and each one of us might need a very different dose. And if you work with compounding pharmacies, they can make whatever dose your doctor or nurse practitioner wants. If you’re getting something from a regular pharmacy, it’s going to really be dependent on the general formulation, whether it’s 100 mg or 200 mg. But the point being that the bio-individuality piece is certainly very important. Now, you mentioned detoxification and I think most of my listeners are familiar with why this is so important, and certainly it’s a large focus of your work, especially with the hormone piece. Let’s talk a little bit about things that can impact detoxification on a significant level. I feel like maybe many women in their 20s and 30s detox pathways are working well enough.

[00:42:26] It’s when we hit perimenopause, that’s really the barometer for how well we’re taking care of ourselves. But what are some of the more common things that can really impact detoxification in the body? And, yes, for listeners, this is a normal physiologic process. But as we get older, I start seeing people that are more impacted by lifestyle choices and how it impacts their detox pathways.

Dr. Anna Cabeca: [00:42:49] Yeah. So, one of the ways, first I measure that is in my book, The Hormone Fix. There’s the medical symptom toxicity questionnaire and the hormone symptom questionnaire. I was just thinking of a patient that came in the other day and she does yoga, she’s tried to eat right and organic, and her toxicity score was 107. Like, if it’s above 10, I’m adding additional detox supplements and supports for you. So, it was 107, and that shocked her too. And the thing is that’s toxicity, and we have to look at, okay, well, what’s causing, it can be what skincare are you using? What makeup? What are you putting on your skin? What are you washing your dishes with? People forget about this.

[00:43:31] And I actually assumed my children knew because I always use natural or clean dishwashing detergent. And my daughter went to the store one day to get some for me and she brought back Cascade. I was like, “Oh, and you cannot wash your baby bottles in this. No way.” I mean, we’re so careful, glass bottles, all this good stuff. And she’s like, “Well, that’s all they had.” I was like, “Well, we’re not using it,” but you think what’s on the dishes will leave a residue. And I actually learned that from my cousin, who’s a sommelier, and he would say, “You have to rinse the glasses or you taste the chemicals in your wine.” And I was like, “Really?” And then he showed me the difference. And again, the eyes don’t see what the mind don’t know. So, what we’re washing or cleaning our dishes with are toxins to our body potentially. 

[00:44:19] So, that’s where you want to use the cleaner sources of it, of dishwashing detergent and stuff. And what you’re cleaning your body with, olive oil soap, goat milk soap, things like that. Again, that’s safe. And it’s been around, tested through the Millennia, so we can know that’s safe and healthy for us. And then there’s heavy metals. Have you had amalgams? How is your dental health, condition of your gums? I mean, how that affects our cardiovascular health. A friend of mine, Ellie Campbell, wrote a book on the hypertension blueprint and talks about the connection with dental health in cardiovascular health and that’s crucial. So, implants, fillers, root canals, amalgams, or the silver fillings can build up toxins over time, especially in the brain. Other ways, you get heavy metals from our drinking water. 

[00:45:10] That is a significant source of heavy metals, as well as hormone disruptors including chlorine and fluorine. And so those are going to shoot out your iodine. And so, this would really need to replace iodine. So also, iodine deficiency is a big part of this hormonal imbalance because of these other competing molecules for those iodine receptor sites. Low vitamin D again, I see so many today, and I could still– I’ve been doing this for over 25 years and preaching about vitamin D, and I still see patients coming in with low vitamin D and diagnosis, for example, breast cancer and they have a low vitamin D of 11. Could have really prevented that heart disease and their vitamin D is at 30. I mean, so a lot we can do to optimize that, so heavy metals. 

[00:45:56] And then the big one that I see a lot is mold toxicity. Mold toxicity is really big. There’s a Mycotoxin mold test I’ve been doing now on most all of my patients. And looking at, in general, we’ve got a clear mold. That’s been a big issue for me. It really sabotaged me. When I moved to Dallas, the place I was living in had black mold. And unbeknownst to me, until they got another flood from the pool and we had to tear up an area while we were living there. So that really shot my system and it hadn’t cleared it well enough. And then I had a second exposure. So, you really have to look at this mold toxicity. And for me, that’s a really big one. It will affect your thyroid.

[00:46:37] There’s biofilms that have to be addressed with mold toxicity, so detoxing from that too is important. The Keto-Green approach really helps. So, intermittent fasting is a great way to naturally detox and support your body during the fast or after the fast. So, using binders to help toxins remove safely is something that I definitely prescribe more and more to help clients, especially if we have mold toxicity, heavy metal toxicity. We’re using binders to get out that toxin.

[00:47:10] And let’s see, what else? Toxic thoughts. That’s the other thing. Toxic thoughts. So, when we act in ways that are negative or hateful towards ourself or towards other people, we don’t see the humanity and others anywhere in the world, any color, race, religious orientation, etc., and we don’t realize that they’re all part of one energy, that’s quantum physics. So, we’re all part of one. We’re all connected. And when we act untrue to that, that creates physiologic stress. 

Cynthia Thurlow: [00:47:41] I think it’s such an important point and I’m curious. You mentioned that your sibling is a sommelier. So, this is someone who has a particularly attuned palate with drinking wine. What is the dish detergent used? Because inevitably someone will ask and so I would rather just ask you outright, what are you using in your home right now? 

Dr. Anna Cabeca: [00:47:59] Oh, my gosh. I knew you were going to ask. And I’m on autoship for it. Hold on. It is Stephen, Truly Free, I think it’s called. 

Cynthia Thurlow: [00:48:07] I think I just heard about that. 

Dr. Anna Cabeca: [00:48:08] Truly Free and My Green Fills is the company. And they send you refills. So, you have the one canner and then you just refill it periodically. And they have laundry detergent and dish detergent, household cleaners, so feel really safe with that company.

Cynthia Thurlow: [00:48:25] Yeah, I’ve been using Branch Basics. That’s been one of the ones that we’ve been using, and using OxiClean, because I have boys and anyone that has boys knows that they can create quite a funk and a stink.

Dr. Anna Cabeca: [00:48:38] I like OxiClean too. 

Cynthia Thurlow: [00:48:40] Yeah, that’s worked out really well. It goes in all of our laundry. So, I’m curious, what are you working on next? Are you working on a new book? What’s next for you other than coming back to clinical practice, which I think is really to the benefit. If you’re in the Dallas area, you need to go see Dr. Anna. 

Dr. Anna Cabeca: [00:48:55] Yeah, yeah, definitely. And I invite clients from all over the world. I love working with patients and having that one-to-one time again, I really missed it. So, it’s nice to be back in. And I’m part of a collaborative. So, we have other integrative and functional specialists that are part of our group. So, it makes it even better. I’m loving doing this. I’m continuing to speak and do some traveling, not too much, because on the weekends, I’m hauling horses in my big old truck, hauling a 33-foot horse trailer from my youngest daughter, who’s in the rodeos. So, we’re doing that and I’m working on my next book, which is on oxytocin.

Cynthia Thurlow: [00:49:31] I love it. Well, I can’t wait to see when– as the book evolves. And obviously we’ll have to have you back again. Please let listeners know how to connect with you, how to get access to your amazing works, your Mighty Maca, all these fun products that you’ve created that really, I mean, I recommend Julva on the regular for women, but all these amazing products that you’ve created to help support women’s needs at different stages in their lives.

Dr. Anna Cabeca: [00:49:53] Yeah. Thank you. So easy to find me at dranna.com. So dranna.com and I invite you to get on our mailing list, our email list, because I do a welcome call twice a month. And so, in video via Zoom, where you get to ask me a question, any question, and we start really building a very tight community this way. So, encourage you to go to dranna.com and then please follow me @thegirlfrienddoctor on social media. So there as well. My flagship products are definitely Mighty Maca, Julva and my balance cream, the combination, I call that my menopause support, but also before, during, and after menopause can really help you. So, thank you, Cynthia, for having me here. I love everything you do and I appreciate you.

Cynthia Thurlow: [00:50:39] Thank you. Likewise. 

[00:50:42] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.