Women’s Hormones, Health and Skin with Dr. Anna Cabeca

Trevor: Hi, welcome to The Spa Doctor podcast. I’m Dr. Trevor Cates. We often talk about root causes on The Spa Doctor podcast and one of the root causes we sometimes talk about is hormone imbalance. Have you ever wondered if your hormones are the reason behind your health or your skin issues? Well, if you’re a woman and you think your hormones may be out of whack or if you’re a woman over 30 and care about your health and want to age gracefully and to have clean, glowing skin you’ll want to watch this podcast.

My guest is Dr. Anna Cabeca, she is an Emory University trained gynecologist and obstetrician and menopause and sexual health expert and international speaker and educator. She is a wealth of information on hormones and so I really hope you enjoy this podcast today because we’re covering how your hormones change throughout your cycle and your life and how these changes impact your health and you skin. She covers how each hormone plays a role and Dr. Cabeca also shares diet and lifestyle changes that you can start today that will help balance your hormones. She also touches on bioidentical hormones and how they may or may not be able to help you with your skin and health challenges. So please enjoy this interview.

Dr. Anna, it’s so great to have you on my podcast.

Anna: Great to be here Trevor, thank you so much for having me. I’m excited about our topic and getting into it.

Trevor: I know! I’m excited too. I know you were on my Glowing Skin Summit a while back and that was fun to have you on that.

Anna: Yeah, that was great. There was a lot of great information out there.

Trevor: Yeah, perfect. So today we’re talking about hormones and skin. As women, how our hormones changes as we age and how that impact our skin so let’s just dive into this and tell everyone … let’s talk about first like through the month, through our cycle. How do our hormones change in a way that can impact our skin?

Anna: Yeah, absolutely. I’m happy too because one of the big things that I think that we worry about as we age is the wrinkles really. Right? So we think about the wrinkles, the loss of the elasticity of our skin, the decreased tone, the dimming. You know, not as fresh, youthful look so there’s a big hormonal connection to that.

I know you’ve talked about in other podcasts inflammation and the role inflammation plays and that’s huge for sure, toxins, inflammation, that’s why we have to keep them so far away from the skin. That also affect our hormones and on a cyclical basis just starting out our cycle, our hormones fluctuate throughout the month, throughout the cycle. This is an important, naturally occurring phenomenon so we start out the first day to go in through the menstrual cycle with our hormones. The first day we start bleeding we call that cycle day one, so the first day you start spotting, bleeding for your menses that’s cycle day one. At that point in our cycle our hormone levels are typically at their lowest and that we’re talking about reproductive hormones including estrogen, progesterone. DHEA and testosterone other two important hormones for reproduction, they’re slightly lower but they’re pretty steady throughout the cycle except for testosterone, we’ll see a peak mid cycle with ovulation which gives us that drive.

Testosterone’s a really important hormone that’s overlooked in so many women’s health situations, but it’s really important. If we consider that testosterone’s a huge muscle building hormone we need that peak mid cycle and it’s important to improve collagen, improve muscle, help with the elasticity of the tissue, and if we are suppressing that hormone with birth control pills we’re not getting that natural increase of muscle integrity that we need. At that time of ovulation typically somewhere between day 12 to 14, but it depends on your cycle, we’ll get a peak in hormones, estrogen, progesterone will start to rise once you’ve have ovulation we’ll start to see an increase in progesterone. We get that peak in testosterone and then that steady increase in progesterone towards the ladder half of our cycle.

Many times, especially in our mid 30s, we start to see some hormone imbalances here because of a couple things. One, stress effecting our reproductive hormones, specifically progesterone creating a decline in progesterone, a decrease maybe also in DHEA and that’s going to affect us with symptoms of PMS, irregular bleeding, spotting in that ladder half of the cycle or irregularly throughout the cycle, heavier periods can all be a result of these hormones imbalances that can occur too as we’re aging and have less eggs being released from the ovaries as well the other factors that can interfere so that’s our monthly fun cycle.

Trevor: Yeah, I know. It’s so intricate and detailed and everybody’s a little bit different too. Right? It’s interesting what you mention about stress impacting these hormones and I think a lot of these people don’t realize the connection between our other hormones, like adrenal hormones and thyroid hormones and how they all work together and they may not change as much during the month but like you said like us being really stressed can play a roll. Right?

Anna: Absolutely, absolutely. I always think of the pictures of the Clinton’s at the beginning of the presidency to the end of the second term. Right? There was a huge 20, 30 years of aging that went on there, stress induced aging. Right? So I mean I think that is a big factor and it does create havoc on our system, so pacing ourselves, replenishing ourselves, taking rejuvenation times for ourself, those are really critical pieces of self-care that we just have to create a discipline and practice around.

Trevor: Right, absolutely. So when it comes to a woman’s cycle, going through the month, it also can cause people to break out more at certain times. Can you explain the hormonal changes that cause women to break out at certain times of the month?

Anna: Yeah, definitely so also that increase in testosterone can increase the oils from the sebaceous glands and that hormone, testosterone, can increase those breakouts. That’s an important part to understand, but again it has an important function in our cycle, in our human anatomy and physiology. That’s really important but we see that testosterone causing an increase in acne, but typically what aggravates that are hormone disrupters in our foods such as diary.

I know that in working with thousands of young women with their menstrual cycle and cyclic acne it is really critical to get them off dairy and doing that makes a huge difference in helping their body detox their hormones naturally. So there are several things that can impair natural detoxification of our hormones, but also considering that testosterone under stress also naturally depending on our enzyme and our genetic make up can convert to dihydrotestosterone, a very active form of testosterone that is typically the chief culprit for that acne.

Trevor: Yeah, so dihydrotestosterone also called DHT. Right? What are some things that people can do naturally to help with that rather than doing birth control pills that suppress our testosterone in a way that’s going to create other problems, right? But there are some herbs and things you can do naturally, right?

Anna: Yeah, absolutely. One of the things that I use always in my practice and we know it’s great for your immune system, great for skin, and it helps decrease the enzyme that creates that really rapid conversion from testosterone to dihydrotestosterone and that’s zinc. Typically I recommend 50 to 60 milligrams a day of a high quality, highly absorbable zine. I think that’s important, it brings in one of my favorite super foods which is oysters, which are high in zinc and good DHA and good nutrients and so that’s a big one for sure.

Other ingredients that we’ve used in my practice to help your body detox, right, we’ve got to cleanse the liver so milk thistle and things that really promote healthy liver detox, a good amount of greens and enzymes, nutrients. We use my product Mighty Maca, so Maca is a great adrenal adaptogen, can really help promote hormonal balance and support you body’s natural processes, but adding in extra greens, alkalinizers, cats claw herb which is great to really decrease inflammation and get to the root of the problems sometimes with inflammation as a culprit is a key ingredients. Tumeric which has so many benefits for the brain, for the skin, for the eyes, it’s really very beneficial.

The other thing that I use in patients like supplement wise is vitamin A supplementation as well. A good combination of vitamin A supplement or vitamin A rich foods working with that in your diet as well, along with zinc and then again trying to block that conversion some mung bean and Swiss oats are a good combination in a capsule that we’ve used to help block that conversion as well so if we have to go that way, but typically I start with zinc.

Trevor: Awesome, great. Thank you. Then also throughout our lives our hormones change too, not just the month or our cycle, but throughout our lives and there are different issues that arise to the skin related to those hormone changes. Like in puberty there’s a lot of times acne breakouts, then acne will reoccur at certain times throughout our lives. Sometimes people think, “Oh, I’m not a teenager anymore so I don’t have to worry about acne,” but then they get a return of it or have acne and they never had it before. So let’s talk about some of those changes that occur with hormones that cause the acne breakouts.

Anna: Yeah and it’s just not fair, is it? Right? It’s just not far. That brings me to just mentioning again at that time of ovulation and we’ll have it sporadically throughout our lives even in the perimenopause menopause, but ovulation our features are much more glowing and enticing. There’s been several studies that looked at images of women at different times of their cycle and ovulation, that peak of fertility are the most recognized attractive time periods for us and I think that’s really cool. So recognizing that ovulation, that natural hormone cycle, does matter.

Trevor: Okay so that’s when we need to schedule our photo shoots and that hot date that we’ve been waiting for?

Anna: Yes or after, like doing video after sex, right? I mean, that’s a good time too. You’ve got oxytocin up and that’s another anti-ager and there’s a radiance and glow that goes with that. But yeah, definitely ovulation is one of the times that you are perceived to be the most attractive and that’s pretty cool.

So as we age, to answer your question more on as we age what’s happening and we definitely see a decline in progesterone first before we start to see that intermittent cyclical rollercoaster of estrogen. Kind of this ride that we go on which creates a combination of moodiness and hot flashes and this overwhelming feeling like we don’t belong in our bodies anymore and I hear that from so many women. That coincides if we look at the transition of menopause to the time when we started our periods called menarche. Those are huge transition factors in our life and these hormone fluctuations take some getting used to for our body and we do have to create a very nurturing environment that supports our body’s ability to adapt and to go through this very natural physiologic transition, which is important for the next third of life or next half of our life.

So we’ll see these declines in progesterone, estrogen, testosterone, DHEA starts to decline in our 20s and again very important hormones. The DHEA and testosterone we know are muscle building hormones, progesterone is important for our brain, for our skin, for our breasts, for hair. Think of pregnancy, high levels of progesterone, estriol, and that beautiful pregnancy hair. Those are really important hormones that tend to diminish as we age and we can definitely see because of this fluctuation because of this drop of the mother hormone, the protective hormone progesterone, we get these imbalances too and we’ll see some acne, we’ll see some changes to the skin, not just the loss of elasticity, the wrinkles around the eyes, you know?

We’ll see that loss in other places as well, but I think when we’re looking at those hormonal changes as we age we have to consider there’s a lot more that is happening then just the decline of estrogen and in our medical systems we’re like okay, well you’re in menopause, you need estrogen if you have a uterus you need a progestin preferably a bioidentical progesterone only, not preferably. But our standard care doesn’t look very much passed estrogen. That’s a minor, minor hormone in the grand scheme of what’s happening with our hormones.

Trevor: Right, right. I think it would be helpful if we went through some of the different hormones and talked about what they specifically do, especially when it relates to the skin. As you’re describing how it relates to the skin describe what the hormone does because it’s kind of an indirect result, right? So estrogen, what role … You already talked about progesterone and how that plays a role in this game, but what about estrogen? What does that do for the skin?

Anna: Estrogen does help with skin elasticity and when we look at estrogen receptors we certainly have estrogen receptors in our skin, we get estrogen as produced in our fat cells, we have other ways to produce estrogen outside of our ovaries. Estrogen is that feminizing hormones, on the effects of our uterus is that it increases the thickness of our uterine lining to help build that up and it’s that kind of hormone that really does lead to the feminization of us, our breast tissue, breast development helps with that, and the softening of our features so to speak.

Trevor: So as we age and our estrogen declines around what age does that usually start and what do people start to notice first?

Anna: Yeah, I think that we are seeing typically when I trained at Emory University 20 years ago plus, over 20 years ago, we looked at estrogen declines in the 40s, right? Now we really start to see it in the mid 30s and think there are several factors to that. Again, we talk about hormone disrupters, the chemicals in our environment, stress, so estrogen’s decline is significantly related to our ovarian function, the function of our ovaries and our ability of our ovaries to have to product multiple follicles every month and to lead to ovulation.

We definitely start to see the decline in the 30s, late 30s early 40s for sure and with that we do start to see some loss of elasticity may note and it’s a combination here but we may note that loss of elasticity we’ll see at the same time because with the estrogen decline there’s a higher testosterone to estrogen ratio than in our 20s and so we’ll see things like peach fuzz and you will definitely see loss of elasticity and those fine lines and wrinkles coming in as a result as well.

Trevor: But probably a higher sex drive too if you’re in the 30s sometimes that happens as a result of some of the other changes, right?

Anna: Well it can depending on … again, the other things we’re doing, the therapeutic lifestyle changes that are in our life because a very common complaint is low sex drive, persistently low sex drive because all the hormones are dropping and progesterone’s drop and progesterone an important hormone to feel good. When we don’t have estrogen on board we lack the ability to be receptive to that invitation for sex, the invitation for intercourse. The testosterone’s an important hormone, so in and of itself it’s important, but without estrogen on board we lack that receptivity that feminine, “Okay, I’m in!” You know? By then we tend to lose that as we age when there’s an imbalance.

Trevor: Absolutely. Then what about testosterone, how does that play a role in our skin? It has to do with the collagen you mentioned?

Anna: Yeah, absolutely. Collagen, muscle, I always think of … Do you ever do these neck exercises? One of the things that you notice when people are aging is the neck muscles drooping, right? I had a shoulder injury so it’s been over a year since I’ve done my boxing, but for whatever reason boxing’s very good to your neck, I think because you clench and it’s just hitting a bag or whatever, not hitting a person. I’m not hitting people so let me clarify.

So there are neck exercises, I have an aunt who lived to be 102 and she would always do the Oh, Ah, Ee neck exercises. Do you know those?Trevor: No.Anna: Okay we should teach them. Can we teach the audience today?

Trevor: Yes, absolutely.

Anna: Okay, so your oh, ah, ee and then you kiss the ceiling neck exercise and this is what my aunt Mary from New Bedford, Massachusetts had taught me when I was 20, plus she would always enter the door tapping her … she would do her neck exercises tapping her chin, stimulating her face, and she would do that everyday in the morning and in the evening and I think she used only Noxzema on her skin. It was ridiculous. She was gorgeous.  The neck exercises that she showed me-

Trevor: And she wasn’t gorgeous because of the Noxzema, it was the other trick that she did, right?

Anna: Yeah, absolutely just smile and a delightful person. Right? So it’s oh, you look up to the ceiling, then oh, ah, ee up at the ceiling and kiss the ceiling so oh, ah, ee and kiss. Or you can do this, oh, ah, ee, and then kiss the ceiling.

Trevor: Okay ready.

Anna: Yeah, ready.

Trevor: Okay.Anna: Oh, ah, ee. We’ll do it again just looking up. Oh, ah, ee.Trevor: Oh, ah, ee. I love it.

Anna: You’ll feel it in your neck tomorrow. You will absolutely feel it in your neck tomorrow. So that’s the neck exercise, but muscles are important, so we can’t just expect our muscles to stay tight and firm on their own and I’m big on pelvic floor exercises, those muscles are critically important for quality of life, but our neck muscles are just right up there.

Again, that’s important, but the loss of elasticity in our neck, in our chin, in our facial muscles, and our cheek bones. Like how do we keep nice, round, youthful cheeks? You’ve got to exercise them and so that’s a big part of it, but also we tend to lose the collagen, the elasticity, and the strength of the muscles when our testosterone declines, when our DHEA declines. So adding those back in, it’s important, it’s a piece of that. So muscle exercises, good nutrition, decrease stress, time to rejuvenate, lots of loving good company, smiles, good friendships, that’s what’s key.

Trevor: Great, great. Then when you mentioned progesterone before and its benefits and you said it’s good for the skin, how is progesterone particularly good for the skin?

Anna: Well progesterone’s the mother hormone. When we look at progesterone and consider it is the mother hormone that we will get DHEA, testosterone, estrogen from progesterone, so it’s like the hormone from cholesterol we get progesterone and then we get these other hormones. It’s that essential piece to puzzle, without progesterone we’re not gonna make DHEA, we’re not gonna make much testosterone, estrogen as a result. It’s up there in that realm but it’s also really important to always oppose estrogen, there’s a delicate balance between progesterone, estrogen or other hormones and that’s critical.

In order for progesterone to work effectively in our brain and our body and our skin we need vitamin D, we need sunlight actually. We get more than vitamin D from the sun, but we need sunlight exposure to our skin to help with the catalyst of the hormone, metabolism receptors and all that magic that happens inside our body, but vitamin D is important to make sure that our hormones are working well.

This is something that I didn’t really recognize until a couple years ago when I was really digging into the research on progesterone and oxytocin and vitamin D kept popping up in all these places as so important for the hormone receptors. That’s again, one of the first things that I would recommend correcting in individuals. Number one, getting outside, getting Earth’s energy, getting sunlight, and then also making sure that our vitamin D levels are healthy, are optimized.

Trevor: Okay, great and there’s a lot that we can to do to support our hormones. We’ve talked about what happens when they’re low and you’ve talked a little bit about how to balance them naturally. I just want to emphasize this, but there’s a lot we can to do naturally with our diet, lifestyle changes to support hormone balance, because a lot of those people rush in to … and I think bioidentical hormones definitely have their place and I want to talk to you about that in a minute, but I think a lot of people are quick to jump to that without supporting the body first overall with a healthy diet and lifestyle. Right?

Anna: Yeah, absolutely and you can’t do one without the other. Very interestingly I interviewed Dr. Edwin Lee yesterday, an endocrinologist on my podcast and we talked about how I wouldn’t prescribe hormones to someone who was driving through for meals. It really is important to have that lifestyle and be willing to recognize that there’s no magic wand, there’s no pill that’s gonna make us perfect. It’s work, it’s the disciplines and practice that we do on a daily basis that is gonna create hormonal balance whether our body’s producing it naturally or we’re taking it from an exogenous source, how we use it in our body. Are we using it for our good or are we using it for our bad and lifestyle is the determining factor, the genetics and lifestyle.

Trevor: What do you think are some of the key things to do, lifestyle, diet, to help with balancing hormones?

Anna: Yeah, I work with a lot of menopausal women and fine tune it especially as our body shifts as we age there’s definitely a shift, right? I always say it’s menopause, not McDonald’s, and with what’s happened to our body and it’s a hormone shift. We’re doing everything good that we thought we were doing right and what’s difference? What are the biggest difference? What will move the needle the most, so to speak? That is definitely it’s reducing carbohydrates, getting alkaline, pushing our body in the ketosis periodically, so that keto alkaline combination is getting alkaline, following the 15 hour between dinner and breakfast at least three times a week rule, having many fasts periodically, things like that make a difference to us because we need healthy fats, healthy oils, and we need to create an alkaline urinary PH at least on a regular basis, to make sure that our body’s living in harmony not under stress and not in inflammation and the other things is, again so part of that is really reducing carbohydrates so that’s one, getting keto alkaline.

The second is getting out in nature, getting out in nature, like I mention we get a lot more than vitamin D from the sun, the Earth’s magnetic field, just getting into nature, getting barefoot in the grass, and that’s hugely a daily practice of getting outside, barefoot, otherwise exposing your body to the elements is crucially beneficial. Again, there’s no magic wand, there’s no magic pill that will substitute that action in our lives and that’s huge. The third is certainly getting a good night’s sleep, getting a good night sleep. I would a add the fourth is have fun, get along with people, have fun, laugh, smile, enjoy yourself, take pleasure in the little things in life. Those are four really big things that do make move the needle more than anything.

Trevor: Right and it’s doing those things on a regular basis, right? You can’t just start doing it one day and expect some sort of miracle to happen, it’s an ongoing thing and the sooner people start it the better off they are. Like the earlier the better, but it’s never too late and turning it into a habit, turning it into a lifestyle rather than just something you do for a weekend or when you get a chance. Right?

Anna: Absolutely, absolutely. We get off track and I want to say this for our listeners, because this is something I struggled with in the last year. We had the hurricane here in last October and I had five moves. The house I was living in had chronic leak that we realized during the hurricane with a major leak, so we had toxic mold that we dealt with. We moved four times, me and my daughters. My father passed away, was sick and then he passed away, it was a hard year. I mean, I totally got off track and it’s been a discipline and a practice to focus on what I’m doing right, what I’m able to do right on a consistent basis versus what all the things that I’ve done wrong. Right? In this time period and eating out too much and doing these things, not getting into my normal routine, but when you can.

Life does throw us curve balls but it’s important to get right back on track and to not beat ourselves up. Be our own best friend and our own best coach as we get right back on track and recognize that even if we’ve fallen back we feel like we’ve aged a decade or so in the last year. We can recover and turn that around and there’s no time limit on that.

Trevor: Right, right. Great, thank you for sharing that. So let’s talk a little bit about bioidentical hormones. When are they a good idea and kind of just an overview. We can spend a lot of time just talking about bioidentical hormones, but just kind of like a little overview of them.

Anna: Yeah, I would say that in general, in my clinical experience, right? Because I mean we do have a tremendous amount of research continuing to emerge on using bioidentical hormones, hormones that are like our own physiologic molecular hormone in and of itself. So take having a prescription, we typically hear prescribing bioidentical hormones or what’s over the counter like progesterone and my clinical experience has led me to use progesterone as a first line hormone because again it’s the mother hormone and our body will pretty much take it where we need it to go in the right circumstances.

Bioidentical progesterone I typically us a topical cream for my clients. We have my formulation which is PureBalance PPR cream and it’s bioidentical progesterone and pregnenolone, not yam, not extracts, it’s pure USP progesterone and pregnenolone and that makes a difference. We typically recommend using that cyclically when we’re having symptoms such as PMS and diet and lifestyle changes haven’t conquered it and we’re having fibrocystic breast symptoms, moodiness, depression, anxiety, all of those. Progesterone’s one of the bests anti-depressants I know when we’re addressing the cause of unbalanced hormones.

So I find that … Again, bioidentical progesterone has a lot of safety and efficacy studies on it and not to be confused with synthetic progestins where we really do have alarm and worry and reason for concern, but not with bioidentical progesterone. I typically recommend that and definitely use it with your physician’s guidance and one who is really well aware, especially when we move on to bioidentical oral progesterone preparation, which again using it at night can help us get a good night’s sleep, so it’s extra, extra benefits there.

I used a lot of progesterone in clients who had postpartum depression. They’re using that to help them versus putting them on Prozac. Progesterone’s probably one of my starter hormones to prescribe and then DHEA. Again, many people our DHEA starts to decline in our 20’s and so using that in typically in a compounding cream, because orally we metabolize first pass through our liver and our liver is dealing with so much already, especially when our hormones are fluctuating. I typically like to use cream or troches which dissolve in-between the cheek and gum and that’s another good way or vaginal preparations or again, topical preparations in a cream. Those are my preferences to use DHEA in that way.

Combining testosterone especially for many reason we’re looking at hormone levels as we age, testosterone and estrogen are the other two hormones that I’ll add in there and definitely in that order when I’m prescribing.

Trevor: Then do you sometimes do some estrogens like estriol or Bi-Est as a cream?

Anna: Yeah, definitely. Typically I like to use troches when I’m prescribing so I typically would have a combination very low dose. We don’t need a lot of estrogen if we’re really working with good herbs and natural medicine and exercise and if we’re using progesterone and testosterone and or DHEA, because that will convert to estrogen. I found that I need to use less and less and less, but typically a Bi-Est and sometimes just E3, estriol inferred in high risk individuals to use that and I typically would combined.

Say for me a typical prescription troche combination would be Bi-Est one milligram in a 80 20 E2 estradiol … Sorry, 80% estriol and then 20% estradiol at that one milligram breakdown, so a small amount in that one troche, but with a milligram of testosterone, a milligram of DHEA, and maybe 30 milligrams or up to 60 milligrams of progesterone in the troche then have them do a quarter of the troche twice a day to start, morning and evening.

The troches that I used to prescribe are these little square, they look like a Chiclets, and so you can just easily break them into quarters and then start at that low dose and a little bit goes a long way when it comes to bioidentical hormone prescribing and our mouth is a great place to absorb it, but periodically, a couple times a week, I would have them use that troche vaginally to help with the integrity of the vaginal tissue and there’s other things but that was area of my expertise was sexual health and vaginal prescribing. So using that in that way for men reasons can have a huge benefit incontinence, vaginal dryness, those things.

Trevor: Yeah and I do want to reiterate what you said that you want to do this with an experience practitioner, healthcare provider who specializes in hormones that does know a lot about this and the bioidentical hormones in particular. Bioidentical hormones are not something that all doctors prescribe, only people that are trained to use them or are understanding naturopathic doctors, functional medicine doctors, and other doctors that end up specializing in this because every woman is so different and men, men use bioidentical hormones too.

We’re all so different and a troche might work well for one person but then creams might work better for another person. Dosing can change, somebody might not need estrogen or testosterone. There’s so many different variabilities in this so it’s really important for people not to listen in and try and go and find this online and do it yourself. You don’t want to do any of this yourself.

Anna: Yeah, and the things that when it comes, you can’t get compounded formulations combined, it’s only be prescription. One thing is that when you using hormones start at the lowest effective does and it does come in different formulas. I will say the same two people can come in with the same problems and everyone go out with completely different solutions or plans. We may use pellets, we may use injection. I never use estrogen pellets, but testosterone pellets or injections. It really depends on the individual and what the capacity of the individual is for this regimen as well. It can definitely make a big difference.

Trevor: Yeah and I want to go back for a minute. You talked about changes in vaginal health, like the dryness and irritation. Some women tend to get more urinary tract infections and yeast infections and things, so let’s talk about some things that women can do, because you’ve actually found some great things that can help women with this, right?

Anna: Yeah, yeah this is one of things that I’ve been working on for the past really decade of my practice is solutions for women in these areas. Initially, very selfishly, I wanted the better surgical results, I wanted better and better surgical results for incontinence surgery and I’m a board verified trained gynecologist, I did a lot of uri-gynecology and so I started using compounding hormones testosterone, DHEA vaginally and getting really great results and then really such great results that the clients didn’t have symptoms of urinary incontinence anymore, right? And so couldn’t operate so to that level and I really hope that for everyone.

I hear so many younger and younger women with issues of incontinence that are scheduling for surgery and really again we have to get to the underlying reasons why and let’s address that or let’s get some integrative support to this tissue and make that available. That’s one of the things I did with my product Julva that we talked about earlier. I think that just makes a big difference, let’s use something directly to the area that will make a difference. If we can avoid surgery let’s do it and if not let’s make sure we get the best surgical outcome that we can get.

When our vulvar tissue is aging around the tissues from our entire females bits, right? Our entire lady bit age just like the skin, we get wrinkles around the eyes, et cetera, we do in our pelvic floor. There’s a weakening of the underlying muscles, the underlying connective tissue and that leads to a lot of dryness and that can be very painful, it can also disrupt our relationships and a secondary, sometimes primary reason for not wanting to have sex is that if it hurts every time you have sex why would you want to have sex anyway, right? It’s often the one plus one doesn’t make two in those individuals, they never really see that connection and it’s important to make that connection and get that triaged. [crosstalk 00:39:16]

Trevor: So before we started recording the podcast you were telling me you actually have a tube of it with you. Right? The Julva cream? Yeah, so tell people what’s in it? What did you put in this cream?

Anna: Yeah, so this is Julva and it is my feminine cream for ladies feminine parts, I don’t know if you can see that there. This is a customized topical cream and it’s really great. I wanted something easy to use that smelled good, all natural ingredients, and that absorbed into the skin really well so that you could use it prior to foreplay or as a natural moisturizing lubricant to use for the vulvar area and that can really help.

The ingredients that I put in it were from years of clinical practice. I used coconut oil, I used emu oil, and DHEA and plant stem cells from the Alpine rose, which are very restorative and regenerative. We tend to see this really beautiful improvement in the tissue right away with this combination and the way I have it formulated is very specific to the order of ingredients that has worked the best from years and years of practice working with sexual health in women so it’s a good combination. We use DHEA and a lot of safety studies on DHEA, a little bit goes a long way and it helps with muscle, it helps with connective tissue. Again, this is a fantastic moisturizer for the pelvic floor, for our feminine lady parts, because that does suffer with the symptoms of aging, not to mention you’ve been using chemicals in our detergent, in our panty liners, in our sanitary pads, and tampons. All those chemicals are toxic exposer, so that does effect our pelvic floor.

We see thinning of the tissue, irritation, infections, et cetera. Keeping that tissue is really, really important and I’m just smiling because I always say one of the main reasons that caregivers or children will put their parents into a nursing home, their aging parents into a nursing home is because of the issue of incontinence and I’m always like, “I am not giving my kids another reason.” They could put me away now if they wanted to. I’m not giving them any additional reasons.

Trevor: Well Dr. Anna I was on your site earlier looking at some of the testimonials and things about the product. Tell people where they can find out, we’ll also have the link up on my website.

Anna: Yeah, we’ll offer your audience a free seven night trial so you can get used to it. That’s at order.julva.com/trial so order.julva.com/trial but the main information is at julva.com, which is short for Joyful Vulva.

Trevor: Okay and this is for our lady parts?

Anna: Yes.Trevor: You could probably put it on your face.

Anna: Well you know, a little bit right here.

Trevor: A little bit right here. Right around the eye area.

Anna: Yeah.

Trevor: All right, great. Then also Dr. Anna, tell everyone about how else they can find you, your website, any other information you want to share.

Anna: Yeah, absolutely. My website is DrAnnaCabeca.com so D-R-A-N-N-A-C-A-B-E-C-A.com and I’ve got great resources and blogs there. Also shout out on Facebook and you can ask questions, I look forward to interacting with you and this has been a pleasure, Trevor. It’s always great to talk with you.

Trevor: Yeah, thank you so much Anna. You’re just a wealth of information and I love talking hormones because this is something that I think is so important and changes so much throughout our lives for both men and women, today we’re focusing on women’s health. But I think it’s so important you know the hormone disrupting chemicals that in our environment, this plays a role in it, and there’s so much we can do with our diet and lifestyle and then we have the option for bioidentical hormones and then creams like yours. There are options for people, I see so many people struggling with these issues and we don’t have to. It’s great to have you on and talk about the solutions and get the answers that we all need. So I appreciate it, thank you.

Anna: Thank you.

Trevor: I hope you enjoyed this interview today with Dr. Anna Cabeca. To learn more about her you can go to pomdev.wpengine.com, go to the podcast page with her interview, and you’ll find all the information about her plus the links that she mentioned and the transcription of the program. She covered a lot today, so the transcription might a good thing to look at. While you’re there I invite you to join The Spa Dr. community so you can see what other podcasts we have, blogs, different information, and you can also subscribe to the podcast on iTunes so you don’t miss any of our upcoming shows.

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