What Nobody Ever Tells You about Bio-Identical Hormones with Dr. Anna Cabeca

The Functional Medicine Radio Show With Dr. Carri

In this episode of The Functional Medicine Radio Show, Dr. Carri’s special guest Dr. Cabeca explains what nobody ever tells us about bio-identical hormones and their effects.

Dr. Cabeca is a board certified Gynecologist and Obstetrician, as well as board certified in Anti-Aging and Regenerative Medicine, an expert in Functional Medicine, and an expert in women’s health. She specializes in bio-identical hormone replacement therapy and natural alternatives, successful menopause and age management medicine.

Main Questions Asked:

• Can you explain what the Women’s Health Initiative was and what that did to the whole area of hormone treatment for women?
• Can you talk about some of the common myths and misconceptions about hormone replacement therapy versus bio-identical hormone replacement therapy?
• Can you explain the pros and cons of hormone testing (blood tests, saliva tests, etc) and what you actually do in your practice?
• Do you have any herbal alternatives for patients who are not comfortable with the thought of using bio-identical hormones?

Key Points made by Dr. Anna:

• What we found out from the Women’s Health Initiative study was that women on estrogen alone had no significant increase of breast cancer and may have a protective effect on colon cancer and bone health (this is using oral hormones because using transdermal is different). But the Premarin-Provera group (Prem-Pro group) showed an increase in breast cancer risk. This created this early halting of the study, headlines everywhere, and women were told to stop their hormones.
• This whole Women’s Initiative study led us to this fear of hormone replacement. What we continue to look at in the research is the risks of bio-identical hormones. Everything else is case specific.
• In my practice, if I have a patient who’s sedentary and going to McDonald’s three times a day, that is not a person I’m going to give any hormones to. I need to see commitment with lifestyle changes, detoxification programmed within her dietary regimen. I need to see therapeutic lifestyle changes because we don’t have magic pills whether they’re bio-identical or synthetic.
• Myth: Bio-identical is 100% benign and safe. Reality: Too much or too little is still a problem. And in someone with significant inflammatory issues, diabetic issues, etc., we’re going to run into problems. I’m not saying I haven’t used them in these situations but I have a very functional medicine practice so there are many spokes on the wheel that are being addressed at the same time.
• There was a study done in France by Dr. Fournier that looked at bio-identical progesterone compared to synthetic Progestins. What it found is that bio-identical progesterone did not increase the risk of breast cancer. However, the Progestins did have an increased risk.
• Progesterone is good for our brain, our bones, and our breasts. Progesterone in and of itself can help with fibrocystic breasts, breast tenderness, PMS. We really need it with or without a uterus.
• Progesterone is helpful for our moods as well. It helps downregulate the brain’s GABA receptors so there’s more GABA available which is our calming neurotransmitter.
• Bio-identical progesterone supports our immune system so if we have immune diseases, we want to make sure we’re on some beneficial, helpful progesterone. It’s neuroprotective, anti-inflammatory, and a natural diuretic which helps with that estrogen dominant PMS weight gain before your period so using bio-identical progesterone can help you there. It helps us get a natural deep sleep and when we have a uterus, it helps stabilize the endometrium. These are all beneficial effects of progesterone.
• Say I have a 58-year old menopausal female who has been without her period for six years, feeling fatigued, low energy, anxious, heart palpitations, moodiness, has loss of sex drive, losing hair, maybe some muscle aches, mid-belly weight gain and overall feels that she’s not aging well, she hurts when she wakes up in the morning, is unable to stop the weight gain despite not changing her habits over the last decade. What do I do about this? I would do blood testing to see what’s going on with her thyroid. Look at total estrogens, progesterone, and testosterone. In total look at a sex hormone binding globulin, look at DHEAs as I’m looking at it in the blood. That would be a hormone panel in addition to some inflammatory markers that I always add in. For example, vitamin D, hsCRP, hemoglobin H1C.
• I may do a salivary test to look at her adrenal pattern throughout the day. I’ll look at a 4-point cortisol throughout the day to see what’s going on throughout the day.
• If you’re taking hormones the testing is different. Depending on how you’re taking the hormone, we’re going to see it differently in the blood, in the saliva, in the urine. It’s important to recognize that the way we’re getting it needs to be taken into account by the measurements when we’re reading the results. It can be really confusing and this is why you need to go to a hormone expert who is used to looking at these panels, and used to looking at the optimal blood levels. Or what are the limitations in salivary testing? What are the limitations in urinary testing? And blood testing? For example, if you’re on a transdermal estrogen patch, we’re not going to see it as significantly in the blood as we will in the saliva.
• So with that said, we do have to be careful in how we’re using our labs to adjust your dosages. That comes down to the art of medicine. Our clinical history, our clinical physical evaluation, and your symptoms scores.
• There are plusses and minuses to each method. That’s why we say “Treat the patient, not the labs”, yet the labs will guide us and they need to be done the same way, the same point in your cycle, the same time of day, same after hormone administration each time you test if for comparison. At least we can control that and see if there are any differences or increases.
• We’re very consistent when we take it and that’s a pet peeve when people send me lab results. I ask them when they took their hormones, what day of the cycle they were on, what time of day it was. Sometimes I want to look at it at different points in a menstrual cycle but that’s a key importance of hormone testing.
• For those who are no comfortable with bio-identical hormones than an herbal alternative is maca.
• Maca is composed of very specific proteins called macaeens. It’s rich in arginine which increases nitric oxide which increases blood vessel health and circulation, hence, which is how Viagra works. It’s an adrenal adaptogen and very alkalinizing.
• There are many other things that we use too but one thing is certainly detoxing the liver. So a detoxifying diet using alkalinizing foods and using healthy fish oils. I’m a big fan of oysters as far as foods go. Oysters, seaweed sushi, Brazil nuts. Those are my standard food prescription because there are so many good nutrients specific to those foods that are beneficial to the menopausal and andropausal woman and man.
• Other herbs I use for the menstrual cycle is chase berry, black cohosh, soy isoflavins but I find the use of a combination approach with anti-inflammatories like tumeric and other natural anti-inflammatories like Cat’s Claws which is another great anti-inflammatory and immune supported herb. These combinational approaches will help us in a very holistic way, bring things to center and bring things to balance.
• Even if we’re giving bio-identical hormones, our body has to detox them well.

Resources Mentioned:

Dr. Anna’s Feel Good Look Good Secrets Webjam

Dr. Anna’s website

Book – Reclaim Your Energy and Feel Normal Again

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