Skip to content

It Takes More Than Hormones to Fix Our Hormones

Dr. Genevieve Newton sits down with Dr. Anna Cabeca — triple board-certified OB/GYN, author of The Hormone Fix and KetoGreen 16, and host of the Girlfriend Doctor podcast — for a rich conversation on what it actually takes to restore hormonal health. Dr. Cabeca shares how years in conventional practice, combined with her own personal health crisis, pushed her toward a functional and integrative approach built around what she calls the “devil’s triad”: chronic inflammation, adrenal dysregulation, and the interplay of hormone imbalance and insulin resistance.

The keto-green diet is central to Dr. Cabeca’s framework — a combination of ketosis with alkalinizing greens, fiber, polyphenols, and fermented foods that supports insulin sensitivity, brain function, and hormonal balance simultaneously. She explains the brain fuel shift that occurs during perimenopause, and why approaches that worked in your 30s may no longer apply. The conversation also explores the underappreciated role of oxytocin — not just as a bonding hormone, but as a powerful driver of resilience and wellbeing that can be cultivated through gratitude, prayer, and human connection.

A significant portion of the episode focuses on genitourinary syndrome of menopause (GSM) — the constellation of vaginal dryness, atrophy, and urinary symptoms that affects most menopausal women but remains underaddressed. Dr. Cabeca and Dr. Gen walk through a complete pelvic health stack including DHEA cream, water-based lubricant, targeted probiotics, pelvic floor exercises, and the Fringe pelvic wand with vibration. A 74-year-old patient story puts all of it in perspective.

 

Listen on the go — The Fringe podcast is available on Spotify and YouTube. Subscribe so you never miss an episode.

 

Transcript

Dr. Genevieve Newton: Hi everyone, welcome to the Fringe Podcast. I'm Dr. Genevieve Newton, Scientific Director at Fringe, and I'm here today speaking to Dr. Anna Cabeca. Very excited to have you as our special guest. Dr. Cabeca is the best-selling author of The Hormone Fix, KetoGreen 16, and Menu Pause. She is triple board certified in gynecology and obstetrics, integrative medicine, and anti-aging and regenerative medicine. She holds special certifications in functional medicine, sexual health, and bioidentical hormone replacement therapy. Dr. Anna is also known as the Girlfriend Doctor and hosts the podcast by the same name, where we spoke about a year ago. We're going to pick up our conversation and talk all things menopause. Tell us how you got here — you started off as a more conventional OB/GYN and then shifted into this functional integrative side. How did that happen?

Dr. Anna Cabeca: I grew up in a culture of first-generation Americans — a lot of food as medicine. I chose osteopathic medicine because of the philosophy of empowering the body to heal itself: alignment, address the issues, the fascia is connected to everything, can't treat one part of the body without treating the rest. Then I did residency at Emory University, one of the best allopathic institutions for OB/GYN. Early on in private practice, I had a patient who came in — 63 years old, history of ductal carcinoma in situ of the breast, it hurt to have sex, she was dry, no doctor would give her hormones. She loved her husband, couldn't have sex because it was too painful, and she said she'd rather die than live this way. And I was like: my job as a physician is not to say the case of do no harm means do nothing. So I dug into the research. She was the president of a biotech company and we dug in together. We found we could use DHEA, testosterone, vaginal estrogen — no contraindications. I read all the research. We wanted to stay away from progestins for sure. And I started working with her. From there, other clients came in — the women with breast cancer, other GYN cancers, over a certain age, just left to suffer. That was completely unacceptable to me. And I started on this journey creating solutions, understanding that it takes more than hormones to fix our hormones. Always address the underlying issues. When a patient comes in with a diagnosis, what caused that diagnosis? Did we address the underlying issues? For me, this is truly my passion.

Dr. Genevieve Newton: You have been a long-time champion for women who are suffering from these issues. What are the root causes you see so often in your practice?

Dr. Anna Cabeca: That comes down to three things — I call them the devil's pitchfork. If we can address these three things, we’re going to heal or reverse 99% of the diagnoses that come up. Number one: inflammation. There is no disease without inflammation that exists in an alkaline, non-inflamed body. Number two: adrenal dysregulation. Our foot on the cortisol pedal, the adrenaline pedal — we're firing up our system, which also contributes to inflammation. Number three: hormone imbalance. With that hormone imbalance, I'm going to talk about insulin resistance. As we get older, reproductive hormones decrease but insulin and cortisol increase. We have to become more insulin sensitive. We have to support our bodies' natural ability to make and use hormones more efficiently. There are so many hormone disruptors. The answer isn't piling on more hormones — believe me, I am a hormone prescriber. I've done this for 30 years. I use bioidentical hormones. But it's really important to address the underlying issues first: empower our bodies to use and produce our hormones most effectively, and avoid, remove, and cleanse our systems from things that are disrupting our hormone receptors, production, or acting as hormone mimickers.

Dr. Genevieve Newton: If I came into your office suffering from the devil's triad, what would you tell me to do from a dietary perspective?

Dr. Anna Cabeca: Foundationally, I call it keto green. A way to get into healthy ketosis — not butter and bacon keto, but getting into ketosis in a healthy way while also focusing on the alkalinizers: the greens, the fiber, low glycemic nutrients, polyphenol-rich foods that feed our gut microbiome. The most important population in the world that I want to protect is the microbiome — the healthy, protective microbiome. So the keto green foundational nutrition: I created medicinal menus that help us get into ketosis and decrease inflammation, improving alkalinization. Each meal has a healthy high-quality protein, good alkalinizing greens or phytonutrients, a healthy fat, and a fermented food. That combination is so empowering and helpful. Food is medicine, or it can be disease-promoting.

Dr. Genevieve Newton: You were really far ahead of the curve because with Atkins and early keto, there wasn't this recognition of the need to support the microbiome and provide fiber. Have you had to fight to get this information accepted?

Dr. Anna Cabeca: Absolutely. I've collected thousands of clients that have gone through surveys pre and post my Magic Menopause program. I'll publish it someday. In my mid-to-late forties, hitting that perimenopausal spiral — even though my hormones were dialed in, I was experiencing the 5, 10, 20 pound weight gain without doing anything different. The mood swings, irritability, monster within me, intolerance, burnout, disconnect. Even as a hormone specialist with my hormones dialed in, I was experiencing this weight gain and brain fog. I knew the keto or low carb diets could help. But I felt what I called keto crazy — not keto flu, but something wasn't right. Something if men can do keto differently than women. No one had really studied it in women, let alone menopausal women. So I started digging in. I checked my urine pH — as acidic as the paper could read. And think as a gynecologist: acid in your bladder long-term is going to create incontinence, interstitial cystitis, infections, urgency symptoms. We know alkaline urine pH is associated with lesser metabolic disease, diabetes, cancer, bone loss. So I needed to add alkalinizers back. I started thinking about cultures that eat ketogenically — the Inuit people, for example. They make fish bone broth. That's the minerals. The minerals are huge alkalinizers. I started adding more minerals, microgreens, sautéed beet greens, kale soup. The alkalinizers were key. And all of a sudden the weight released and my mood lifted. I had this sense of peace — nothing in my life had changed. Still single mom of all my kids, soul breadwinner, lots of stress and trauma. But I felt that peace. And as a result, my mornings changed completely. And I realized it wasn't just what we eat. Cortisol — you can be eating all that good nutrition but be stressed out and angry, and cortisol creates that acidic environment. Cortisol is the key that unlocks the door to those intact cell membranes. Oxytocin does the opposite. The practice of gratitude, presence, joy, prayer, meditation, getting out in nature — these things increase oxytocin and seal that gate, creating alkaline urine pH. So I took this and called it my Magic Menopause program. I took my most difficult patients through it — the stubborn ones where I couldn't get the needle to move. And every single one of them felt better within a few weeks. That became my Magic Menopause program, launched in 2014.

Dr. Genevieve Newton: I love that you have that spirit connection in there because that's been my personal experience too — it's a triad of mind, body, spirit in terms of being healthy, and you really can't have one without the others. Can you speak to the biochemical aspect of the keto-green approach in perimenopause specifically?

Dr. Anna Cabeca: In 2015, a research article was published looking at MRIs and SPECT scans of women's brains, examining glucose metabolism. Glucose metabolism or gluconeogenesis in the brain is an estrogen-dependent phenomenon — it flows along the decline of progesterone more so than estrogen, though progesterone is not well studied in the female brain. During the time period when progesterone and estrogen start to decline, your brain is actually starving for fuel. It’s not using glucose as much. So you forget your words, you don't know why you went into a room. It's a very challenging and concerning experience. But the use of ketones for fuel in the brain is not hormone-dependent. When I shifted into ketosis, my memory was there, my clarity was there. And with the alkalinization in that healthy way, really focusing on feeding the gut microbiome, addressing our physiology in a supportive low-inflammatory way — that's key. That period from roughly 35 to 60 is a period of neuroendocrine vulnerability. But through lifestyle and nutrition, we can shift that. And I've proven: through the keto green approach, in as little as ten days, hot flashes can be gone. Because insulin resistance is what's driving the hot flashes — they're symptoms of insulin resistance, not just estrogen insufficiency. If you create insulin sensitivity, you've just improved longevity.

Dr. Genevieve Newton: I turned 50 this year and I'm definitely menopausal. It hasn't been a super challenging experience so far — I’m very focused on my diet and my spiritual wellbeing. There's this ongoing conversation among friends about hormones. Today many people think you can't be well through this transition without replacing hormones. What's your take?

Dr. Anna Cabeca: It's always about being in alignment with the patient's personal preferences and practices. I will say — I personally will be on my balance cream and my Jolva cream until I die. And probably some testosterone. I want to keep my bladder as healthy as possible. But I also have clients who chose not to use hormones. And nutrition, lifestyle, and nature are really important interventions for them. When I walked the Camino de Santiago, one of the most amazing women I saw was in her late seventies — all smile lines, laugh lines, body like a twenty-year-old, strong, agile, walking fast, energetic. Not on hormones. Not on handfuls of supplements. Not biohacking herself. And I honor that absolutely. I think: if I was hiking the Camino or living in the Amazon, waking up with sunrise, going to sleep with sunset, not exposed to EMFs, not burning the candle at both ends — maybe I wouldn't need hormones or as much. We get so much more from nature and sunshine than just vitamin D. In the Blue Zones, not one of the factors was supplements or hormones. It was connection, all the oxytocin-increasing practices. The most powerful pharmacy in the world is the one in our own body. So tapping into that — that's creating your Blue Zone. It's not a heck yes or a heck no on hormones. It has to be in alignment with our lifestyle and our choices.

Dr. Genevieve Newton: At Fringe, our philosophy has always been not about biohacking or super-physiological doses and really high intensities. With supplements: what are we missing that we really can't get from our diet anymore, and can we get that from a food-based supplement? With red light therapy: let's mimic the intensity of the sun to bring in some of what people are missing from their interior-focused lifestyles. If you ask us whether it's better to go out in the sun — absolutely yes. We want you to do that. In the context of menopause and genitourinary syndrome specifically — those urinary and sexual symptoms — how do you see non-pharmacological options, including light-based therapies, fitting in?

Dr. Anna Cabeca: I think it's essential. I talk about vulvar topical hormonal therapy, red light therapy, vaginal microbiome support therapy — all of this is critical to vaginal health and wellness. Even my clients in their 80s, I have them using topical hormones in this area because incontinence, urgency, dryness all make a difference. And not just red light — the reason I recommend the Fringe wand is it's red light with vibration. Vibration helps with blood flow and vascularity. It works better in hormonally sensitive tissue, making it more flexible and more elastic and supporting natural glandular secretions. When I recommended the red light vaginal and vibration therapy to my patients, they were on board immediately because they understand how red light is affecting their skin in other areas — helping with aging, helping with healing, it's collagen-promoting. So let's add that down there as well. If we think of the healthy pelvic floor stack, that's definitely included. And there's no negative risk that I know of. I have a 74-year-old patient I love telling this story about. I asked her in the office: how's your sex life going? She said, Dr. Anna, in this last year since we fixed things down there, it has been the best in our marriage. Fifty years married. And she said: we've always loved each other, sex was okay, but over the years it was something we did. We love each other and care about each other. But since addressing everything — using Jolva, adding the vaginal microbes, the Lactobacillus crispatus supplementation, adding red light therapy — they increased the quality of their intimacy and relationship. She said: not just in the bedroom, but in all areas of life, we're laughing more together, having more fun. That's oxytocin. When we create that safety and trust by addressing those issues, by addressing clitoral atrophy, vulvovaginal atrophy, dryness — the body feels safer, has more pleasure, more enjoyment. That's game changing. That's why I champion vulvovaginal care.

Dr. Genevieve Newton: I would love for you to get detailed with us about that pelvic stack. If you wrote this down on a prescription pad for a patient, what would it look like?

Dr. Anna Cabeca: Number one: I start clients on Jolva. I started compounding hormones with DHEA in the 1990s, and Jolva is the result of that evolution — plant stem cells and DHEA in a very emollient, absorbent base. Typically I tell clients to start every other day for the first one to two weeks, then daily, applied clitoris to anus, the vulvar labial tissue. That naturally helps with moisture. Number two: my new lubricant Velvee — aloe, hyaluronan, clean, water-based, propanediol, no propylene glycol, no parabens. It's a great lubricant during sex and also soothing. Number three: VB probiotic — the vaginal targeted probiotic with high quality strains, including Lactobacillus crispatus. Key. Number four: pelvic floor exercises. Muscle is magic and the most important muscles are in the pelvic floor — keep them strong and healthy. Number five: red light and vibration. The reason I like the Fringe wand over some others is it's a narrower diameter. You also have the blue light option, which for any inflammation, infections, or post-coital tenderness, you can use that blue light and it can really cool things down. For the probiotics: initially, especially if you haven't been on any in a while, I typically have my postmenopausal women on it at least three months — two capsules a day for two to three months, then take a break, but integrate it back in periodically. For younger patients in their 20s, just doing one course of the probiotic should be fine. I think it's one of those things where like the seasons change, do a bottle every quarter just for that preventative repopulating of healthy bacteria. Because as I've been doing vaginal cultures on clients in their twenties, thirties, forties, and beyond, I'm not seeing the healthy bacteria. I see a lot of dysbiotic or just aseptic vaginas from antibiotic use, hormone disruptors, washes. All of that has affected the vaginal microbiome. Adding in a vaginal probiotic — I have patients who've been on my Jolva product for over ten years and then we add in the vaginal probiotic and they're like: my God, even better. Not getting up at all at night to pee. These are the changes I'm hearing from the community.

Dr. Genevieve Newton: I love how comprehensive this toolkit is, and it's also not onerous — it's really manageable. It's a very different message than what a lot of women are getting today, which is just go on hormone replacement therapy and use vaginal estrogen. There's a lot more to the story. Is there something you want to add on the hormone side?

Dr. Anna Cabeca: Yes. In every prescription vaginal estrogen, unless it's compounded, there are hormone disruptors in it — that's what gives it the shelf stability for years. Those ingredients can actually cause disruption of the vaginal mucosa cells and disruption of the microbiome. So there's a double-edged sword. Yes, estrogen can help the mucosa. But compared to DHEA or testosterone, it's not addressing the deeper layers. I've been following the work of Dr. Ferdinand Labrie out of McGill University for over two decades. Vaginal DHEA increases the strength of the muscle walls. Topical use, together with pelvic floor exercises, improves glandular secretion. According to the published research and my clinical experience, vaginal DHEA and vaginal testosterone work so much better than estrogen alone. So much better.

Dr. Genevieve Newton: Thank you for sharing all of that. Where can people find you?

Dr. Anna Cabeca: Easy to find me at dranna.com — D-R-A-N-N-A dot com. And on social media at The Girlfriend Doctor. Check out my YouTube channel. My books — The Hormone Fix, KetoGreen 16, and Menu Pause — are available anywhere books are sold.

Dr. Genevieve Newton: Amazing. Thank you so much, and thanks everyone for joining us today. We'll look forward to seeing you again.

Previous Post Next Post
Last updated: June 24, 2026
Fringe

about the author

Dr. Genevieve Newton, DC, PhD

Gen spent close to 20 years as a researcher and educator in the field of nutritional sciences before joining Fringe as its Scientific Director. Gen’s job is to “bring the science” that supports Fringe’s products and education. She is passionate about all things Fringe, and is a deep believer in healing body, mind and spirit using the gifts of the natural world.

The contents in this blog; such as text, content, graphics are intended for educational purposes only. The Content is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider.