Dr. Anna Cabeca

Secrets to Improving Pelvic Health at Any Age by Dr. Anna Cabeca

As a gynecologist I talk to thousands of women about the health of their lady parts. In particular, I talk about the importance of prevention relating to women’s vaginal health concerns. Today I want to focus on what you should know about your pelvic health. This is also something men should think about, by the way, as their pelvic health is important as well.

Pelvic health is important to all women physically, mentally and sexually

Pelvic health is important to all women physically, mentally and sexually

Pelvic health is important starting in your 20’s

I’m guessing some of the younger women out there are about to click off the page as they are likely thinking, “I’m too young to worry about my pelvic health. That sounds like an older woman’s problem to me!”

But you’d be wrong! Pelvic health is important at any age. Women should be thinking about their pelvic muscles starting in their 20’s as that is when several key hormones like estrogen and DHEA actually start to decline. And if you’ve had a pregnancy you’ve already put some wear and tear on your pelvic muscles and should be exercising them to help them recover.

Lifestyle considerations can add to your risk for pelvic health issues

There are a lot of additional lifestyle considerations that can impact your pelvic health at any age. Poor posture or even sitting all day long at work every day can impact your pelvic muscles. 

If you are overweight, all that weight pushes down on your abdomen and further exhausts your pelvic floor muscles. If you have diabetes or another chronic disease there can be impact. 
A poor diet, having food intolerances or digestive issues can affect your musculature. Anything that makes you strain can only make the downward stress worse on your pelvic muscles.

As women’s sexual hormones decline further in their 30’s, this starts to affect the muscles and tissues around the pelvic area, vagina, uterus, rectum and bladder. And while initially a woman in her 30’s may not experience any obvious symptoms…the symptoms will typically worsen over time if nothing preventative is done.

By 40, most women will have weakened pelvic muscles

In my experience most women have weakened pelvic muscles starting at age 40.

By this time many women have started to have slight urinary leakage (stress urinary incontinence is the medical term). 

You know what I’m talking about: that tiny bit of uncontrolled pee that happens when you laugh or cough. Or the trickle of urine that occurs every time you exercise. It may be so slight at first you ignore it. And then, maybe you start wearing a thin panty-liner. No problem, right? Just wear a daily panty-liner.

Did you know that it is estimated that 70% of women use period-specific products – such as panty-liners – for incontinence purposes?

And while statistics vary, stress urinary incontinence has been estimated to affect over 50% of women between the ages of 20 to 80 years. Some estimates are even higher. They Mayo Clinic, for example, uses 85% as their estimate.

I hate to tell you but it is likely to get worse if you don’t exercise your pelvic muscles. Not only will the urinary leakage get worse, but as your pelvic muscles weaken, all the organs that those muscles normally help to stay up start to fall down through your vagina, a problem called pelvic prolapse (an issue that can eventually require surgery).

See the graphic? Your pelvic muscles are like a strong sling that holds everything else up. Now imagine that sling slowly falling and weakening.

Your pelvic muscles are like a supportive hammock

Your pelvic muscles are like a supportive hammock

And the issue just isn’t about leaking!

Although I personally think that issue alone makes me want to do my pelvic strengthening exercises faithfully, weak pelvic muscles can also affect your ability to enjoy sexual intimacy.

And the reason for this is two-fold. First, weak pelvic muscles don’t provide as good of blood flow and nerve supply to surrounding tissues (needed for optimal sensation). Exercising these muscles may improve your orgasms!

Weak muscles can cause leaking, a decrease in both sensation and libido

Weak muscles can cause leaking, a decrease in both sensation and libido

Second, if you are leaking…maybe you just won’t feel very sexy. I can tell you there is a lot of recent research that says that weak pelvic muscles, incontinence, and other vaginal symptoms affect us ladies beyond just the physical symptoms! It embarrasses us. It impacts our relationships. It makes us stop doing things we love to do, like bike-riding, jogging, a favorite sport or…even our making love.

But pelvic health isn’t just about sex

Even if you aren’t having sex your pelvic health is vital to you not developing severe incontinence issues and/or needing to have surgery due to pelvic prolapse.

The number one reason older women end up in a convalescent home is that they have incontinence. So it really is an issue that spans a woman’s entire life.

So what’s a woman to do? 

First, relax when sitting on the toilet!

Yes, it’s true. So many of us are in too great of hurry, so what do we do? We try and force out the pee or poop as we really need to get back to the kids or work. Think about it, when was the last time you really relaxed while on the toilet? It makes a difference. All of the forcing and pushing further stretches – and stresses - your pelvic muscles.

Second, try to be more aware of your pelvic muscles. It is likely you never think about them (until you start to tinkle more and more). Once they have your attention, the best exercise for them is something called Kegels. You’ve probably heard of them, but I have found most women don’t do them regularly. And for those that do, many do them incorrectly!

Here’s how to do the perfect Kegel for the best results.

It is easy to do the perfect Kegel

It is easy to do the perfect Kegel

In this short video you will learn how to do Kegel exercises as well as how to test to see if you are doing them properly. There are 3 simple steps.

Pay particular attention to the breathing! When we cough and laugh we do those things on the exhale…so it is important that we are able to contract (and keep that pee in) on the exhale as well.

Step 1: Focusing on the area between your vagina and anus (called the perineal body), pull up on the exhale. Contract those pelvic floor muscles.

Step 2: Hold this contraction for a count of three. Then relax. You’ll eventually want to increase this count, up to eight.

Step 3: While you are holding this contraction, try and breathe normally and relax.

These steps should be repeated. Do three sets of eight lifts, three to five times per week.

And by the way, men can do Kegels, too!

Do you have hyperactive muscles? A small number of women have the opposite issue of pelvic floor muscle weakness; they may have tense or hyperactive muscles. You can discuss your own pelvic health status with your doctor or there is a self-test you can do. 

Try and stop your urine midstream when you are peeing. If you can’t stop your urine stream, your pelvic floor muscles are likely not as strong as they should be. This isn’t a test you should repeat too often (and definitely don’t do this as an exercise routine!). Just do it to initially self-test yourself… and maybe repeat in a month if you implement Kegels. And then do the self-test infrequently after that.

A feminine cream containing DHEA may also help

DHEA is a natural hormone in our body that is important to the integrity of skin, muscle, and bone and also has a role in maintaining libido. Like other hormones it decreases over time beginning in a woman’s 30’s. Many people take oral DHEA to improve energy level and mental alertness, but here I am talking about a cream that is applied topically around the vulva.

DHEA applied locally at the vagina can improve the musculature of the deeper layers of the vagina (decreasing symptoms of urinary leakage and pelvic prolapse), as well as improving vaginal dryness and irritation, vaginal and vulva discomfort, and even libido.

That’s why I used DHEA in my new feminine restorative cream, Julva®

You can get a free 7-night trial of Julva here, just pay $4.95 shipping and handling. 

For international shipping, there's this special link for International Julva trial packs. It runs about $13-18 for USPS first class, it just takes awhile to get there. 

So no matter what your age, take care of your important pelvic muscles! And share this information with all of the ladies in your life.

Found this interesting?


Dr. Anna Cabeca is an Emory University trained and board certified Gynecologist and Obstetrician.  In addition, she is board certified in Anti-Aging and Regenerative Medicine and an expert in Functional Medicine and Women’s Health.  She specializes in bioidentical hormone replacement therapy and natural alternatives, successful menopause and age management medicine.  

Dr. Cabeca is the creator of the highly acclaimed virtual transformational programs: WomensRestorativeHealth.com, SexualCPR.com, and MagicMenopause.com. She is also the creator of the superfoods drink Mighty Maca™ and the new feminine anti-aging cream, Julva™.

Dr. Cabeca is passionate about supporting women (and the men that love them) in creating health and hormone balance for themselves as well as many generations to come.

To connect with her:


Top Ten Podcasts of 2016

As the year comes to a close, I want to celebrate ALL the guest experts we had on Women's Wellness Radio this year, and our listening community.  It was a great year of growth, both in knowledge and in community building.

Today I'm sharing the top ten most downloaded episodes, in case you want to catch one or two that you missed.  Here we go:

1. Why Your Probiotic Supplement Isn't Working With Kiran Krishnan

This episode I saved for many months to make it out 100th episode! This interview with Kiran Krishnan, microbiologist and founder of Megaspore Probiotics, is super fascinating. This conversation breaks through confusion about the gut and myths about probiotics.

2. Natural Solutions for Hormonal Problems with Dr. Carrie Jones   

This was a very popular episode right away!  Dr. Carrie has great insights on hormone labs and why our hormones go haywire. She also shares some of her favorite supplements. Don't miss the free handout on the page.

3. The Hormonal Imbalances That Make You Gain Weight With Cammi Balleck  

Well, I didn't know this show was so popular 'til today!  It suggests to me that lots of women in our community are dealing with hormonally-based weight issues, so I'll bring more resources to you on this subject.

4. Seven Keys to Fertility Into Your 40s With Dr. Anna Cabeca       

This was an interesting one for me too!  I am fascinated with the topic of optimizing fertility at an older age, and Dr. Cabeca is both an inspiring and knowledgeable expert in this area.

5.  The Autoimmune Fix With Dr. Tom O'Bryan   

This was less of a surprise.  Dr. Tom O'Bryan is a well-known expert in the field of gluten intolerance and autoimmunity, and many women in our community are dealing with autoimmunity. What wowed me in this interview was what a talented presenter Dr. Tom is.  

6. Easy Essential Oils for Women's Health with Dr. Mariza Snyder   

I had no idea this episode was creeping up the ranks.  It suggests to me that you all are hungry for more practical, simple solutions. Let's do it!

7.  A Holistic Approach To Adrenal Healing With Kelly Graham 

I also did not know this one was faring so well!  But adrenal dys-regulation is so prevalent today, I shouldn't be surprised. What I loved about Kelly's presentation was her insight on how we put ourselves into this box.

8. Nutrition And More For A Healthy Cycle With Caroline Zwickson   

Y'all love to learn about your cycles!  Caroline brings some clear explanation and great tips with this one.

9. Why You Need to Support Your Mitochondria With Susanne Bennett    

We have a tie for #9 with the exact same number of downloads.  Dr. Bennett gives a rarely-heard and much-needed explanation of the importance of our mitochondria.  This one is good for chronic disease and infertility.  

9. Interpreting Your Period Symptoms with Rachel Eyre      

I loved this episode with Rachel Eyre and I'm so glad it made the top ten.  We cover some detailed stuff like uterine positioning and clots in menstrual blood...and vaginal steaming!

10.  A Healthy Dose of Productivity with Laura McClellan  

And I'm so happy this episode squeaked in there, because I'm a big fan of Laura. She is not in the 'health space', but she an incredibly wise teacher on the important subject of getting sh*t done with wearing yourself out.  She has great presence. 

I am filled with gratitude as I write this for our experts and our listeners. Looking back and remembering all these amazing conversations gives me energy for the year to come!

If you are not yet a subscriber, you can subscribe by searching 'womens wellness radio' on most podcast player apps. Here is the iTunes link. Get a new episode very week!

If you want to share a favorite episode, speaker, take-away or memory from the podcast this past year, I'd really love to read it below!

A Better Approach to Perimenopause

This is a guest blog article from our friend Dr. Anna Cabeca, MD, OB/GYN.  Learn more about Anna and her resources at the close of the article.


What do I mean by that?  In healthy menstruating females, hormones cycle on a monthly basis.  Our first day of our period is cycle day one, progesterone and estrogen is at their lowest; this is the follicular phase.  At around cycle day 12 - 14, ovulation occurs and our progesterone levels increase awaiting a pregnancy, this is the luteal phase of the menstrual cycle, if pregnancy does not occur, progesterone drops and our period occurs again.  

Commonly, in our thirties, our progesterone levels start to drop, more than our estrogen levels, creating something called estrogen dominance. This gives us irregular menstrual cycles, possibly heavier bleeding, increased pain with the menses and PMS symptoms such as breast tenderness, irritability, bloating, etc.  

We may also begin to lose our sex drive and vaginal lubrication.  Our skin may become itchy, noticeably more wrinkled - sometimes this seems to appear overnight - welcome to hormone imbalance!

What can you do about hormone imbalances?  

The answer is not just one thing.  I always recommend a balanced head to toe approach.  My head to toe approach encourages every woman to take control of her health!  So, where should the focus be for women at this time?

Focus on the spiritual:  What is the mental atmosphere that you find yourself in and what can you do to gain some perceived control of it?

Environment: What are your personal and work environments; and what could be interfering with your ability to achieve happiness? How much nature are you experiencing?  Are you getting enough sunlight? When was the last time you walked outside barefoot?

Nutrition:  Your body is your temple and what should you be ingesting to nurture it? Is the food you are eating promoting ketosis or fat-burning?  Is it alkalinizing? These two principles are key.

Digestion:  No matter how well you eat, you have to ensure that you have appropriate digestion - that means adequate acid and digestive enzymes in your stomach and healthy bacterial flora in your intestines to absorb the nutrients. A surprising number of women have poor digestion.

Detoxification: Since the 1950's, corporations have introduced greater than 500,000 chemicals into our environment.  Additionally, no matter how we get our hormones, whether it is from what our body naturally produces or from the xeno-estrogens from the environment from pesticides, herbicides, food we eat, air we breathe, etc.;  how our body gets rid of it is even more important.  All my patients are introduced to my nutrient and protein base detoxification program that includes a modified elimination diet to remove foods, etc., that are likely to produce allergies.

Hormonal balancing: We need to consider the hypothalamic, pituitary, adrenal, and gonadal axis, i.e. the entire hormone web.  Additionally, each woman is hormonally unique and part of achieving your optimal health is in understanding this and achieving your own hormonal balance.

Structure and function: Physical strength and exercise are the final and very important aspects to achieving optimal health.

So, when I approach a woman who has symptoms of hormone imbalance, and this is my area of expertise for the last 20 years, we need to incorporate all of the above aspects into a balanced treatment program.  For hormone balancing, I consider the major hormones such as adrenaline, cortisol and thyroid, and the hormones estrogen, progesterone, testosterone, and DHEA.  

Based on a given individual, I may recommend bio-identical hormone therapy for things such as for treating hot flashes, helping with bones, brain, and heart, improving our sex lives, skin, and energy, and for maintaining our optimal body weight.  

My approach has always been to prescribe the lowest doses in the most balanced fashion, based on a given woman’s specific medical history and symptoms, along with test results such as saliva and serum hormone testing.  Adding hormones may help, but there are a couple key physiologic lifestyle tips that we must incorporate for optimum success and optimum menopausal experience.  

Let me give an example:

Zoe is 43 years old and her periods had gradually becoming more frequent; she complained of more irritability prior to her periods and absolutely no sex drive.  And even worse than this – she just felt out of sync.  She said that she used to organize all 4 children’s schedules and keep her bills organized, and she volunteered a lot at the school; yet she suddenly felt that she couldn’t even organize her car pool.  She had 'lost her edge'.  

I took an extensive history, covering all 7 topics above, and did serum, saliva and urinary testing to evaluate hormones and detoxification.  She was definitely progesterone deficient, estrogen dominant and also was fatty acid deficient, i.e. she needed more healthy fats, especially omega 3's in her diet.  I prescribed a bio-identical progesterone cream and a testosterone cream and in 3 weeks she returned stating she was "feeling better than she had in years!"  She had "gotten her edge back".  She was also sleeping better, her sex drive returned and her focus and stamina returned.  I had also recommended a balanced quality multivitamin, omega 3's, calcium, and a few other nutrients based on nutrient testing such as Co Q 10, Alpha lipoic acid, and carnitine to improve her energy and weight as well.

Her periods became regular, in fact, she stated she couldn't even tell when her periods were coming - the PMS was entirely gone and her relationship with her husband became more satisfying and intimate again.

Dr. Anna Cabeca OB/GYN

Dr. Anna Cabeca OB/GYN

It is hard for women, especially because we have so many different roles and obligations, to take the time for ourselves that we need in order to feel our best and perform our best for all those that we love around us.  

I encourage each and every one of you to take that time…to remember to try and do as much naturally as you can towards the 7 areas above so that you can achieve your optimal health.

And if you are still struggling with haywire hormones, join me in learning more about the above principles. Download my free eBook, “3 Menopause Mistakes That Leave You Feeling Fat, Tired, and Stressed!”