You’ve increased estrogen.

You’ve supported the gut.

You’ve cleaned up the protocol.

And… she’s still dealing with dryness. recurrent UTIs., and discomfort that keeps coming back.

At some point, it stops being a hormone conversation.

When labs look “fine” and symptoms persist, adding more support doesn’t fix the problem. It just exposes it.

In this episode, Dr. Ritamarie sits down with Dr. Anna Cabeca to look at a pattern that gets missed in conventional and functional care: the vaginal microbiome.

This is NOT a side topic but a primary driver.

They walk through what happens when Lactobacillus balance is disrupted, why vaginal pH shifts matter more than most practitioners realize, and how these changes can create symptoms that look hormonal but don’t respond to hormone-based approaches.

You’ll start to see why some cases don’t resolve…

and what to look at next when they don’t.

What’s Inside This Episode?

Normal estrogen… but persistent dryness
Why UTIs keep coming back
When pH—not hormones—is the issue
The key Lactobacillus strains that matter
How antibiotics and HRT disrupt the ecosystem
Urgency and leakage that aren’t a bladder problem
The link to fertility, aging, and tissue health
Why systemic protocols fail when the issue is local

Resources and Links

Download the Full Transcript
Download our FREE Metabolic Health Guide here.
Join the Next-Level Health Practitioner Facebook group here for free resources and community support
Visit INEMethod.com for advanced health practitioner training and tools to elevate your clinical skills and grow your practice by getting life-changing results.
Check out other podcast episodes here

Dr Anna’s Resources and Links

Dr Anna’s Website: https://drannacabeca.com

Check out Dr Anna’s products

Find her on Social Media

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YouTube: The Girlfriend Doctor:

TikTok

Podcast

Labs & Testing Mentioned in This Episode

These tools go beyond traditional testing (HPV, chlamydia, gonorrhea, trichomonas) and help assess overall vaginal microbiome balance, including beneficial Lactobacillus species.

MDL (Medical Diagnostic Laboratories) - Vaginal testing that includes both pathogenic organisms and beneficial bacteria
BiomeFX Vaginal Microbiome Kit - Advanced microbiome analysis to assess vaginal bacterial balance
Tiny Health Vaginal Microbiome Test - At-home testing option for evaluating vaginal microbial health

Guest Bio

Anna Cabeca, DO, OBGYN, FACOG, is best selling author of The Hormone Fix and Keto-Green 16 and MenuPause. Dr. Anna is triple-board certified and a fellow of 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.

She lectures frequently on those topics and shares the secret behind the ebb and flow of intimacy as she demystifies the fascinating hormonal changes over time. She will help you discover how the “love hormone”, Oxytocin can breathe life into your relationship, and how Cortisol can take it away - and how the delicate balancing act of those hormones can reignite your libido and support a healthy relationship, most importantly the one you have with yourself.

She is sassy, blunt, speaks from the heart and has a wonderful sense of humor, and this is why we call her The Girlfriend Doctor, because everyone needs a friend like her!

She has personally developed natural products to help women balance hormones and thrive through menopause including the highly acclaimed Julva® cream for the vulva and MightyMaca® Plus, a powerful superfood blend. She lives in Dallas with her daughters, horses and dogs.