The client is a young woman with amenorrhea that hasn’t responded to dietary and lifestyle changes. Her gynecologist has advised her to start taking hormonal birth control to regain her period, but since she reacts very sensitively to hormones—bad PMDD, migraines with aura—she hasn’t followed that recommendation. She has a history of anorexia nervosa, anxiety, hypersensitivity, and depression. She is now at an acceptable weight and has been taking anticonvulsants for atypical trigeminal neuralgia for three years with a bad flare-up last summer that has left her virtually incapable of living a normal life. With that kind of health history and current vitamin D deficiency, I’m adamant about taking steps to prevent osteoporosis and restore hormone balance, but unsure about where to start. Any ideas or recommendations?

Chris Kresser:  This sounds like a tricky case. With hormone stuff, I would definitely look at gut health, and I would definitely look at HPA axis. We’re not going to be talking a lot about treatment of male and female hormones in this course, but we are going to be talking a lot about treating the HPA axis, and in the vast majority of cases, particularly with younger women and men, I’ve found that addressing the HPA axis is the first and sometimes only step that’s needed when the sex hormones are out of balance, along with all the other stuff we’re talking about—normalizing nutrient balance, addressing gut pathologies, etc. It’s usually cortisol, DHEA, and the adrenal hormones that are really out of balance, and if you bring those back into line with some of the strategies we’re going to be talking about in the HPA axis unit, that can help tremendously and sometimes eliminates the need for any kind of male or female hormone support.

A lot of her symptoms that you mentioned—anxiety, depression—these are typically gut-brain related, the gut-brain axis, so if you haven’t looked into her digestive situation, I would definitely do that. Migraines can be related to that, as well, although it sounds like that’s more related to when she takes hormones.

Regarding trigeminal neuralgia, I’m not sure what her resources are, but if she’s this poorly off and she if she can afford this, then I would have her consider seeing someone who works in dental orthopedics, like Dr. Dwight Jennings in Alameda. If I had trigeminal neuralgia myself or I had a patient with trigeminal neuralgia, I would definitely send him or her to Dr. Jennings. He brings the lower jaw forward and does other adjustments to the jaw that can be profoundly helpful with TMJ, all kinds of neurological conditions, including Parkinson’s, which he is having pretty remarkable success with, any kind of musculoskeletal pain, autoimmune disease. It’s really quite remarkable work, and I’ll have him on my podcast at some point.

Then you want to do some pretty comprehensive blood chemistry screening and possibly something like the NutrEval from Genova to test for her nutrient status because it sounds like that could be an issue here. If you’re familiar with hormone testing, doing the DUTCH hormone panel and looking at any signs of a PCOS type of presentation might also be helpful.