Any thoughts on the patient I have with vaginal bleeding only during intercourse? She’s been checked out by the gynecologist, has thin epithelial, the vaginal exam caused some bleeding too, but she has no other signs of lack of estrogen. Eats Paleo, generally very healthy, any suggestions on perhaps topicals, EVCLO, or where to go next. Periods are regular, not too heavy, not too crampy.

Chris Kresser:  I would definitely use the DUTCH comprehensive panel, Marcy, if you haven’t already. It sounds like she’s had some testing by the gynecologist, but I’m not seeing any lab results testing for cortisol, HPA axis dysregulation, and even estrogen dominance or low estrogen problems with progesterone or estrogen metabolites, high testosterone, PCOS-type of presentation. I know we didn’t go over estrogen, progesterone, sex hormones in this course in terms of how to how to interpret the DUTCH results, but if you run that test, the folks at Precision Hormones will be happy to help you interpret it. And if you asked me as well, I’ll help too. Because that symptom, vaginal bleeding, is, I cannot imagine that there isn’t some kind of hormonal involvement here. I would also look, in case it’s like this where you have a symptom that is nonspecific and you’re not clear what’s causing it, this is where the whole workup is really important. And I encourage, and I know I’ve said this before, but I’m going to say it again.

It’s, in a way, it’s functional medicine and clinicians. We don’t care as much about symptoms and signs. We do care about them in that they’ve caused suffering for our patients, and we care about them insomuch as they can point to potential underlying causes. But we really always want to get to the root of the cause. And you can, unfortunately, knowing what the symptoms are and how they present is not often enough to tell you what those causes are because a lot of symptoms and presentations have multiple ideologies and potential underlying pathology.

So this is why every patient that comes to see me gets the full Case Review. It’s why I never start with a patient by just having a kind of, like having them come into the office and talk to me a little bit about their symptoms and then make some recommendations for testing and treatment based on those symptoms because I don’t think that’s effective, and that’s why the Case Review model is so powerful. Because in a situation like this, where you have this kind of symptom that you wouldn’t be able to otherwise figure out, you can learn a lot from the blood chemistry, the gut panel, and then the HPA axis screening, and later as you learn it, screening for hormones as well.