The patient is 19 years old and comes in for the first time into the office. She has actually seen someone else before. She has been recently started on OCP’s (oral contraceptives). She was first on a tricyclic for three months. She was then switched to a progestin only (norethindrone) daily because of a previous history of migraines.  (Progestins are three dimensional chemical analogs of the real hormone progesterone.) The other practitioner was concerned about possible stroke.

She was asked if she had sexual intercourse regularly and replied somewhat sheepishly not often. I pointed out to her that her sheepish response probably reflected some degree of being uncomfortable with the idea of sexual relations with her boyfriend and this she would need to explore. She was also advised that progestin only contraception could be associated with a) normal menstrual flow, b) no menstrual flow, and c) constant irregular flow.

She underwent a pelvic examination which showed no evidence of any findings of inflammation present in the pelvis. She was advised that she probably fell into the c) category.

She was advised how the menstrual flow was controlled from the hypothalamus and pituitary glands in the brain acting in conjunction with the ovaries to produce different hormones, the final activity of which caused the lining of the uterus to grow, ripen and then shed when no pregnancy ensued.

She was given the black box analogy about the systems way of looking at the human or any organism. The characteristic input stimulus and output adaptive response was discussed. The energy flow in the black box part of the system was also discussed. The nervous system control in the sympathetic/parasympathetic system, in terms of its ability to increase or decrease energy flow and processing, in the black box portion was discussed.

She was told that the typical western medical approach was to modify the flow of the process in the black box by pharmaceuticals which affected different levels of the five part flow a) incorporation of energy b) transfer of energy c) utilization of energy d) and recycling of utilization products. She was told this is the equivalent of modifying a computer’s output by changing the chips or resistors on the motherboard. Certainly, the output would change, but there would be no predictability. This, essentially, is what happens, when a new drug is introduced, as it is not possible to truly know its effect on a population, until the entire population is exposed. From this perspective, there is no predictability, even in the use of her OCP’s. If she is a candidate for a stroke, she will not know until she has one or until she develops a clot, when pregnant.

The other approach in the black box analogy would be to see what changes in input would create the desired output adaptive response. To this end, she would have to look at the fact that human DNA is influenced by emotion. This has been experimentally shown. She would need to address this issue. This was of particular significance as she had “bad acne”, which seemed to be related both to her cycle and to her stress level, as she was to report.

She was amenable to these ideas and indicated a willingness to explore them further. She planned to return to the office in two to three months to evaluate how she was doing at that point.