Key words
Menorrhagia - Uterine adenomyosis - Trillium pendulum -
Natrum muriaticum
Introduction
Uterine adenomyosis is the benign invasion of endometrial glands and stroma into the
myometrium. Most
cases (90 %) occur in multiparous women, and about 80 % of women with adenomyosis
are 40 to 50 years
old. The most frequent symptoms are menorrhagia, dysmenorrhoea, and metrorrhagia.
Classically the uterus
is diffusely enlarged and tender to palpation. The role of adenomyosis in the pathogenesis
of
menometrorrhagia is perplexing, in part because it frequently occurs in asymptomatic
women [1]. Adenomyosis has been found in 54 % of uteri examined at autopsy [2]. In a prospective study of patients undergoing hysterectomy, there was no
difference in duration of menstrual bleeding or presence of dysmenorrhoea in the 28
patients found to
have adenomyosis and 157 without adenomyosis or endometriosis [3]. On the
other hand, adenomyosis is often associated with abnormal uterine bleeding. Adenomyosis
was found in
hysteroscopic biopsy specimens in 37 % of 90 menorrhagic women. However, if the uterine
cavity was
normal, the number of patients who had significant adenomyosis increased to 66 % [4]. Adenomyosis was found in 20 of 43 women with an enlarged uterus without evidence
of
leiomyomata on ultrasound who had a hysterectomy for persistent menorrhagia [5]. Ultimately, the role of adenomyosis in abnormal uterine bleeding may prove to be
quantitative, with more extensive disease and greater depth of myometrial invasion
more likely to cause
abnormal bleeding [1].
Adenomyosis typically affects women of reproductive age. In general, affected women
are multiparous, and
the condition is seen with higher frequency in woman with a history of surgical uterine
procedures
(e.g., Caesarean section, dilatation and curettage). It has a reported incidence ranging
widely from 5
to 70 % [6]. Diagnosis can be made with the help of transabdominal and
transvaginal ultrasound, hysteroscopy and MRI. Homeopathy offers a better alternative
for the treatment
of uterine adenomyosis. The below presented case is one such example where homeopathic
medicine proved
to be safe and effective in the treatment of uterine adenomyosis by not only improving
the general
health of the individual but also preserving her uterus.
Case Presentation
A female patient of 27 years of age has come to the OPD complaining of bleeding per
vagina continuously
for the past fifteen days. The blood was dark red and clotted. The patient was suffering
from irregular
menstrual cycles with protracted and profuse bleeding for almost a year. The patient
has been on
allopathic medication for almost the past six months with no relief. As the patient
had already two
children and the menorrhagia was devastating and not responding to treatment she was
advised to undergo
a hysterectomy by the consulting gynaecologist. As the patient was reluctant to undergo
surgery and had
previously benefitted from homeopathy, she opted for homeopathic therapy. She was
referred to the OPD of
the Extension Clinical Research Unit, Princess Durru Shehvar Childrenʼs & General
Hospital,
Hyderabad by the consultant gynaecologist of the said hospital. Her presenting complaints
were:
a) Menstrual cycles appeared every fifteen days.
b) Each cycle lasted for about ten days.
c) Severe pain, abdomen and back, felt during the flow with much exhaustion and fainting.
Past history
She had an attack of chikun-gunya two years back and had taken an allopathic treatment
with relief.
The pains subsided within a month. Family history was unremarkable. Parents were not
alive and
mother died one year back. Patient had four siblings – three sisters, one brother
– who were all
clinically normal.
She was the third child of non-consanguineous parents. She was educated up to tenth
class and
discontinued as she was married early. She attained menarche at the age of twelve
years. Her
menstrual cycles were regular every thirty days, bleeding lasting for five days. She
was a housewife
and had two children – one male and one female, one was a normal delivery and the
second one an
emergency caesarean. Her first childbirth was five years back and her last childbirth
was three
years back.
Physical generals
-
Thermal reaction: Hot patient, desire for cold weather and air
-
Desire: Salty food and salt
-
Aversion: Nonspecific
-
Intolerance: Milk
-
Appetite: Diminished
-
Thirst: Extreme dryness of mucous membranes and thirst extreme
-
Stool: Constipated, alternate days with burning in anus
-
Urine: Normal (complained of involuntary urine on sneezing and coughing for the past
three
months)
-
Perspiration: Profuse especially in hot weather, oily
-
Sleep: Disturbed due to thoughts of her dead mother
Mental generals
-
Desires to be alone
-
Sensitive to noises and trifles
-
Never weeps before others, but broods when alone secretly
-
Consolation by others aggravates her troubles
-
Very much stressed after the death of her mother, observed that the present complaint
started
after the death of her mother
General physical examination
She is medium complexioned, normal built.
Height: 5”6′, Weight: 65 kg, BMI (body mass index): 23.
Anaemic – Nil, Jaundice – Nil, Cyanosis – Nil, Generalised lymphadenopathy – Nil.
Pulse – 72/min, Temperature – 98.6 °F, Respiratory rate – 12/min, BP – 110/70 mmHg.
Respiratory system: lungs are clear.
Cardiovascular system: S1, S2 normal, no added sounds.
Gastrointestinal system: NAD.
Locomotor system: NAD.
Pelvic examination: Bleeding present.
Routine haemogram: Haemoglobin 8 gms/dl.
USG pelvis shows bulky uterus diagnosed with adenomyosis of uterus (Fig. [2]).
Fig. 1 Repertorisation of the case (Complete Repertory in Hompath Classic).
Fig. 2 USG pelvis at entry.
Treatment
Initially Trillium pendulum 30 C, one dose every four hours has been prescribed to control
bleeding per vagina with pain, severe pain in back, and much exhaustion with fainting
as presented by
the patient. The case was repertorised on the basis of the Complete Repertory
[7] taking into consideration the totality (Fig. [1]). Natrum muriaticum was thought to be appropriate for the case, as it was found
suitable after repertorisation and in consultation with materia medica.
Follow-Up Criteria
The case was followed for a period of one year post-menstrually with USG pelvis done
at entry and at the
end of one year as per the protocol.
1st follow-up: The patient had reported after two days with cessation of bleeding after taking
Trillium pendulum 30 C. Placebo continued for fifteen days.
2nd follow-up: At this juncture, the case was analysed, evaluated and repertorised. Natrum
muriaticum 30 C in a single dose was prescribed based on the totality, with placebo daily, one
dose for a month.
3rd follow-up: After a month with the first dose of Natrum muriaticum 30 C, the menses
appeared on the 29th day and bleeding lasted for five days. Weakness reduced. Pain
in back and abdomen
relieved. She was therefore given placebo, daily, one dose for a month.
4th follow-up: The patient reported in the next month post-menstrually. She had menses on the 28th
day and bleeding lasted for five days. Pain in back and abdomen reappeared during
menses. Natrum
muriaticum 30 C, one dose was repeated with placebo for one month.
5th follow-up: The patient reported in the next month post-menstrually; had menses on the 30th day
and bleeding for five days. Pain in abdomen and back relieved. She was therefore given
placebo, daily,
one dose for a month.
6th follow-up: The patient reported in the next follow-up post-menstrually; had menses on the 27th
day and bleeding for five days. Pain in abdomen and back reappeared. Natrum muriaticum 200 C, one
dose with placebo for one month was prescribed.
7th follow-up: The patient reported in the next month post-menstrually; had menses on the 30th day
and bleeding for five days. Pain in abdomen and back relieved. She was therefore given
placebo, daily,
one dose for a month.
8th follow-up: Next month, the menses appeared on the 31st day, bleeding lasted for five days, no
complaints. Placebo for one month.
9th follow-up: Next follow up, the patient reported after two months. The last menses came early
by two weeks, bleeding was profuse, lasted for five days and spotting lasted for five
days. Now
Natrum muriaticum 200 C, one dose was repeated with placebo, daily, one dose for a month.
10th follow-up: Next follow up, the patient reported after two months. Menses had been all three
months every 30 days, bleeding lasted for five days. No other complaints. In this
follow-up, USG pelvis
has been done for the final assessment of the case.
Impression of the report: Uterus is normal, no evidence of any mass lesion inside the uterus,
normal pelvic scan (Fig. [3]).
Fig. 3 USG pelvis at end (after 1 year of treatment).
Discussion
The patient presented with adenomyosis uterus in the reproductive age group i.e.,
27 years of age and
with abnormal uterine bleeding as per the version of McCausland
[8]. There is no family history reported in the present case. Abnormal uterine
bleeding is the most frequently cited symptom in women with adenomyosis of the uterus
as per
Stewartʼs classification system
[9] of clinical presentation of uterine adenomyosis and the present case
reported with continuous bleeding per vagina as the chief complaint for fifteen days.
When initially the subject approached with the complaint of continuous bleeding per
vagina with severe
back pain and much exhaustion with fainting, Trillium pendulum was thought to be appropriate as
per Boericke
[10] and Allen
[11]. After giving Trillium pendulum 30 C, bleeding per vagina
stopped. At this juncture, the case had been taken in detail, analysed, evaluated
and repertorised to
select a similimum. In the case along with the totality much emphasis was observed
on the mental general
and causation i.e., ailments after the death of the mother became the guiding symptom.
The selection of
Natrum muriaticum is thus based on the totality of characteristic symptoms further guided by
the keynote that is the prominent mental general. The dose of Natrum muriaticum was administered
post-menstrually in this case in accordance with Allen [12].
Initially Natrum muriaticum 30 C, single dose was given. In the subsequent follow-ups, the same
was repeated once and later also prescribed in a higher potency (i.e., 200 C potency)
as per the
requirement of the case. Finally, at the end of one year, USG pelvis revealed no evidence
of mass lesion
in the uterus. As rightly said by Thomas Skinner
[13], “Constitutional treatment alone was and is all that is necessary for
successful treatment of all vaginal, uterine and ovarian diseases”. The same holds true in this
case of uterine adenomyosis too.
Conclusion
In the present case, a striking peculiarity in terms of mental general and causation,
i.e., ailments from
the death of her parent (mother), was taken into consideration for the prescription.
Though the totality
of the symptoms was considered for the prescription but much emphasis has been given
to this mental
general which in turn proved to be successful in not only providing symptomatic relief
to the patient
but also in the complete elimination of the adenomyosis of the uterus at the end of
one yearʼs
treatment. Therefore, it can be concluded that in this case the homeopathic constitutional
approach is
highly effective in the cure of uterine adenomyosis.
Conflict of Interest
We declare no conflict of interest.
