Abstract: A case of PCOS is well taken and worked out according to the principles of Law of Similia, then comes the follow up which is overall a different and essential task and the result fundamentally depends upon the unadulterated prescription. The aim of this article is to show the efficacy of Homoeopathic medicine in PCOS.
Key-word: PCOS, Repertory, Miasm, Sepia, Homoeopathy.
Introduction
Disease is the antithesis of health, and cannot exist as a primary condition, but always be secondary to health. we are brought to the conclusion that pathology must have its origin to physiology; that pathological process are initiated in physiological processes, and that for disease, however varied its nature, there will always be found a prototype in health.
Polycystic Ovarian Syndrome is one of the commonest endocrine disorders affecting women of reproductive age group. It affects about 4% to 12 % of women worldwide. It has been recognized that the presence of enlarged ovaries with multiple small cysts (2 to 9 mm) and a hyper vascularised, androgen-secreting stroma are associated with signs of excess of androgen and menstrual cycle disturbance. It is commonly associated with obesity and insulin resistance.
Now a days, people give considerable attention to PCOS because of its high prevalence possible metabolic, cardiovascular and reproductive consequences. In developed countries, PCOS is the most common cause of anovulatory infertily, hyperandrogenism and hirsutism. The prevalence of PCOS has increased in recent years.
Polycystic Ovarian Syndrome (PCOS) is a chronic condition and defined as an anovulation or oligo-ovulation with clinical or laboratory evidence of hyperandrogenism and without evidence of any other underlying conditions like congenital adrenal hyperplasia, Cushing’s syndrome.
Patho-Physiology
Ovarian Compartment
· Most consistent contributor of androgens.
· Free & total testosterone levels correlate directly with LH levels.
· Ovaries more sensitive to gonadotropic stimulation.
Adrenal Compartment
· Hyper-responsiveness of DHEAS to stimulation with ACTH.
· DHEAS increased in about 50% of patient with PCOS.
· PCOS may be a+n exaggeration of adrenarche.
Peripheral Compartment
· Activity of 5 alpha- reductase in the skin largely determines the presence or absence of hisutism.
· Peripheral aromatization is increased with increased body weight.
· With the obesity the metabolism of estrogens is decreased.
· Estrone (E1) level is increased due to peripheral aromatization of androstenedione.
Hypothalamic-pituitary Compartment
· Inscrease in LH pulse frequency.
· Elevated LH and LH-to-FSH ratio.
· FSH is not increased.
· Mildly elevated prolactin level.
Clinical Features
Menstrual Dysfunction
· Due to oligo ovulation or chronic anovulation.
· Menstrual condition: – 30% regular menstrual cycle, 50% oligomenorrhoea & 20% amenorrhoea.
· PCO: 23% women of reproductive age.
· PCOS: 5% to 10% women of reproductive age.
Obesity
· Occurs in more than 50% of patients of PCOS.
· Body fat is generally deposited centrally (android obesity).
· Waist to hip ratio indicates risk of Diabetes mellitus & Cardiaovascular Diseases.
· Also induce insulin resistance & hyperinsulinaemia which in turn increase the androgen.
Hyperandrogenism
· Hirsutism
· Acne
· Male pattern alopecia
· Sleep apnoea
· Clitoromegaly
Diagnostic Criteria
· Oligomenorrhoea or amenorrhoea.
· Hyperandrogenism (Hirsutism, acne, male pattern alopecia).
· Hyperandrogenemia (elevatedlevel of free or total testosterone).
· Polycystic ovaries on ultrasound.
· Elevated LH-to-FSH ratio.
· Insulin resistance.
· Perimenarchal onset of hirsutism.
· Obesity
Case Study
A female(O.P.D. Regd. No: 18889, Address: Charial Bazar, Police Station: Budge Budge, W.B.), aged about 28 years old Muslim patient came to NIH OPD on Dec. 04, 2013 with complaints of Irregular menses; very scanty, blackish in character for one days at 40-45 interval, pain in abdomen before 2-3 days of menses & pain in lower abdomen during menses for eight years; LMP was 26-11-2013 and Excessive hair growth all over the body for last 3years. She was treated by Non-Homoeopathic and Homoeopathic Medicine with no improvement previously.After further enquiry I got more information regarding White discharge per vagina, Discharge is thick, offensive in character and itching of the parts. She had Chicken pox at the age of 4 years.
Personal History:
Marital status – married; Occupation – housewife; Diet – diet regular; Living environment – pakka house and pond around; Socio- economic status-upper middle class.
Homoeopathic Generalities:
A. Physical General
General tendencies:Tendency to catch cold.
Thermal reaction:chilly patient.
Appetite: average; Desire:sour; Aversion: fatty food;Thirst:2-3 lit./day; Salivation/ dryness of mouth: average; Taste: normal.
Bowel: soft stool;once daily.
Urine: clear.
Perspiration: average.
Sleep: decreased.
B. Mental General: Desire to be alone.
Clinical Examination
General survey:
Built– average; Nutrition – obese; Decubitus – of choice; Anaemia – absent; Jaundice – absent; Clubbing – not found; Oedema – not found;Neck vein – not engorged and not pulsatile; Neck gland – not palpable; Pulse –76 /min; regular; Blood pressure– 112/80 mm Hg; Respiration –14 /min; Obesity – present; Weight- 73kg; Height- 1.54 Meter; B.M.I= 30.80; Body hair – hirsutism; Depigmentation / hyperpigmentation – nothing; Examination of palm, sole, vertex – normal; Tongue – moist.
Systemic examination:
Skin and mucous membrane- Acne on face; Hirsutism; Chloasma on face.
Provisional Diagnosis: Polycystic Ovarian Syndrome.
Laboratory Investigations: on02-12-2013 USG of lower abdomen-Polycystic right ovary and small left ovary.
Confirmed Diagnosis: Polycystic Ovarian Syndrome as per expert’s opinion.
Miasmatic Diagnosis: Mixed- Miasmatic with predominance of Psora.
Totality of the Symptoms:
Causation: Fundamental – Mixed- miasmatic with predominance of Psora.
Characteristic Mental Generals Symptom:
Desire to be alone
Characteristics Physical Generals Symptom:
Aversion to fat
Desire for sour
Thermal reaction-chilly patient
Tendency to catch cold
Hirsutism
Characteristics Particulars:
Chloasma- brown spots on face
Leucorrhoea- itching
Menses scanty
Menses late
Ovarian cysts
Repertorization: Synthesis Repertory by using RADAR 9.1 version
Analysis of Repertorial Result: SEP.26/10; NAT. M 21/8; SULPH. 20/9; LYC. 19/10; KALI C.19/9; PULS.19/9; PHOS. 18/10…
Repertorial Selection with Reasons: Sepia is the reportorial selection because it covers maximum number of rubrics with highest score.
Final selection of Medicine (after consultation of Materia Medica and with reasons):it is found that Sepia seems to cover the totality of symptoms as well as miasmatic background of the patient, so Sepia is finally selected for the case.
Prescription
On 04-12-2013: Rx Sepia– LM1/16; Doses; A.D. for 32 days; to be taken in the morning Vac. Ven.
Follow Up
11-02-2014: LMP 01-02-2014; Menses for 2 days at 40-45 days interval, scanty, blackish; leucorrhoea less than before. Acne, chloasma same as before and prescribed Sepia- LM 2/16 doses; A.D. x 32days.
17-03-2014: Menses for 3-4 days at 40 days interval, scanty, blackish; leucorrhoea reduced.Acne, chloasma better than before and prescribed Sepia- LM3, LM4/16 doses per LM; A.D. x 64 days.
11-06-2014: LMP 24-05-2014; Menses for 3-4 days at30-40 days interval, average; acne improved; Sleep sound and prescribed Sepia- LM5/16; Doses; A.D. x 32 days after that Sepia LM6/16; Doses; A. D. for 32 days.
14-08-2014:Patient feels better as a whole.LMP 20-07-2014; Menses for 4-5 days at 28-30 days interval. No leucorrhoea, chloasma (brown spots on face) improving gradually and prescribed Sepia LM7/16; Doses; A.D. x 32 days.
v Report Dated 12-08-2014:USG of lower abdomen –Normal study
Both ovaries are normal in shape, size and echotexture; Rt. ovary 2.5×1.5cm, Lt Ovary2.8×1.7cm
Before Treatment After Treatment
Comments: Patient was improving gradually during treatment. So, case may be considered as “improved one”
References:
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3. Fauci Anthony S., Longo Dan L. Ed et al.: Harrison’s Principles of internal medicine;17th Edition; Mc Graw Hill Medical Publishing division, New Delhi;2008.
4. MichaelT. Sheehan, Polycystic Ovarian Syndrome: Diagnosis and Management. Clin Med Res. 2004 Feb; 2(1): 13-27.
5. Schroyens F.: Repertorium Homoeopathicum Syntheticum; edition 9.1; B. Jain Publishers Pvt. Ltd., New Delhi; 2014.
