A case of endometrial polyp cured with homoeopathy

A case of endometrial polyp cured with homoeopathy

Abstract: Endometrial polyps or uterine polyps are abnormal growths of endometrial glands which typically protrude into the uterine cavity. Endometrial polyps are relatively common and usually benign in nature, may affect women of reproductive age groups as well as post-menopausal women. In modern medicine, surgical intervention is the only treatment but as per my little experience, most of the female gynaecological diseases can be cured effectively by a well selected homoeopathic simillimum. The constitutional approach always yields wonderful results.

Keywords

Abbreviations: Ultrasonography (USG), hormonal replacement therapy (HRT), last menstrual period (LMP), aggravation (>), amelioration (>)

Introduction

Endometrial polyps, also called uterine polyps, are discrete outgrowths of endometrium that contain a variable amount of gland stroma and blood vessels, attached by a pedicle, which moves with the flow of the distension medium. They may be pedunculated or sessile ^(1,2), single or multiple. They may vary in size from as small as a sesame seed to as big as golf ball (0.5 – 4 cm). It is probable that they are present in 25% of women with abnormal vaginal bleeding although atleast 10% of asymptomatic women are also likely to have polyps.⁽²⁾

In most cases, the uterine polyps are benign but removal is necessary to exclude the remote possibility of infertility & malignancy.

Causes

The cause is unknown. It may be linked to changes in oestrogen levels. Endometrial polyps are more common in reproductive age group especially in 40s or 50s. It may be due to the changes in oestrogen levels that happen just before and during menopause.⁽³⁾

It would appear that these endometrial polyps are relatively insensitive to cyclical hormonal changes and so are not shed at the time of menstruation. In addition they may contain hyperplastic foci, particularly in those that are symptomatic.⁽²⁾

The other risk factors may include:

Obesity

Hypertension

Diabetes

Women experiencing abnormal bleeding while taking HRT

Tamoxifen – a drug used for breast cancer (found in upto 30% of such cases)⁽⁴⁾

Clinical presentation

1. Asymptomatic, especially in case of solitary/ small sized polyp
2.  Unscheduled vaginal bleeding or spotting is the commonest symptom. The persistent intermenstrual bleeding for at least 3 months or more is significant.
3. Heavy bleeding
4. Vaginal bleeding after menopause
5. Trouble getting pregnant

Complications of uterine polyps

Malignant change is rare but it may coexist with endometrial carcinoma.

The predictors of malignancy are: (a) Size more than 10mm; (b) Postmenopausal status; (c) Abnormal uterine bleeding ⁽⁴⁾

Polyps also interfere with fertility because they can keep a fertilized egg from attaching to your uterus or block your fallopian tubes or cervix.

Miscarriages are more common in females having polyps.

Diagnosis ^(2,3)

• Ultrasound (USG)
• Transvaginal ultrasound (TVS)
•  Hysterosonography
•  Hysteroscopy
•  Endometrial biopsy

Case report

Introduction

Miss Pink, aged 27 years, unmarried female came to me on 14^th September 2020 with the complaint of irregular vaginal bleeding with weakness and trembling of legs. She was working as a beautician but stopped due to lockdown imposed during Covid-19. She was fair in complexion, with blue circles around the eyes.

Presenting complaints

The chief complaints of the patient were intermenstrual vaginal spotting since 5-6 days. Along with that, she also complains of much weakness with trembling of legs.

History of presenting complaints

The patient was apparently well 5-6 days back then she started complaining of intermenstrual spotting when she urinates. She looked very depressed and sad. On further enquiry, it was found that some family disputes were going on for the last 15- 20 days since then she became silent and irritable; anger was quite visible but suppressed, otherwise she was a sincere happy girl but emotional too.

Menstrual history:

LMP: 29^th August 2020

Duration 2-3 days

Character of the bleeding: Dark red in colour with few clots

Past history: she had acne in the past for which she had undergone homoeopathic treatment (6-7 months back)

Family history: Nothing specific was found

Physicals generals

The patient’s appetite was quite decreased, doesn’t want to eat anything. She is thirst less. She had desire for salty things. She is a hot patient.

Mental generals

She was irritable in nature, jealous, contradiction aggravated her. She became angry on slightest triggers but didn’t express herself. Suppressed anger, used to weep only when alone, fastidious.

On examination:

The patient was found to be hypotensive; measured blood pressure was 100/60mm Hg. The appearance of tongue was found to be clean and moist.

Investigations: Ultrasound revealed that the endometrial lining was mildly thickened and heterogenous in ecopattern. The endometrial thickness is 13mm.

Endometrial polyp sized 11* 7.8mm.

Analysis and evaluation of symptoms

Mental generals	Physical generals	Particulars
Irritability++   Jealousy+++   Weeps when alone++   Contradiction aggravates++	Thirstless ++   Desire salty things   Hot patient	Intermenstrual bleeding while urination   Hypotension   Weakness with trembling of legs

Miasmatic Analysis ⁽⁵⁾

S.No.	Presenting symptoms	Psora	Syphilis	Sycosis	Tubercular	Predominant miasm
1	Irritability	√		√		Tuberculo-psoric
2	Jealous	√		√
3	Desiresalty				√
4	Weakness	√
5	Hypotension	√
6	Eyes – around blue rings	√			√
7	Menses- too frequent				√
8	Polyps- bleeding, uterine				√

Following symptoms were considered for Repertorisaton using Hompath⁽⁶⁾:

1. Mind – irritability
2. Mind – jealousy
3. Mind – weeping, tearful mood: alone, being agg
4. Mind – contradiction: ailments from; agg
5. Stomach – thirstlessness
6. Generalities – food & drinks: salt or salty food desires
7. Clinical – hypotension
8. Extremities – trembling; legs
9. Female genitalia – haemorrhage; uterine, metrorrhagia

Repertorial Result

Selection of remedy with justification

The repertorial result of the case showed that the highest ranked remedy which covers most of the symptoms of the patient was Natrum muriaticum. After considering materia medica, Natrum muriaticum was found to be a useful remedy for menstrual irregularities, depression. The general constitution and mental picture of the patient was also similar to Natrum muriaticum as described in materia medica⁽⁷⁾. This remedy was also covering the predominant miasm, i.e. tuberculo-psoric miasm.⁽⁵⁾

Thus, according to the totality of the symptoms and miasmatic predominance, SINGLE DOSE of Natrum muriaticum 200CH was prescribed according to the susceptibility of the patient.

Prescription

Natrum muriaticum 200CH, single dose

Followed by Placebo 30, thrice a day for one month.

Management

Along with the homoeopathic medicines, the patient was advised to exercise regularly for atleast 30 minutes. She was suggested few disease specific yoga exercises to be followed regularly like butterfly pose, cobra pose (bhujangasana), standing forward bend, hare pose, etc.

Diet should include variety of healthy foods like whole grains, green leafy vegetables, low fat dairy products, seasonal fruits. Drink atleast 3-4 litres of water in a day. Restrict excessive salt or sweets intake. A diet rich in transfat should be avoided.

Follow -UPs

Date	Symptoms	Prescription	Justification
8th Oct 2020	No intermenstrual spotting Patient feels better   Menstrual history LMP: 27th  September 2020 Duration : 7 days Flow: Profuse, dark red in colour with clots Leucorrhoea – white, thick, acrid, little offensive   Pustular eruptions appear over genitals- old symptom   She looks little better mentally too.	Placebo 30	Return of old symptom indicates good response. It indicates that the path of recovery is following the right direction according to the Hering’s law of cure.   Prognosis : good Next step should be “Wait & watch”
4th Nov 2020	No intermenstrual bleeding Patient is better in general   Menstrual history LMP: 29th October 2020 Duration : 6 days Flow : Normal   Multiple joint pains appeared but relieved without medicines Aggravation: Morning   Painful eruption appear over tip of left index finger with Cracked & chapped finger tips < winters   Eruptions over genitalia appeared on & off.	Placebo 30     Advise : Apply petroleum jelly over the cracked and chapped fingers	Patient is still improving in general. No intermenstrual bleeding occurs.   There was coming and going of symptoms. One should not interfere with the ongoing action of remedy   Next step should be “wait & watch”   Advised for another USG
10th Dec 2020	No intermenstrual bleeding occur   Painful eruption over tip of left index finger and cracked chapped hands better.   Pustular eruptions over genitalia were still there.   Acidity++ Eructations after eating Back pain (lumbo-sacral region) with stiffness	Natrum muriaticum 1M/ single dose Followed by Placebo 30	Patient was better. But ultrasound revealed increase of the size of polyp, i.e. 13.3 * 9.4mm. But good point was the endometrial thickness was normal this time and heterogenous ecopattern turns homogenous.   Pustular eruptions are still there. Therefore, higher potency of same remedy was used in spite of change of remedy.
7th Jan 2021	No intermenstrual bleeding occur Backache still same Acidity – same with pain in epigastrium Hyperpigmentation over cheeks     Menstrual history LMP – 25 December 2020 Duration: 5-6 days Flow: normal Leucorrhoea – white, thick and offensive Mentally, the patient was indifferent to her family members especially to her mother whom she loved the most.	Sepia officinalis 1M	Due to the marked and peculiar symptom of the patient, i.e. “indifference with loved ones”, Sepia officinalis was chosen as it is the remedy which complements and follows Natrum muriaticum well.(7)
5th Feb 2021	No intermenstrual bleeding occurred Acidity better Back pain slightly better stiffness in the morning   Menstrual history LMP – 21st Jan 2021 Duration: 6 days Flow: normal Leucorrhoea better   Pustular eruptions reappeared but in less intensity.	Placebo 30	Placebo was given as the patient was improving.
5th Mar 2021	Patient much better No intermenstrual bleeding occur   Menstrual history LMP 15th Feb 2021 Duration 7 days Flow normal   Acidity better Back pain with stiffness better. Pustular eruptions completely disappeared.	Placebo 30	Patient  much improved   Advised for another USG after next menstrual cycle.

Conclusion

In modern era, the menstrual problems are increasing more likely due to sedentary life styles, improper diet and mental stress which disturbs the hormonal levels. Homoeopathy have promising results in such gynaeco-surgical cases and saves the patients from getting under the surgical knife. Homoeopathy treats the patient as a whole, not just the disease. Individualisation plays the major role in the selection of most similar remedy. Patients may respond well to the constitutional remedy than to a specific or therapeutic remedy.

References

1) Monga A, Dobbs S. Gynaecology by ten teachers, 19th edition. CRC Press, Taylor & Francis group, LLC. p100

2) Edmonds D K. Dewhurst’s textbook of obstetrics & gynaecology, 7th edition. Blackwell Publishing: 2007; p637

3) Martin J L. WebMD (Online); 2020

Available from: https://www.webmd.com/cancer/cervical-cancer/uterine-polyps

4) Dutta D C. Textbook of Gynecology, 6^th edition, Jaypee Brothers Medical Publishers (P) Ltd, New Delhi; p235

5) Banerjea S K. Miasmatic Prescribing, its philosophy, diagnostic classifications, clinical tips, miasmatic repertory, miasmatic weightage of medicines and case illustrations, Second extended edition: 2006, B Jain Publishers (P) Ltd, New Delhi

6) Hompath Software

7) Boericke W; Pocket Manual of Homoeopathic Materia Medica & Repertory, Low Price edition: 2006, B Jain Publishers (P) Ltd, New Delhi

About the author:

Dr Shweta Singh, MD (HOM.)

Senior Homoeopathic Consultant, Orbit Clinics, New Delhi

Assistant Professor; Department of Organon of Medicine (JRK Homoeopathic Medical College & Hospital)

Medical Director, Muskan Foundation, New Delhi

Vice- President, Delhi Homoeopathic Medical Association

Chief Administrator, KHA Homoeopathy Study Group, USA