Constitutional Approach to A Patient In Pcos- A Case Study

CONSTITUTIONAL APPROACH TO A PATIENT IN PCOS- A Case Study

Abstract

Polycystic ovarian syndrome or polycystic ovarian disease also known as PCOS or PCOD today is widely spread all over the world and affects the health of the women not only physically but also mentally. It affects women as a whole and produce multi organ changes in the body which result as a group of symptoms. Most of the women who suffers from PCOS are in reproductive age. Today with different presenting complaints of every individual woman has made this disease quite difficult for diagnosis, as a result doctor is unable to find out the cause which ultimately leads to increase in the intensity of the symptoms. The exact cause for PCOS is still not clear as it is multifactorial disease which has genetic as well as environmental cause. Here Homoeopathy has played a major role in treating diseases with multifactorial causes. As in homoeopathy every individual is differ from each other, here proper case taking plays a major role in for finding the exact root cause of the disease. Here a case report of PCOS is presented showing the importance of case taking and individualization in Homoeopathy.¹

Keywords: –

PCOS,Homoeopathy, Menstrual abnormality, Hirsutism, Amenorrhea, Homoeopathic medicine, Natrum mur.

Introduction: –

It was originally described in 1935 by Stein and Leventhal as a syndrome as the patient manifest with the symptom’s amenorrhea, hirsutism and obesity which is associated with enlarged polycystic ovaries.This disease is characterised by excessive androgen production by the ovaries mainly.⁶

Certain biochemical factors with clinicallyincreased level of androgen from ovaries along with other factors including adrenal play’s major role in producing this disease in almost 80% of the patients.

Other factors which are responsible for are-

1. Increased level of LH and Insulin
2. Decreased level of FSH
3. Increased level of androgens

The first measure for treating is reducing patients over weight. As increased weight leads to many major health issues and once the weight is reduced, the factors which are responsible for the diseasecomes in their normal ranges which improves the patient’s menstrual cycle as well as fertility.

In PCOS the diagnostic criteria varies from clinical symptoms, hormonal changesand physiological changes seen in ultrasonography of the ovaries.¹

Patients suffering from it most frequently have complain of:

1. Irregular menses associated with anovulation which is the cause of irregular menses (less than nine menstrual cycles per year; cycles of average duration exceeding 36–40 days). There is presence of secondary amenorrhea.
2. Presence of facial hair (hirsutism) and acne.^1,2,3

As per Rotterdam criteria, it is defined as the presence of any two of the three features:-

(1) Oligo/amenorrhoea: absence of menstruation for 45 days or more and/or ≤8 menses/year.

(2)  Clinical  hyperandrogenism: Modified  Ferriman  and Gallwey Score of 6 or higher.

(3) Polycystic ovaries: presence of >10  cysts,  2–8  mm  in diameter,  usually  combined  with increased ovarian  volume  of >10  cm3, and an echo-dense stroma in pelvic  ultrasound  scan. (Acne Global Severity Scale score 1 and above)

The first approach in treating a women is changing her lifestyle. This change should be done by eating healthy food instead of farinaceous food.  In addition to an improvement in the metabolic comorbidities associated with obesity, weight loss reduces hyperinsulinaemia and increases insulin sensitivity, leading also to a decrease in LH and androgen levels.Once the weight loss is attained in women, patient herself can notice in improvement in ovulation.^2,3

Case Report: –

Presenting complaint: –

A 23-year-old female came to the OPD on 23/2/22 at Chandola Homoeopathic Medical College and Hospital (Rudrapur) with the following complaints-

1. Pain in the abdomen since 2019

Location- whole abdomen

Character- pricking type

Modalities- aggravation: -before menses, during menses; amelioration: – after taking allopathic medicines

• Irregular menses since since 2019

Menses regular only after taking allopathic pills

Duration of cycle – irregular, delayed

Duration of menses- 3-4 days

Character of blood- brownish, clotted sometimes, non-offensive, scanty

Associated complaints- pain before menses start 4-5 days

Location- lower back

Character of pain- dull aching

Modalities: – aggravation- during and before menses; amelioration- rest

LMP- 15-2-22

• Hair fall since 2019

No dandruff, hair fall in bunches from root

Modalities- aggravation- oiling and combing

History of presenting complaints: –

Patients was well before feb 2019. Gradually patients develop pain in her whole abdomen which increases day by day. She also observed delayed in her menses and once her menses appeared quantity of the blood was less than before. This also happens in next months as patient’s menses delayed months by months and even sometimes it skips the date of the monthand appeared on the next mid of the month. According to the patient, she observes that the pain in her abdomen gets increased before the menses appeared, get worse during the menses. Patient also complain of hair fall with her menstrual irregularity.

The patient was a medical college student. At the time the patient came to me she was having irregular menses.

Treatment history: –

Patient has taken allopathic pills for her all the complaints. As she discontinues her allopathic treatments patient’s complaints reappeared again.

Physician observation: -Patient was mild in nature during her case taking. Facial hair on chin was seen. On asking she told than it startedwith her menstrual irregularity. 

Patients’ appearance– Patient is of fair complexion, with small height, less hair on her scalp and dark circles around her eyes.

Past history– typhoid in year 2021

Family history-

1. Mother- diabetic and hypertensive
2. Father- heart disease

Physical generals-

1. RHC- hot patient
2. Appetite- good (3 meals)
3. Thirst- thirsty (drinks around 3-4 litres)
4. Desire- salty +++, spicy, fast foods
5. Aversion- sweet
6. Intolerance – not present
7. Bowel- satisfactory and regular
8. Bladder- no abnormality present
9. Sleep- refreshing sleep (7-8 hrs)
10. Perspiration- profuse, non-offensive mostly on face
11. Addiction- not present

Mental generals: –

1. Anger. When things are not done accordingly it causes irritation to the patient. She expresses it by speaking loudly, shouting on others. Early patients control her anger but since 5-6 years she can’t control her anger.
2. On consolation patients anger get increased. She even gives wrongly answer to her patients also.
3. Doesn’t like company so much. Wants to be alone when does not feel well.
4. Weeping tendency present. Weeps on small things but not in front of anyone. Weeps alone in her room.
5. Do not share her secrets. Keep them inside her.
6. Very moody in nature
7. She felt guilty after arguing with her parents. Realises that she should not talked to her parents like this. Cries when alone.
8. She is not so extroverted as she does not have much friends.
9. Memory is weak. She cannot focused on her studies. According to the patient she felt she has changed now able to focus on her studies.

General examination: –

Weight- 45kg

Height- 4’11

Blood pressure- 110/70mmHg

Pulse- 84/min

Systemic examination:-

Nothing abnormalities present

Diagnosis:-

Polycystic Ovarian Syndrome

Totality of symptoms: –

1. Anger. Expressive
2. Consolation aggravation.
3. Company aversion
4. Wants to be alone
5. Weeping tendency. Weeps alone
6. Introverted, keeps her secrets to herself
7. Melancholy
8. Desire- salty++
9. Whole abdomen pain, aggravation- before and during menses.
10. Irregular and delayed menses
11. Hair fall

CASE ANALYSIS

Analysis and evaluation: –

Sno	Types of symptoms	Symptoms	Intensity	Miasmatic background
1	Mentals general	Anger. Expressive	++	Sycosis
2	Mentals general	Consolation aggravation	++	Psora
3	Mentals general	Company aversion	+	Psora
4	Mentals general	Wants to be alone	+	Psora
5	Mentals general	Weeping tendency. Weeps alone	++	Psora
6	Mentals general	Introverted, keeps her secrets to herself	++	Psora
7	Mentals general	Melancholy	+	Psora
8	Physical general	Desire- salt	++	Psora
9	Particulars	Whole abdomen pain, aggravation- before and during menses	++	Psora
10	Particulars	Irregular and delayed menses	++	Sycosis
11	Particulars	Hair fall	++	Psora

Miasmatic analysis shows Psoric and Sycosis predominance.

Prescription: –

Natrum Mur200, single dose was prescribed once in a month, followed by sac lac for two weeks.

Justification:– Natrum Mur was prescribed as it covers the mental picture of the patient. Physical general’s patient prefer salty things where we found Natrum mur also prefer salty things. In particulars in Natrum mur there is irregular and delayed menses with pain in abdomen. And Natrum mur acts on the roots of the scalp helps in reducing hair fall and increases hair growth.^5,8

Selection of Dose and Repetition: –

According to Dr J. T. Kent, when you get more peculiar and characteristic mentals followed by physical and particulars symptoms of the remedy appear in case, the higher is the susceptibility of the patient and the higher the potency of the selected medicineshould be prescribed.⁷

Single dose is prescribed based on Hahnemann’s rule that indicated remedy should only be repeated when improvement ceases.

Repertorization: –

Since, there is peculiar symptoms are present therefore non-repertorial approach has been taken.

First prescription: –

Date- 23/2/22

Natrum mur 200 single dose

Placebo 30/tds/for 15 days

Follow up-

Date	Complaints	Prescription
9/3/22	Pain in abdomen not present Menses yet not appeared Hairfall still present	Natrum mur 200 single dose Placebo 30/tds for 15 days
24/3/22	No pain in abdomen before and during menses this time LMP- 18/3/22 Discharge of blood was slightly increased than before. Low back ache was present during menses. Hair fall present	Natrum mur 200 single dose Followed by Placebo 30/tds for 1 month
23/4/22	No pain in abdomen. Hair fall present but slightly decreased. New complaint- itching on both checks Agg:- morning, afternoon Ame:- scratching (slight) LMP- 15/4/22	Natrum mur 200 single dose Placebo 30/tds for 1 month
23/5/22	LMP- 20/05/22 No pain before menses Hair fall reduced Itching on checks not present	Natrum mur 200 single dose Placebo 30/tds for 15 days
9/6/22	Hair fall reappeared according to the patient New complaint- darkening of skin colour since she left allopathic medicines. Hair growth on both upper and lower extremities increased	Natrum mur 200 single dose Placebo 30/tds for 2 months. As patient was going to her home.
30/7/22	Hair fall decreased Darkening of skin colour reduced Hair growth on both upper and lower extremities reduced. No pain in abdomen before menses LMP- 22/6/22 LMP- 20/7/22	Natrum mur 200 single dose Placebo 30/tds for 1 month
23/8/22	No pain abdomen Darkening on skin reduced Hair growth on both upper and lower extremities reduced. Hair fall much reduced LMP- 17/8/22 Advised for USG	Natrum mur 200 single dose Placebo 30/tds for 1 month
27/9/22	Hair fall not present No pain in abdomen Darkening of skin much reduced LMP- 21/9//22	Natrum mur 200 single dose Placebo 30/tds for 30 days
27/10/22	Hair fall not present LMP- 20/10/22	Natrum mur 200 single dose Placebo 30/tds for 2 months
5/1/23	Hair fall not present No pain in abdomen Normal menstrual blood flow LMP- 22/11/22 LMP- 23/12/22	Natrum mur 200 single dose Placebo 30/tds for 2months. Patient was gone to her home
27/2/23	LMP- 20/2/23 LMP- 21/1/23 Menstrual flow normal. No clots. Hair fall not present Patient advised for USG	Natrum mur 200single dose Placebo 30/tds for 15 days

Conclusion: –

Homoeopathy believes in constitution, as every person in this world has different constitution. In homoeopathy when medicine is prescribed according to the constitution, result is definitely present. Here above-mentionedcase which was diagnosed with Polycystic Ovarian Syndrome is cured with the homoeopathic medicine given constitutionally. Case taking plays a major role in homoeopathy so in above mention case, case taking was done according to our master Dr Hahnemann’s instruction given in organon of medicine from aphorism 83 to 104 and on the basis of totality of symptoms Natrum mur 200 is prescribed to the patient and the patient was totally cured.⁴

Conflicts of interest: –

None

Consent: –

Consent of the patient was taken for the publication of her case with her reports.

Bibiligraphy:-

1. https://books.google.com/books?id=bEv9DwAAQBAJ
2. https://www.homeopathy360.com/homeopathic-medicine-or-treatment-for-polycystic-ovarian-syndrome-pcos
3. https://www.homoeopathy-course.com/images/pdf/SubrataBook.pdf
4. Hahnemann CFS. Organon of Medicine. Boericke W, translator. 6th ed. New Delhi: B Jain Publishers (P) Ltd; 2012
5. Allen HC. Keynotes and Characteristics with Comparison of Some of the Leading Remedies of the Materia Medica with Bowel Nosodes. 15th impression. New Delhi: a Jain Publishers (P) Ltd; 2016
6. Dutta D C. Textbook of gynecology including contraception. Enlarged and revised reprint of sixth edition. Japee brother’s medical publisher(P)itd.New Delhi.Nov2013
7. Kent J T. Lectures on Homoeopathic Philosophywith Word Index. 6^th edition. New Delhi: B Jain Publishers (P) Ltd. 2005
8. Kent J T. Lectures on Homoeopathic Materia Medica. Introduction by- Dr. Jugal Kishore. Low priced edition: 2006. New Delhi: B. Jain Publisher (P) Ltd. 2007. Page no- 766-772.