Long way from conception to completion-a case repo right of endometriosis - Dr T. Aarathi Reddy

Long way from conception to completion-a case repo right of endometriosis By Dr T. Aarathi Reddy

Abstract: A female came with the complaint of pain in right lower limb during her periods. Pain is severe in nature due to which there is no sleep. Heavy bleeding associated with severe pain in abdomen, backache, and she was diagnosed with endometriosis. Patient was eager to conceive. After analyzing the totality of symptoms and by considering the mental symptoms, Sepia Officinalis 200C was prescribed, which proved to be effective in treating the endometriosis and most fortunately she conceived.

Key words: endometriosis, right lower limb pain, totality of symptoms, Sepia officinalis.

Abbreviations: AUS- abdominal ultrasound, MRI- magnetic resonance of imaging, CA 125 cancer antigen, Rt-right, LL-lower limb, HPT – home pregnancy test, LMP – last menstrual period.


Presence of functioning endometrium in sites other than uterine mucosa is called endometriosis. Ectopic endometrial tissues are found at sites other than uterus and are called endometriosis external. Endometriosis is an aggressive, progressive and invasive disease. Prevalence is about 10-15%.

Sites of endometriosis: abdominal, extra abdominal, remote.

Risk factors:

1. Low parity

2. Delayed child bearing

3. Family history of endometriosis

4. Genital tract obstruction

5. Environmental toxins

6. Peritoneal fluid abnormalities.1

Many theories have been proposed to explain the occurrence of endometriosis but genetic predisposition is now evolving and focus has been given on alterations or genetic mutations that may start in-utero or in adolescents and young adults.2 Immune system is postulated by many to have a role in determining who can develop endometriosis, as well as the extent and clinical manifestation of the disease. 3

Adolescents with the disease are more likely to experience a variety of symptoms which can be safely improved or alleviated by appropriate menstrual management or suppression.4However; sometimes cycle pains respond poorly to anti prostaglandins and contraceptive pills and this may be attributed to internal scarring, adhesions, pelvic cysts, chocolate ovarian cysts, bowel obstruction and peritonitis.5

The diagnosis of adolescents’ endometriosis is sometimes enigmatic; however, history and clinical examination usually lead the physician to suspect it.6 The use of AUS and MRI remain an important addition to the non-invasive diagnosis and should be performed before treatment, especially surgical one.7 On the other hand some biological markers may be used for prediction and treatment follow up in endometriosis, commonly CA125.8 It goes without saying that laparoscopy with biopsy of the suspicious lesions remains the gold standard for diagnosis as well as management intervention in severe cases. 9

Adolescent endometriosis is an underestimated health problem particularly in developing countries. Many reasons contribute to this undeniable difficulty in diagnosis. Of these; difficult visiting of gynecologists by young girls, the infeasibility of local examinations, trans-vaginal ultrasound and diagnostic surgical procedures. This study aimed to investigate the prevalence of adolescence endometriosis among school girls with severe dysmenorrhea.6

Clinical Features:

1. Dysmenorrhea

2. Abnormal uterine bleeding

3. Infertility

4. Dyspareunia

5. Chronic pelvic pain

6. Abdominal pain


A 25years old, hindu lady reported on 12.10.20 with a complaint of pain in right lower limb during menses since menarche was eager to conceive. History of married life with a duration of 3years.

History of presenting complaints and treatment history

Patient has a history of pain in right lower limb during menses since menarche. She took analgesics for her temporary relief, while the symptoms started reappearing. In view of eager to conceive, the patient approached a gynecologist which accidentally revealed Endometriosis.

Past history: Known case of hypothyroidism since 2years on treatment

Family history All members in the family are healthy and alive with no significant medical history.

Obstetrical and gynecological history: Gravida – 1.   

Menstrual history

28 days cycle with 3-4days duration, normal flow. Married life of 3 years duration.

Physical generals: There was pain in right lower limb during menses, severe in nature associated with pain in right thigh extending from hip to thigh only during menses. Aggravation by slight exertion. Ameliorated by pressure and drawing of limbs. Decreased sleep, pain during intercourse. Dryness of vagina. Decreased sexual desire, hot flushes, desire for eating all the time. She had craving for spicy food.

Mental generals: Patient is sad, difficulty in concentration. She is a teacher by profession, where she is unable to remember and concentrate due to the fear that she will never have child for the reason of her endometriosis. She used to spend 10000 rupees for a weekdays medicine which was increasing her anxiety, stress regarding the financial crisis. She became very irritable since she had been diagnosed with endometriosis. She weeps without any cause. She dislikes consolation. Quarrelling tendency, feels better by crying. Palpitation for thunderstorm, sudden noises.

Provisional diagnosis: endometriosis with primary infertility1

Analysis and evaluation of symptoms 12:

S.No Category Symptoms Common/uncommon Intensity
1 mental generals weeping-causeless Uncommon ++
2 mental generals weeping- ameliorating condition Common ++
3 mental generals concentration difficulty Uncommon ++
4 mental generals fear thunderstorm Uncommon ++
5 mental generals sensitive to slight noise Uncommon ++
6 physical generals heat flushes of Common +
7 physical generals desires spicy food Uncommon ++
8 physical generals sleep restless Common +
9 physical particulars pain in right thigh during menses <slight exertion>pressure, drawing limbs Uncommon +++

Totality of symptoms:

1. Weeps without any reason

2. feels better by crying

3. Difficulty in thinking and concentration

4. Fear of thunderstorm

5. Sensitive to slight noise

6. Hot flushes all over the body.

7. Desire for spicy food

8. Pain in Right thigh during menses

9. Pain during intercourse

10. Decreased sexual desire

11. Aggravation by slight exertion, amelioration by pressure and drawing of limbs.

12. Decreased sleep. 

                                                                        Figure 1     Reperightorisation 10            

Justification of remedy:

Profound melancholy, weeping without cause, difficulty in concentration, fear of thunderstorm, sensitive to noise13,depressed mood, pain in right ll, drawing type of pain < slight exertion, weak memory, uterine disorders with menstrual irregularities, aversion to sex, heat flushes. Sepia Officinalis is having more efficacy in treating the infertility with endometriosis. The remedy was chosen according to the principles and practices of homoeopathy and given on the basis of constitutional totality after detailed case taking, recording, interpretation, and evaluation of symptoms, and Repertorisaton, whenever required. Hence, Sepia Officinalis was chosen as the prescribing remedy.                                                                  

First prescription: Sepia Officinalis 200+ was prescribed, three doses were advised, for 3 consecutive mornings, and placebo 15 days.

                                                Table 1: Follow up with prescription

Date Symptoms Prescription
(1st visit ) 12/10/20 Pain in right lower limb during menses since menarche. She took analgesics for her temporary relief, while the symptoms started reappearing. In view of eager to conceive, the patient approached a gynaecologist which accidentally revealed endometriosis in ultrasonography of abdomen and pelvis. Hence, she was under the treatment for endometriosis, but there was no improvement with allopathic treatment, hence approached with the complaints of eager to conceive. Detailed history was obtained.   1.Sepia officinalis 200 potency of water dose for 3 consecutive days 2.Placebo once a day before going to bed for 15days duration
05/11/20 Eager to conceive History of pain in right thigh during menses – much better for the last menstrual cycle. Intensity of pain – much better when compared to previous analgesics. History of sleep improved. LMP:1/11/20 1.Placebo 4pills daily once to night
17.12.20 Had not yet attained menses, advised HPT ,which revealed HPT=+ve, ultrasonography (abdomen and pelvis) showed single intrauterine gestational sac at weeks and 3 days Placebo 4pills 1 month


Thus, it is the responsibility of the homoeopathic fraternity to make people aware about the scope of homoeopathy for infertility. The dynamic homoeopathic remedies are not only effective but can do wonders in treating infertility with the most efficient and gentle form.


1.D C Dutta’s Textbook of Gynaecology,8th edition, New Delhi:B.Jain Publishers(P)Ltd;2020

2. Gargett CE, Schwab KE, Brosens JJ, et al. Potential role of endometrial stem/progenitor cells in the pathogenesis of early-onset endometriosis. Mol Hum Reprod. 2014 Jul;20(7):591–8.[ Cited 2021 April 3rd] Available from https://pubmed.ncbi.nlm.nih.gov/24674992

3. Doyle JO, Missmer SA, Laufer MR. The effect of combined surgical-medical intervention on the progression of endometriosis in an adolescent and young adult population. J Pediatr Adolesc Gynecol. 2009;22:257.[Cited 2021 April 25] Available from https://pubmed.ncbi.nlm.nih.gov/19646673

4. Altshuler AL, Hillard PJ. Menstrual suppression for adolescents. Top of Form Curr Opin Obstet Gynecol. 2014 Oct;26(5):323–31. doi: 10.1097/GCO.0000000000000098. [Cited 2021 April 26]Available from https://journals.lww.com/co-obgyn/Abstract/2014/10000

5. Kapok Dharmesh, Davila Willy, Laufer MR, et al. Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy. J Pediatr Adolescent Gynecology. 1997;10:199–202. [Cited 2021 April 26] Available from https://pubmed.ncbi.nlm.nih.gov/9391902

6. Osayande Amimi s, suarna mehulic Diagnosis and Initial Management of Dysmenorrhea. Am Fam Physician. 2014 Mar 1;89(5):341–346. [Cied 2021 April 28]Available from https://pubmed.ncbi.nlm.nih.gov/24695505

7. Bekiesińska-Figatowska M. Magnetic resonance imaging as a non-invasive detection tool for extraovarian endometriosis–own experience. Ginekol Pol. 2014 Sep;85(9):658–64.[Cited 2021 May 1st.Available from  https://pubmed.ncbi.nlm.nih.gov/25322536

8. Pittaway Donald E. The use of serial CA125 concentrations to monitor endometriosis in inferightile women. American Journal of Obstetrics and Gynecology. 1990 Sep;163(3):1032–103. [Cited 2021 May 5th Available from http://dx.doi.org/10.1016/0002-9378(90)91119-W.

9. American College of Obstetricians and Gynecologists. Management of endometriosis. ACOG Practice Bulletin No. 114. Obstetrics and Gynecology. 2010; 116(1):225–236.[Cited 2021 Ma5th.Available from https://www.ncbi.nlm.nih.gov/pmc/arighticles/PMC4461025

10. RADAR (computer program).Version 10.Belgium: Archibel Software: 2010.

11. Clarke JH.A Dictionary of Practical Materia Medica.New Delhi;B.Jain Publishers Pvt.Ltd.;2014

12. Kent JT, Lectures on Homoeopathic Materia Medica,New Delhi:B.Jain Publishers(P)Ltd;2013

13. Allen HC.Keynotes and characteristics with comparisons of some of the leading remedies    

 of Materia Medica with Bowel Nosodes. B.Jain Publishers:2002

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Dr T. Aarathi Reddy

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