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.
INTRODUCTION
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
CASE STUDY
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 |
Conclusion
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.
References
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About Author:
Dr T. Aarathi Reddy
