ABSTRACT
Ovarian cyst , functional or inflammatory cyst develop almost during child bearing age they can be asymptomatic or they produce local discomfort , menstrual disturbances, infertility or in rare cases it may cause acute symptoms like haemorrhage, rupture or torsion. Ovarian cyst in childbearing age group can be managed with watchful waiting with repeat examination after 1-3mths after cyst is discovered. In conventional system of medicine, hormonal treatment with painkillers are given, as hormonal pills to prevent ovulation and decrease the risk of forming new cysts. Cysts larger than 40mm usually require surgery. In this paper, a case report of right ovarian cyst measuring 40x25x34mm with volume {17.7ml} which was treated using homoeopathic medicine Staphysagria with appearance of menses within 2 days, followed by regular menses thereafter and regression of the cyst reported in three months of treatment.
Keywords: ovarian cyst, Staphysagria.
Abbreviations: h/o – history of, USG – ultrasonography, ICD – International Classification of Diseases, LMP – last menstrual period
INTRODUCTION
During a woman’s menstrual cycle an egg grows in a sac called follicle that is present inside the ovary. A mature follicle ready for ovulation is around 25mm. Sometimes a follicle does not release egg during ovulation and instead continues to fill with fluid inside ovary called as follicular cyst. In other cases the follicle releases the egg but the sac seals up again and swells with fluid or blood instead of dissolving. This is called as corpus luteum cyst [1]. Both these condition are functional ovarian cyst and are common. A physiological cyst is considered around 25-30mm. There are potential risk factors for developing ovarian cysts namely h/o previous ovarian cyst, irregular menses, infertility, pcod, obesity etc. Ovarian cyst in childbearing age group can be managed with watchful waiting with repeat examination after 1-3months after cyst is discovered. Hormonal treatment with pain killer, hormonal pills to prevent ovulation and decrease the risk of forming new cysts. Cyst larger than 40mm usually require surgery.[2]
Ovarian cysts don’t show any symptoms until they become large up to a harmful size. Homoeopathy is a holistic system of therapeutics that gives importance to mind and emotions and its impact on the body. As Dr J H Allen has mentioned in his book, “Chronic Miasms: Psora and Pseudo-Psora Vol-1” that body is subservient to the mind. Individual variations in mental generals and constitution of patient to decide the most similar homoeopathic remedy has proved effective in curing ovarian cyst.[3]
CASE REPORT
A 30year old female patient came to clinic on 20.08.2021 with pain in right lower abdomen.
HISTORY OF PRESENTING ILLNESS
Patient was suffering from slight pain in right inguinal region 2 months back. Pain increased, day by day, incapacitating her daily activity with anxiety perspiration nausea and vomiting during the pain. She had the history of similar complaints after her first delivery in 2017 and had recovered with allopathic medicine. So for the present complaints, she consulted a gynaecologist, and was advised USG pelvis and after diagnosing the case She was prescribed hormonal drugs and pain killers and told if she did not respond to tablets she had to undergo therapeutic laparoscopic surgery. After one day of taking hormonal medicine, the pain increased and then she came for homoeopathic consultation.
PRESENTING COMPLAINT WITH DETAILS.
| COMPLAINTS WITH DURATION | LOCATION | SENSATION | MODALITIES | ASSOCIATED CONCOMITANTS |
| 1.Pain in the right side of lower abdomen extending to thighs since 2months 2.Amenorrhoea since 6 months with brown spotting 4months back for 1 day. | Right iliac region radiating suprapubic region and travelling down towards thigh and calf muscles. | Intermittent severe Pricking, dragging and pulling type of pain | <exertion, <standing longtime, <lifting heavy things. | Weakness and anxiety with perspiration Nausea and vomiting occ during pain |
HISTORY OF PAST ILLNESS
1. History of recurrent urinary tract infection since 1year – Took allopathic treatment
2. History of ovarian cyst in 2017- Took hormonal tablets with pain killers.
3. Bartholin’s cyst 3mths back: Incision and drainage done.
FAMILY HISTORY:
Nothing specific. All keeping good health.
PHYSICAL GENERALS
Appetite: Good (Occasionally gets acidity complaints with decreased appetite and nausea)
Thirst: Thirstless drinks only during meals. 4-5 glasses/day.
Urine: Burning while passing urine with frequency of day/night – 6/1
Bowels: Regular
Sleep : gets sleep but feels lazy and dull in the morning to do her household works.
Dreams : Nothing specific
Perspiration : Generalised, especially during pain in abdomen
Desires and Aversion: Nothing particular
Reaction to thermals: Chilly
MENTAL GENERALS:
Easily irritated and angry, but never says anything and weeps when alone, hence suppressing her emotions.
LIFE SPACE INVESTIGATIONS
She was born and bought up in a conservative family. Got married at early age. Her marital life was not good, her husband was very dominating type. He allowed her to go out under strict conditions with time, place and company. Even if she came out for anything, he used to call her asking about being late, etc. which was very disturbing for her. She used to get irritated and angry but she never said anything back.
Now, she has become used to it. She told that her husband used to treat her like a slave, and his family members also support him. She thought that it was quite natural after marriage, and wife should obey their husband, no matter what, but with heavy heart and tears.
MENSTRUAL HISTORY
Menarche: 14 years
Amenorrhoea since 6 months with slight brown discharge for one day 4mths back.
OBSTETRIC HISTORY
2 full term normal delivery G-2, P-2, L-2, A-0
No h/o contraception.
ABDOMEN EXAMINATION:
Tenderness felt in the right inguinal and suprapubic region radiating to thigh and leg.
DIAGNOSIS:
ICD-10 N83.201 unspecified ovarian cyst, right side.
-Generalised abdominal pain with significant tenderness often associated with rebound tenderness.
-Abdomen is distended moderately with decreased bowel sound.
-Occasional dizziness or syncope.
-Amenorrhoea of short duration followed by fairly prolonged uterine bleeding.
-Irregular menstrual cycles
-Dull/sharp ache in lower abdomen on side of the cyst [4] INVESTIGATIONS
-Pelvic ultrasonography
ANALYSIS OF SYMPTOMS (According to Dr Hahnemann)
| COMMON SYMPTOMS | UNCOMMON SYMPTOMS |
| Pain in the right side of abdomen Extending to thighs Amenorrhoea | Severe Pricking, dragging type of pain<exertion, longstanding, lifting heavy thingsBurning while passing urine ThirstlessnessEasily gets irritated and angered. Suppression of emotions |
EVALUATION OF SYMPTOMS :
| MENTAL GENERALS | PHYSICAL GENRALS | PARTICULARS |
| Easily gets irritated and angered Suppressed emotions | Burning while passing urine ThirstlessnessSleep gets sleep but feels dullness in morning | Pain in the right side of abdomen extending to thighs AmenorrhoeaSevere pricking, dragging type of pain<exertion, longstanding, lifting heavy things |
TOTALITY OF SYMPTOMS:
- Easily gets irritated and angry
- Suppressed emotions
- Burning, while passing urine
- Thirstlessness
- Sleep gets sleep but feels dullness in morning
- Pain in the right side of abdomen extending to thighs
- Amenorrhoea
- Severe, pricking, dragging type of pain
- <exertion, long-standing, lifting heavy things
REPERTORISATION:
- [MIND] Ailments from anger, vexation suppressed from:
- [MIND]Ailments from domination by others, a long history of:
- [MIND]Ailments from excitement emotional, mental symptoms from:
- [STOMACH]Thirstlessness
- [URINE]Burning, hot:
- [FEMALE GENITLIA]Menses absent, amenorrhea:
- [ABDOMEN]Pain dragging, bearing down:
- [ABDOMEN]Pain general indignation, after:
- [ABDOMEN]Pain general exertion, after:
- [ABDOMEN]Pain general standing, while agg:
- [GENERALITIES]Heat vital, lack of:
Remedy prescribed on 20/08/21
Staphysagria 0/3 for 15 days with 7 succussion and 7 drops twice a day empty stomach.
JUSTIFICATION
Staphysagria
Diseases of the genito-urinary tract and skin, most frequently give symptoms calling for this drug. As written by Dr J.T. Kent: “The mental symptoms are very important and the impressions made upon the mind, thence upon the body guide to Staphysagria as a remedy.” Staphysagria is generally prescribed acutely for the physical affects of suppressed anger. The patient feels the anger and resentment clearly but no expression. The force of it rebounds upon the body, producing physical symptoms. Staphysagria is a very sensitive type, in particular they are sensitive to parental aggression and disapproval. The commonest cause of this resentment is rejection by loved ones, usually a partner, especially when the rejection is done in an aggressive, hurtful way.[5]
FOLLOW-UP
| DATE OF VISIT | COMPLAINTS | PRESCRIPTION |
| 04/09/2021 | Had loose stools 3-4 times a day within 24 hrs after taking medicine for 3 days. -She got her periods on 24-08-2021. -Intensity of pain on abdomen reduced by 60% -Burning pain while urination reduced | Advised to stop medicine during menses. Continue same medicine from 7 day of menses one time morning empty stomach. |
| 1/10/2021 | Abdominal pain reduced 80% Only occasional pain LMP : 22|09|2021 Menses :Regular, normal flow 5-6days No burning while urinating Sleep improved She said, “I am feeling fresh now ” Advised to do USG abdomen on next visit | PL/15 days |
| 27/11/2021 | No pain in abdomen LMP-25/11/2021 Menses regular, generals better. | USG- Ovaries normal size no cyst found. |
| 31/12/2021 | LMP-24/12/2021 No complaints. | PL/15days. |
REPERTORIAL CHART:
CONCLUSION
In the above case, rapid gentle and permanent cure was experienced, in recurrent ovarian cyst with exhibition of Hering’s law of cure. As per aphorism 281 where the homoeopath takes into account the sensitivity or nature of the patient, the nature of the disease, and nature of the remedy in a fashion more elaborate than any allopathic physician is able to do. Individualisaton also pertains to dose and potency, based on the sensitivity of the patient. Remedy chosen according to the totality of the active symptoms including the generals of the case.[6] Staphysagria suits a state in which one has suffered humiliation, insults, or indignation. This patient remained in a state of silent grief and started to feel her grief and exhibit anger and sensitivity (easily offended). She talks everything being contained within a wall in her. Submissive, No bitterness. Does not stand up for herself. Anger not expressed or partially expressed. Couldn’t say no, yielding. Lack of thirst. In this case report of right ovarian cyst measuring 40x25x34mm volume{17.7ml}Staphysagria has resolved the present cyst that was reported within 3 months of treatment. Individualised homoeopathic medicine avoided surgery, as well as the relapse of the cysts. Till date, she had regular menses without pain and burning urination. She was experiencing complete freedom in executing her duties.
Non-recurrence of any complaints in past 4 months suggests that ovarian cyst can be treated successfully through individualised homoeopathic medicine, where allopathic hormone – related treatment or surgery is otherwise advised with chances of relapse.
REFERENCES:
- Ovarian cysts [Internet]. Healthline. 2015 [cited 2022 Jan 10]. Available from: https://www.healthline.com/health/ovarian-cysts
- Kumar S, Padubidri VG, Daftary SN, editors. Shaw’s textbook of gynecology-eBook. 17th ed. New Delhi, India: Elsevier; 2018.
- Allen JH. Chronic miasms with repertory: Revised edition. New Delhi, India: B Jain; 2021.
- Berek JS, editor. Berek and Novak’s Gynecology. 14th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2006.
- Kent J.T. Lectures on homoeopathic materia medica: Together with Kent’s “new remedies” incorporated & arranged in one alphabetical order. New Delhi, India: B Jain; 2021.
- Hahnemann S. Organon of medicine: Sixth edition. New Delhi, India: B Jain; 2021.
Name of the author
Dr Fauzia M Ansari .MD(Hom)
Professor and PG Guide
Dept of Organon of Medicine.
A M Shaikh Homoeopathic Medical College – Belagavi
Dr Fauzia has teaching experience of 20 yrs, Clinical experience of 21 years,PG Guide since 7 years. Member of BOS for PG in RGUHS Karnataka.
