A Case of Endometriosis

In June 2011, I saw a new patient, a 27 year old young woman, a petite, sweet girl with big brown eyes and heart shaped face. She spoke quietly during the whole consultation, as if she was embarrassed to be talking about herself.

On a routine gynaecological check up the patient found out she has endometriosis. Ultrasound confirmed the presence of a big chocolate cyst (5cm in diameter). The doctor did not give her enough information and she is quite scared now, especially that this condition may affect her fertility, as her aunt suffered from endometriosis and never had children.

Physically there are no symptoms that would indicate endometriosis. Her periods are regular, not painful, the flow is normal, they last 3-4 days and there is only occasional headache in PMS.

She was a bright, active and very healthy child. When she was 7, the civil war started and it affected her family, as her grandfather died as a prisoner of the war. The patient was quite close to him and remembers being very sad when grandfather passed away. When she was 13 her father left the family to go abroad for work. This event was also very sad for her, as she is close to her father. At eighteen, the patient moved to another city because of the better university education and chances for jobs. At the university, she had the first serious relationship. She remembers being very much in love with that boyfriend. Unfortunately she got pregnant and as neither of them felt it was the right time to start a family, she had an abortion. The relationship continued for a while but she felt quite guilty about the abortion and eventually broke up with the boyfriend. At the time, she dealt with the abortion bravely, however after several years she started feeling more guilty and shameful. At some point she was even ashamed to go to Church because of it.

When she was 25 all of a sudden she started having panic attacks. She could not go outside, suffered from agoraphobia, and stayed at home a lot. Going to the Church helped her and she slowly started to suffer less with panic attacks. She gets all quiet and looks down as she tells me that even nowadays she often feels embarrassed when in Church, as she is not worthy of God’s love; “I find it hard to stop feeling guilty about the abortion; it is a sin and I am now rightfully being punished with endometriosis for committing that sin.”

The patient feels very responsible about her family situation and the marriage of her parents; now her mother lives alone and her brother and father are working together; they all live in separate countries and see each other only several times a year. She says “I am doing everything I can to make my parents marriage better, I organize their travel, I encourage them to speak more, it breaks my heart to see them physically apart”.

All I managed to get in terms of general symptoms was that the patient is chilly, sleeps well, likes all food, and only dislikes milk and cream cheese. She loves the sun and the seaside +++ and dislikes cold and wet weather.

Analysis and prescription

This is an interesting case of an asymptomatic endometriosis. I did not have much time to repertorize, as I prescribed on the spot for the patient. While we were talking, I looked up several rubrics in Murphy’s repertory:

Mind delusion sin unpardonable has committed

Mind guilt feelings

Mind over-responsible

Mind religious affections, either depression sadness or melancholia

Mind shame ailments from

The remedies that came up most strongly were Anacardium, Aurum and Nat Mur. At that point I really was not sure which one fits the patient best, as all three remedies have religious affections, can have guilt feelings and self-reproaching and both Aurum and Nat Mur can be over responsible. Luckily I was taught by my mentor Mike Bridger that often when we see more than one remedy, it is not a “trick, it is rather a sign that very likely the patient will need all these remedies during the course of the treatment. What also helped me decide was remembering that Burnett often used Aurum Mur Natronatum (double salt of Aurum and Nat Mur) for asymptomatic uterine fibroids and tumours. In fact Burnett stated that Aur-m-n has more power over uterine tumours than any other remedy. I gave the patient Aur-m-n 30C, one dose daily for 21 days.

First follow up, after two months

The patient had two good months and she felt encouraged to continue homeopathic treatment, as the last ultrasound showed the cyst was smaller, with a 2.5cm diameter. Lately she feels worse emotionally, full of negative energy, slightly depressed and sensitive. Last week she cried when alone. She is not happy when alone, she would prefer company, reproaches herself for wanting to be with a man. “I enjoy being in the relationship, but what is the point when I always look for reasons to suffer in it?”

In the last month there were two situations when she felt panicky, but she managed to calm herself with prayers. She feels she is changing slowly, feels less responsible for her mother’s loneliness and is now investing more energy in her work and social life. There are still guilty feelings about abortion.

I saw this as a positive reaction to the remedy, so I decided to continue, this time with Aur-m-n 200, one dose a week for four weeks.

Second follow up, after two moths

The patient is really well emotionally this time; she feels she is less worried about her past, hardly ever thinks of abortion. She learned to not get involved with the family issues and feels that she should focus more on her life and feels much lighter about her previous responsibility for her parents’ relationship. Lately she has a throbbing headache before her period and intermittent whitish leucorrhoea. Her thirst has changed, so she is thirstier now and she noticed some night sweats which she did not have before. She feels good when alone now. She started a relationship with someone who lives in another country and is happy about it. Sleep is good and appetite and digestion are very good.

At this point I thought there are more indications for Nat Mur than Aur-m-n so I gave her Nat Mur 200, once a week for four weeks. The physical symptoms of headache, leucorrhoea and sweating point to Nat Mur and the fact that the patient feels better now about being alone, may indicate a stronger need to prescribe Nat Mur at this point in the treatment.

Third follow up, after two months

The patient is doing very well. She enjoyed organizing the wedding of her brother. The family functions really nicely now and she feels good that she could help, but she did not worry about mum and dad, the amount of time they spend together and other issues related to her parents relationship that used to worry her before. The last uterine ultrasound showed that the cyst is smaller, the diameter being 1cm. The relationship with the boyfriend is going well; there was reduction of headaches and leucorrhoea. Overall she had a good two months and nothing worries her at the moment.

There was no prescription at this appointment. I saw this lovely young lady a few more times in the last year and she continues to do well. I only prescribed Nat Mur 1M and at one point Tub 30C intercurrently.