Chief Complaints on 16/11/2015
27 year old female presented with complaints of primary infertility (married life: 2 years). She had PCOS and hormonal disorder, (FSH, LH and Prolactin levels were not proportionate) which led to failure of ovulation.The husband’s investigations were normal.
Menarche age 13 years; Menses were irregular and postponing right from beginning.She has taken hormone replacement therapy twice so far, but with little effect. Before menses she suffered from pain in hypogastric region lumbago and anorexia. During menses – profuse bleeding < exertion ++ on 2nd and 3rd day, nausea ++, pain in hypogastric region. Last menses date- 30/10/15.
(Below: Fig 1: Ultrasound Sonography of abdomen/ Fig 2: Hormone reports
Desire for: sweets ++, spices ++, ice cream +++, fat ++, chocolates ++.
She had an aversion to warm things +++, salt ++ and her thirst was moderate. She was a chilly patient but on the other hand could not tolerate the sun +++
She was sensitive and sympathetic +++, could not see suffering of others and felt as if the same suffering were happening to her.She had strong anxiety about others i.e. for people around her+++. She could not stay relaxed if anybody was sick at home, or whenever her husband didn’t reach home on time – she called him till she was convinced that he was fine and would return soon.
She had many fears: fear of hospital ++, blood +++, thunderstorm ++, heights ++
Palpitations during thunderstorm+++
Being of sensitive nature, she got offended very easily +++. She was a closed person, an introvert with aversion to consolation ++. She was of sweet and mild +++ disposition.Also, I found out that there was a strong grief +++. She was sad because she was not able to conceive. She was greatly affected by her husband’s and in laws’ behavior towards her.She did not express anger ++. She preferred keeping quiet rather than expressing anger and hurting others. She was sensitive to music, which could cause weeping ++. Thinking too much about the behavior of others caused headache++.
Some other symptoms
Vesicular eruptions on lips every 2-3 months, Aphthae on tongue, and lips off and on. Brittle nails ++
Prescription – Natrium Phosphoricum 200 for BD 3 days followed by 1M BD for 3 days.
Analysis of prescription:
Extracts of Natrium Phosphoricumfrom Radar Keynotes:
– Refined, Sensitive, Sympathetic
– Closes down easily when hurt,aversion to consolation,reserved
– Discontented (Calc-p). Clairvoyance.
– Nervous fears on waking. Imagines, on waking at night, that pieces of furniture are persons. Hears footsteps in next room.
– Fear something will happen,agg. night; bad news, dark, storm, disease, death.
Easily starting, agg. noise.
– agg. Thunderstorm.
– agg. Mental exertion.
– Desire: fried eggs, salt, spices, (fried) fish, beer, ice cream.
– agg. : Sugar, milk, fat.
– Headache agg. right side, during thunderstorm, mental exertion.
– Fullness from mental exertion.
DD of remedies –
Phosphorus was very close as patient has lot of anxieties and fears. But patient was very reserved and had aggravation from consolation.
Natrium Muriaticum – a grief remedy was another possibility, as patient was very sensitive, offended easily, had consolation aggravation. But anxieties predominated and other general characteristic symptoms were absent.
Ignatia – Another remedy close to Natrium Phosphoricum for which patient should have symptoms like sighing, fruit aversion, perspiration on face, which were absent.
Sepia has strong grief and consolation aggravation, but Sepia is not sensitive like this patient. On the other hand, the Sepia personality is known to express anger without consideration of feelings of others, sarcastic.
Pulsatilla can be prescribed for grief and also covers aversion to warm foods, but the Pulsatilla patient is weepy and wants consolation, which was missing in this patient.
Table 1 Follow Up
|1st Follow Up- After 4 months – March 2016||First observation is she appears to be happier, her grief has reduced. She is not hurt as intensely as she used to be previously.Energy has improved a lot, can work longer than before.Has eruptions on lips, swollen lips.- 7/12/2015, 13/01/2016, 07/3/2016
Dysmenorrhea, appetite and nausea during menses are better than before.
FSH, LH Prolactin are still abnormal.
|2nd Follow Up- After 7 months – June 2016||Whole period has been uneventful except irregular menses. Her Premenstrual Syndrome has improved but menses are still delayed.
Successive menstrual period dates – 20/04/2016, 01/06/2016.
She is much better emotionally, her anxieties have reduced, energy levels are better.
Hormone levels have improved.
|3rd Follow Up- After 10 months- September 2016||Successive menstrual period dates – 18/07/2016, 01/09/2016. Menses delayed again.
She appears sad as not able to conceive because of her menses issues. She feels bad for family and for herself.
There is withdrawl, with aversion to consolation 2+
Aversion to warm food3+
All fears and anxieties present. She is sad again.There was improvement initially, but she hasn’t conceived yet; her family members keep asking repeatedly, this adds on to her stress. This type of behavior of family members has started affecting her again and though hormone levels have improved, there are no satisfactory progressive changes in menses, which still get delayed affecting time of ovulation.
Considering that improvement has slowed down, and as she still has keynotes of Natrum Phosphoricum,
it’s repeated in potency since it previously helped her.
|Natrum Phos 1M, BD for 7 days.|
|4th Follow Up- After 14 months- January 2017||Successive menstrual period dates – 11/10/2016, 13/11/2016, 12/12/2016
As there was further improvement in hormone levels menses improved.Mild fever appeared in between, upto 100 degrees F (37.7 degree Celsius), which subsided without medicine. She developed eruptions on lips during fever, but with lesser intensity.
Follicular study was performed which showed signs of ovulation.
|5th Follow Up- September 2017||Successive menstrual period dates – 15/01/2017, 25/02/2017, 12/03/2017, 10/04/2017, 07/05/2017, 05/06/2017
As seen in the reports, there was improvement in hormone levels, in turn in menses and follicular study showed successful ovulation in the months of May and June.
She was better emotionally, appeared happy, said I don’t keep things in my mind now, speak out whenever required. Moreover, there was one more sad event a few days back as she lost her grandfather, whom she loved a lot. She felt very bad, was sad for some days, but recovered soon from it and new medicine or repetition was not required, which inturn proves that she has been helped deeply by Natrium Phosphoricum and is still under its effect. She was still not able to conceive in the months of May and June inspite of normal ovulation.
But after long treatment of about 22 months, she was finally able to conceive in September 2017.
The evidence in the form of changes in the reports of the patient shows that classical homeopathycan act at on deep endocrine disorders and in some cases of infertility.