A Case of Anxiety and Painful Menses

Patient: Abby, 31 years old

Chief Complaints:  Painful Menses, Migraines

The symptoms had come on 3.5 years earlier after the birth of her first son. Patient is tall and of slight build, fair skin and dark hair.

She desired support to come off the contraceptive pill. She had many menstrual issues to be treated with a history of endometriosis. She had very heavy periods lasting 10-11 days and containing large clots. She would feel nausea, abdominal pain and headaches 12 hours prior to menses. The first 1-2 days were extremely painful, consisting of sharp, stabbing pains in her abdomen extending to her knees and upwards to her back.

She would experience migraines of slow onset, moving from the occiput to forehead, sharp pain behind both eyes and she was photophobic at these times. Although short-lived, these migraines would leave her feeling “woozy and with a hang-over”.  Abby also had profuse cold perspiration which she had suffered from since puberty. Her perspiration was located in the axillae, chest and sternum and was not offensive. When asked about her temperature generally, she expressed always being cold; she had “cold bones” that she couldn’t warm up. When we began to talk about these physical symptoms, I got the first insight into her mental/emotional state.

She told me “everything is fast for me. I need to slow down.” She described how she had felt anxiety since childhood, which was at its peak when she was in her 20’s. She had previously suffered from panic attacks that were worse when  there were too many people around her or she was over stimulated by loud sounds. She described herself as fast-talking and high functioning with manic energy. She often used the words flight and escape.

Initial Prescription:  Iodum 200c, once daily for 3 days and consultation via phone after the 3 days.  Iodum was well indicated at this point of the case. The hurry, nervousness and restlessness are very marked, and of course there can be anxiety seen in Iodum. Of course, with Iodum, we can also see profuse sweat that is cold which fit Abby’s case. 

Rubrics used in the repertorisation included:

Mind, restlessness

Mind, Hurry

Mind, anxiety

Generalities, overactivity

Generalities, warm-blooded

Generalities, sensation of heat

Generalities, agg. Menses during

Perspiration, during slight exertion

Perspiration, profuse

Genitalia, female, pain, menses, dysmenorrhoea

After 2 weeks: Abby had come off the contraceptive pill and the first wonderful words from her mouth were “I had a nothing period. It was short and light with minimal pain.” She had experienced night sweats in the first 3 days after the remedy but now the sweats and her daily cold perspiration were much better.

She still felt like she was moving fast with lots to do. She had high expectations of herself and had to push herself all the time. She had suffered an acute cold after this remedy also, and with a few doses of Mercurius sol 30c, this had resolved.

There were clearly physical issues that needed resolving, and she was beginning to open up to the anxiety that she was feeling. She started to become more aware of the anxiety and the feelings that she had suppressed for some time. As she had told me previously about her ability to paint and write, I suggested that she begin to write about her anxiety; where she feels it, what it feel like, what made it worse etc.

Approximately a month after her initial consultation, I received an email from Abby, 10 days before her scheduled follow up. It was a detailed account of the anxiety that she had started to acknowledge and accept. She described the anxiety that covered all levels of being. She described the feeling of anxiety in her chest, throat and head. It was tight and suffocating and compelled her to hold her breath. She felt constricted and had a desire to escape.

Mentally she described a lack of focus, a detachment and a dullness. She was distracted by little things, and was procrastinating, all the while being obsessive and making sure all her boxes were ticked. She was preoccupied by time, and measured her day by what she had achieved; she was also anxious about being late and said that she was experiencing “OCD tendencies” (fastidiousness).

She described feeling claustrophobic, overwhelmed and over stimulated. She had a fear of being judged and not being good enough.

One week before I received Abby’s email, New Zealand was shaken by a 7.8 magnitude earthquake in Kaikoura, approximately 500kms away from us in Wellington. She had made no mention of her experiences of the earthquake, although I was handing out many prescriptions of Aconite to many others who were affected.

Second Prescription: Arsenicum 200c once daily for 5 days then reassess

Although there are several anxiety remedies that could fit this part of the case, Arsenicum was chosen. Aconite was a comparable remedy, but although Abby’s anxiety had increased since the earthquake, it was much deeper than Aconite might suggest. The restlessness and intensity of Arsenicum was present along with physical symptoms such as cold sweat. She felt her anxiety in the tightness of chest as indicated in Arsenicum, and had spoken of fastidiousness and anxiety on expectations of her as we can see in Arsenicum.

After 10 days on Arsenicum:

“I felt relaxed and euphoric; like a different person. I felt separated from my body and this allowed me to locate my anxiety. I walked everywhere! I walked slowly and with purpose, breathing deeply. I felt relaxed and calm. I could breathe out any anxiety that came up and I was less driven by momentum.”

When asked of the effect the earthquake had on her, she said she had a “massive breakdown”. She hadn’t slept well since, and felt “on-edge” as did many of the New Zealanders affected.

Prescription: Repeat Arsenicum 200c one dose, then repeat if required.

At the next follow-up only 10 days later, there was no hurried, frantic nervousness. As the case progressed over 14 months, Abby’s anxiety has shifted and the emotional feelings we now work on are of a completely different nature. There is no hurry, no manic energy, no chaos.

Without this fast-pace, and with the aid of several well indicated remedies such as Natrum Mur for anxiety arising prior to an extended time with family, and Zirconium after having trouble with her creativity and art, Abby is finding her emotional resilience has improved immensely.

Abby now has no menstrual issues to report at our consultations.