A Case of Painful Menses

 

A 44 year old woman came in January 2012 with complaints of polyp in her uterus as well as painful, clotted menses. Other than these complaints, she was experiencing severe migraines for the more than twenty years. She also felt heaviness in both legs. The patient had an ultrasound test done in December 2011 with a follow-up diagnosis of “bulk in uterus”. It was a middle of the cycle, so there was a possibility that it was not a polyp. Her hormones were in a normal range.

 

Her period started when she was 13 years old with normal duration of 5-6 days every 27-29 days. After her last child, 7 years ago, the period became much lighter. She was told by her gynecologist that the uterus didn’t contract back. Around ovulation time the patient felt heaviness in the abdomen; dull/sore pain in ovaries with more pain on the right side. The pain extended to her legs, under knees and in the lower back area (lumbar vertebrae). This pain lasted for about two weeks from ovulation to beginning of the period.

 

Her period is very painful with much mucous and clots. The clots usually look like pieces of liver. The blood is dark red with increased viscosity during last 5 months. The onset of her period starts quickly sometimes, other times slower. On the first day, the patient experienced feeling a great heaviness in her abdomen. Heaviness is worse from lying and better from walking, warm applications, and light pressure. Her period in December 2011 was earlier, very heavy and the blood was darker, vinous (not brown), and very viscous, “as plazma”.

 

OTHER SYMPTOMS.

Migraine.

The patient has headaches all the time. It started in 1991 after a flu when she was working hard on her PhD thesis and was very stressed. During the HA episode, the patient had great weakness, dizziness, and swelling of the face. The migraine is worse during spring and fall, before a thunderstorm and definitely worse after drinking alcohol. The headache is significantly better from massage, sweets, and hard pressure.

Gallbladder

Her gallbladder was removed in 2007. There were 18 stones, one cm each. After surgery, the patient felt burning pains in her R-scapula, the same type of pain after eating cheese.

Stomach symptoms

The patient felt heaviness (not a pain sensation) in her stomach. She has no flatulence. It is worse after fatty food, any bread, sour cherry (burning pain), and garlic.

Skin

The patient has some papillomas and pigmentations on the chest area. Skin is dry and itching all over the body with more intense itching on the legs and after shower.

Mental – Emotional Characteristics and Personality

The patient is a 44 year old stay-at-home mother. She lives with her husband and three kids (sixteen, eleven and seven years old). She has a PhD in sociology, but doesn’t work in Canada because of her kids. She is very responsible, friendly, nice and quiet. Most of the time she feels very tired because of the many family duties. She spends all her time taking care of her family. She dreams to have one free night just to sit on a sofa and to watch Tom & Jerry without catering to anyone else.

 

Food – She likes dry fruits, lean meat, sour milk, and cabbage. She doesn’t like fatty meat (not just because it is not good for her health), milk, coffee (tastes sour, but likes the smell), wine, pomegranate, and sausages. She has an aversion to a bacon.

 

Thirst. She is not thirsty.  When she drinks, she prefers warm drinks.

Appetite is normal. She doesn’t have unusual symptoms when hungry.

Open sun- She doesn’t like to spend a lot of time in the sun and is usually the shade.

Body t.  – Chilly.  Feet and hands are cold; she doesn’t use socks.

Fears/phobias –  The patient has a fear of losing somebody (relatives, family members) and that some family member will get seriously sick. She doesn’t have fear of death.

 

Sleep: The patient has difficulty falling asleep. Usually she couldn’t sleep until one hour after getting in bed because she couldn’t relax. As she said, she is “solving problems” in her sleep.  Her mind doesn’t rest as she’s continuing to think about her problems and how to solve them. She sleeps usually 5-6 hours each night, from 12-1AM to 6AM and wakes up unrefreshed and very tired. Noise and light disturb her sleep ability significantly. Se experiences low energy from 1:00 to 1:30 pm almost each day.

 

Dreams: she has a lot of very bright and emotional dreams about different situations, some without any sense. Very often in her dreams she sees continuation of what she was reading or seeing (situation of the day or on TV).

 

LIFE STYLE AND FAMILY HISTORY

The patient is does all major housework and drives the kids to after school activities.  These keep her occupied from early morning till late night. Her husband is very busy with his two jobs and is not able to help her with family duties. The relationship between spouses and other family members are good. She doesn’t have deep pathology running in her family. All grandparents have lived to be quite old. Her mother passed away at 66, because of cervical cancer.  Her father is alive at 76 and in relatively good health.

 

CASE ANASYSIS

For the patient, the most urgent problem for which she would like help are the polyps and period difficulties. The most characteristic polyp/menstrual symptoms and some characteristic personal symptoms were chosen, such as sleep and dream rubrics because it is what the patient has in her unconscious mind.

 

SYMPTOMS AND RUBRICS

Symptom: The patient had been diagnosed with a polyp in the uterus in January 2012

Rubric: FEMALE GENITALIA/SEX – POLYPUS – Uterus

 

Symptom: During menses blood is very thick, especially last cycle in December 2011

Rubric: FEMALE GENITALIA/SEX – MENSES – thick

 

Symptom: The menstrual blood is very dark in color, but not black, and not brown

Rubric: FEMALE GENITALIA/SEX – MENSES – dark

 

Symptom: The patient notices some mucous in her menstrual blood.

Rubric: FEMALE GENITALIA/SEX – MENSES – bloody mucous

 

Symptom: Very often menstrual blood contains liver-like clots

Rubric: FEMALE GENITALIA/SEX – MENSES – fluid blood contains clots

 

Symptom: The patient usually feels pain during menstrual cycle

Rubric: ABDOMEN – HEAVINESS – menses – during – agg.

 

Symptom:  She usually feels pain after ovulation and before the menstrual cycle

Rubric: ABDOMEN – HEAVINESS – menses – before – agg.

 

Symptom: Beside heaviness in abdomen during menses, the patient feels sore/dull pain.

Rubric: ABDOMEN – PAIN – menses – during – agg. – sore

 

Symptom: When the patient is finally trying to fall asleep after a busy day, she can’t stop thinking. She is not able to switch her mind off from the problems of the day. Usually she doesn’t sleep for one hour straight.

Rubric: SLEEP – SLEEPLESSNESS – thoughts – activity of thoughts; from

 

Symptom: During sleep the patient has dreams about her problems, as she said “I am solving my problems during sleep”.

Rubric: DREAMS – BUSINESS – day, of the

The ten top remedies according to repertorization were :

Puls, Bell, Sep, Nux-v, Plat, Cocc, Graph, Lyc, Sulph and Aloe

 

Pulsatilla was prescribed not just because this remedy has all the symptoms which have been repertorized, but also many general symptoms, such as aversion to alcoholic drinks, coffee, and fat. This remedy, like the patient, is worse from thunderstorms and better from motion.  Pulsatilla has characteristic symptoms of blood during the menstrual cycle: clots, mucous, high viscosity, very dark color of blood, as well, heaviness in abdomen before and after menses. Many remedies have some kind of pain, usually sharp and cutting; Pulsatilla has these pains as well, but it has the specific feeling of heaviness in abdomen, as the patient has – “as from a stone”. Sepia usually has cutting, sharp abdominal pain. Pulsatilla is also worried about her family, bit Sepia not really. Even her dreams are usually related to family matters (business of the day).

 

Pulsatilla doesn’t have time for herself, doesn’t get enough sleep and she has “great sleepiness during the day, wakes confused, languid, unfreshed (Vithoulkas).

Pulsatilla has very specific and characteristic wandering pains. Patient’s migraine is not the same each time. It could be anywhere in the head, with any kind of pain. Symptoms of Pulsatilla are noticeably better from fresh air, and the patient fells much better in fresh air.

 

The personality of the patient is close to Pulsatilla, who is “A soft, well-spoken individual with nice tender feeling. Optimistic…can never be aggressive or cruel – Vithoulkas. The patient was calm and friendly during the interview. She didn’t weep, as Pulsatilla usually weeps, but her health was not as bad. She supports herself with vitamins, and there was some hope that the polyp was misdiagnosed (but, menstrual characteristics suggest that she has some problems).

 

First follow up in March 2012

The patient took two dry doses of Pulsatilla 200c, one dose after ovulation and the second dose on the first day of the period. After the remedy, the viscosity of the blood was 80% less; the color of blood was much brighter (was dark red); the intensity of period (flow) was much less as well. She had no clots similar to liver color and density, but she had one big clot on the fifth or sixth day of her period. That one clot had lighter color, less density, and looked more like mucous. She had less mucous in the blood with less pain before and during the period. Usually the pain was in her abdomen and extending to the legs, but that time she didn’t feel it. The patient didn’t have pain (heaviness) in her abdomen after her period. On average, there was an improvement in period symptoms:

• Heaviness of flow: (≈ 30% less) from 7/10 to 5/10
• Pain: (≈ 60%) from 8/10 to 3/10

Head pain (migraine) and sleep problems remained almost the same. She is less sleepy during the day (≈ 20% better). Her energy is good, better than before Pulsatilla.

 

I suggested repeating 1 dry dose of Pulsatilla 200c, 2 pellets on the first day of her period.

 

Second follow up in April 2012

After repeating one dose of Pulsatilla, two new symptoms have developed: swelling and dull pain in breast from ovulation to beginning of menses. Swelling is similar to the feeling when breast milk is coming. There was stinging pain in both ovaries before menses, whereas previously she had dull pain in ovaries. The viscosity and color of the blood during period, as well as flow of the blood were completely normal. The patient had no clots similar to liver, only several small clots of normal color and consistency. Mucous in blood was much less, which only occurred during the first three days. The pain during her period is back again, almost the same as before Pulsatilla. Pain was described as dragging and extending to legs, back and thighs. Heaviness in her abdomen before period also returned.

Head pain, R-sided migraine, remains almost the same, but there were no visual problems with head pain. Sleep problems remained the same. Her energy was not great, but she didn’t sleep enough. Pulsatilla did a good job in relieving patient’s period symptoms. She had a heavy period with very dark viscous blood, a lot of unusually colored clots, and mucous. Now she has normal flow, regular blood color  viscosity; almost no clots mucous in the blood.

 

Currently, the patient has remaining/returning symptoms of pain and heaviness in abdomen and new symptoms of fullness and soreness of breast from ovulation to beginning of flow, and stitching pain in ovaries. Since the patient doesn’t have many of the previous Sx, a new set of symptoms were repertorized.

 

Pulsatilla still was very high but another remedy, Calc-carb had a good chance to help the patient with the breast soreness and heaviness. As well, Calc-carb hassome striking symptoms for the case, such as: craving for sweets during HA (the only remedy which has it), headache from change of weather, and is chilly. Constitutionally, the patient is very similar to Carb-carb: she is busy, hard-working, worries about health, and slightly obese.

 

Third follow-up in May 2012

The patient took one dry dose of Calcarea Carbonica 200c. No new Sx have been developed. The viscosity and color of blood and intensity of flow all are normal, and there were no clots and almost no mucous. There was no pain in abdomen during her period and no pain in ovaries before period. Heaviness in abdomen before period and heaviness in breast from ovulation to period improved slightly. Remedy Calc-carb 200c one dry dose was given.

 

Forth follow-up in July 2012

Period characteristics are normal. Heaviness in breast from ovulation to period is almost gone. There was no pain or heaviness in abdomen before period. Energy is much better, but can be attributed to her kids not being in school that time. Her ability to fall asleep improved and her mind is not so busy with planning and analyzing when she is ready to sleep. As Dr. Hahnemann wrote in Chronic Diseases, “Calcarea when potentized has a long-continued action.” No remedy that time was given.