Dysmenorrhea and Menorrhagia in a Woman of 19

This is the case of a young girl, Ms. P.K, aged 19 years, a college student, who was suffering from profuse menstrual bleeding with much pain. She also suffered from constipation, headache and coryza.

1^st visit on 28/11/2007

Present Complaints

1. Menses- early by 4-5 days; profuse; lasted 5-6 days; pain in mid lower abdomen, severe, before onset and on last day > pressing.
2. Milky white discharges per va-gina intermittently round the month.
3. Stool – hard stool, often in 2-3 days interval, very offensive, unsatisfactory.
4. Headache – sometimes left side and sometimes right side; with nausea

Headache > vomiting, or taking allopathic pills; < going under sun.

5. Coryza with sneezing from going under sun after bathing.
6. Must eat soon when hungry; if late then epigastric region pain > lying on abdomen, > after eating.
7. Dark discoloration on sides of tongue since childhood.

Generalities

1. Appetite poor since childhood.
2. Perspiration profuse on chest, back. Even in winter sweats if takes covering of blanket for some time.
3. Temperature reaction: though patient is hot, her feet become icy cold in winter.
4. Sleep: late to come after going to bed. Cannot lie on back; she starts groaning with suffocation (supposedly due to sleep paralysis).

Nothing else remarkable noted as physical symptom.

Mind:

1. Irritable, throws things sometimes out of rage. Would not speak to the person concerned as long as it is not absolutely necessary. Anger < consolation.
2. Intolerance of contradiction
3. Overly sympathetic; even watching sad scenes in movies or, on seeing others’ in distress gets easily tearful.
4. Oversensitive to anybody saying hurtful words to her, which gets tears.
5. Very fond of travelling. Whenever she gets a chance, she is ready to go.
6. Fond of music. Listens daily before going to bed at night.
7. Since 2-3 weeks before exams starts she is under constant anxiety, leads to vomiting after food sometimes. Anxiety remains even after exams though reduced.
8. Fear of darkness – she sleeps with her elder sister. If her sister fell asleep before her then she cannot sleep due to fear.
9. Fear of ghosts when alone.
10. Wants bed sheets very neat and clean. Nobody should touch her books as kept on her table.

Family History

Paternal side  – hydrocele with bulky epididymis. COPD, leukoderma, stroke, paralysis, asthma

Brother – dry skin rashes, scaly

Maternal grandmother – suffered from uterine bleeding for the last year of her life that led to her death. Diagnosis could not be found.

Remedy selected   Carcinosin 10M / 1 dose + 8 doses of placebo. – 28.11.2007

Report on 28/12/07

1. Aggravation of headache for two days with feverish feeling after medicines started. 2^nd agg on 23/12/07 > after vomiting around midnight.
2. Menses from 21/12/07 to 27/12/07 ( 7 days). Pain much less but profuse.
3. Stool more or less regular; softer. Sometimes 1 day absent but next day complete.
4. Dark mark on tongue much lighter.
5. Body weight. – 47kgs.
6. Rx Placebo given for one month.

Report on 19/02/08

No further significant improvement.  Rx Again placebo given.

Report on 01/04/08

Agg of headache, both temples with nausea and vomiting (occasionally) in every 2-4 days since 12/03/08. [ N.B. Her board exams started from 11/03/08 till 31/03/08]

Perspiration – profuseness decreased. Leucorrhoea reduced. Epigastric pain due to hunger better.

New symptom: appearance of skin eruptions, papular, itching on arm and neck.

Old symptom reappeared – granular eruptions on margins of eyelids with itching. Occurred 3 years ago.  Other improvements continue same as reported earlier.

Report on 10/07/08

1. Nausea much less in intensity during last two menses. But headache during last menses (30/06/08 to 07/07/08) more. Took analgesic tablets.
2. USG lower abdomen advised.

[ USG Report:- one Rt. Ovarian cyst (diameter 1.4 cm.) dated – 05/08/08]

Report on 10/08/08

1. Headache frequency increased.
2. Sleep late to come again. Breaks in between.
3. Irritability that was less earlier, increased again.

Rx Carcinosin 10M repeated.

Report on 25/08/08

1. Fever came on 20^th night between 9-10 p.m., lasted 4 days with body ache and headache, nausea. [applied ointment for headache.]
2. Nausea continues on attempt to eat.
3. Weakness with pain in chest, cough.

Report on 24/09/08:  menses from 22/08/08 to 01/09/08 (11 days) profuse followed by increased weakness. But, now weakness less.

Report on 21/10/08:  Reported better. Headaches occasionally from emotional causes like dispute with friend, hurt sentiments, stress of exams, etc. but frequency and intensity less. Menses from 16/10/08 to 21/10/08 (6 days). Another important thing reported: she can now sleep on back, no more groaning due to sleep paralysis.

Report on 29/12/08

1. Rashes appeared – reddish, dry with itching on forearm < after bath. Gone after some days.
2. Menses lasted 9 days but pain only before onset 1 day bearable.
3. Weakness much better.
4. Earlier sleep was late to come.
5. Appetite good.

On 21/01/2009 her look was quite fresh. Complaints were better than earlier. Body weight 48 kgs.

2^nd USG on 30.01.09 report was within normal limits.

Reported on 03/06/09 that previous symptom of coryza with sneezing from going under sun after bathing not felt since many months.

Underwent an emotional turmoil in between (28/06/10) due to loss of confidence in her love relations. Another emotional disturbance occurred due to misunderstanding with an old friend (02/10/10). Aggravation in headaches from crying, sleeplessness; loss of appetite; menstrual pains increased and inter menstrual bleeding. Patient improved gradually with counseling and Rubrum (second best remedy).

Last reported on 30/04/11 that she had been doing well in every way and was doing a job.

The important points in the case:

1. The case had some indications of Nat-mur (agg from sun; irritability; anger < consolation; over sensitiveness) but Carcinosin covered the case squarely.
2. The appearance of skin eruptions (report on 01/04/08) along with present complaints improving confirmed that the selected medicine was correct because it followed the Law of direction of cure.

Lessons that I learned from this case:

1. Repetition of the remedy (in high potency) was too soon. That is understood from the prolonged aggravation that followed thereafter for many months. That was my mistake. I should have waited. In my later years I have noticed that such temporary flare ups often happen which go away without repetition either through finding out and removal of the maintaining cause or, if no maintaining cause found, then by management, counseling and the second best remedy. Sometimes, if repetition is soon required due to some exciting cause then a lower potency of the remedy (if still having indications) viz. 30C or, LM1 does the work.
2. I also observed how emotional disturbances can aggravate the complaints of a case particularly the menstrual complaints.