Introduction
Menopause is defined as the cessation of menstruation due to decreasing ovarian function. This normally occurs around age 50 and may be accompanied by various symptoms that result from the decline in blood levels of estrogen and progesterone. Symptoms vary, but may include hot flashes, sleep disturbances, fatigue, irritability, headache, nervousness, depression, and decline in sex drive. (McConnell, p. 515). Given the potential side effects of hormone replacement therapy (HRT), many women seek alternatives for managing uncomfortable menopausal symptoms. Homeopathy has been used extensively for this purpose. This case report discusses an individualized treatment approach for menopausal symptoms that considers homeopathic principles and utilizes homeopathic medicines.
Case Presentation
Date of Initial Consultation: 11.11.19
Mary was fifty-five when she contacted me for homeopathic support during my second year of study at the Canadian College of Homeopathic Medicine. She was one of my first clinical externship patients supervised by Monica Frohmann, DSHomMed, RHom.
Mary presented with the main complaints of insomnia, heart palpitations, and hot flashes, all of which she felt were associated with menopause. She also noted constipation as a main complaint and expressed a desire for thyroid support (she had a previous diagnosis of hypothyroidism but was not taking any medications at the time or having any notable thyroid symptoms). Our dialogue and her symptoms shared during our first meeting and follow-up appointments have been summarized and edited here for length and clarity.
Initial Appointment
Mary: My main concern is that I’ve had sleep problems for quite a while in menopause. I feel a rushing feeling in my chest like rapid heartbeat, mostly at night sometimes during day. It got better after I got off thyroid medication. I was on thyroid medication for 15 years. Since then, it has gotten better but I still sometimes have the feeling in my chest. Certain things seem to set it off: smells, certain supplements or herbs, cleaning supplies, chemicals.
Age fifty was when this really started to happen. This coincided with changes in my cycle. Hot flashes play a part in my sleep difficulty; I would start to fall asleep and get a hot flash. Chest symptoms aren’t always there when I have trouble falling asleep. The two don’t always go together. It will come in chunks of time. It feels like it’s a cycle having to do with hormones somehow. It’s like a switch has been left on and can’t turn it off. When I’m having chest stuff, that’s when I can’t sleep all night.
I also have reflux recently. I can’t tolerate fats. I feel like I’m a bottle lying on its side with contents coming up into throat. I have to clear my throat a lot, like there’s mucous there, and I’ll cough now and then. It feels as if I have post nasal drip. I’m swallowing a lot.
I’ve had constipation since my mid-forties. No pain, no gas, it just seems like things don’t move the way they used to. I don’t even have the urge to go, like my intestines aren’t even doing anything, not moving. When I do go, things aren’t really hard. And I won’t go all at once. But if I don’t take anything for it, I’m unable to go at all.
I’m just really finicky. I have to be careful what I eat and get enough sleep. If I go half an hour past bedtime, it sets me off. And I can fall asleep sitting up watching TV and then go to bed and not be able to sleep. I did not grow up like this. I used to be a sleep walker as a kid.
I feel like a highly sensitive person; I’m sensitive to other people’s energy. I can’t wear any eyeliner or lipstick, because it causes redness and dermatitis, with little pimples and around my eyes too. There will be hives/red welts with white dot in the middle. They itch and are red. Hot water would make it worse…after a shower they’d really stand out.
It’s either too hot or too cold for me. I’m always adjusting the thermostat, taking things on and off. Menopause has made it worse. I used to be colder when younger. Now I’m back and forth between being too hot or too cold. I get hot feet, will sleep with my feet sticking out of covers.
I start and my feet are cold, then I go to sleep and wake up with hot feet and stick them out. Hot feet were always a thing, but I used to be more chilly. Now I’m sensitive to external temperature and not as cold because of hot flashes.
I used to struggle with anxiety and depression. Now, I’m worried I’m going to get Alzheimer’s. I’m always googling things I shouldn’t. So, I do worry about health. When heart stuff happened, freaked out about what I might have. It can get triggered when something comes up. I’m a germaphobe a bit too. I don’t like people to touch my hands or my face. If holding hands, I will ask if they washed their hands. I’m afraid I’ll get a pimple if someone touched my face.
I had horrible PMS mentally when I was younger. I would feel like I was in a dark hole of despair, thinking about suicide because that was a way out; would fantasize, but I wouldn’t do it. Mindfulness meditation really helped. I haven’t had a period for 3-4 years now, and I feel much more even, no ups and downs. I still feel like I have some ebbs and flows, but not as extreme.
I also had two UTIs since menopause. I had lots of bladder infections in my teens and early twenties, even if peeing after sex. I hadn’t had one in years (since my 30’s) until after antibiotics recently for mastitis.
I had trauma: my mother left family when I was six. I have abandonment issues. She just left, and I didn’t see her for a month or more. I lived with my dad. He was good parent but didn’t know what to do. He wasn’t affectionate. I was highly traumatized by that.
Mom was a charismatic affectionate person, so to have her leave was really awful. When I did see her, she had a new man. She wasn’t stable. She drank and wasn’t reliable. She wouldn’t show up for visits. I learned how to be a peacemaker. I’ve been to lot of therapy about it.
My dad, even though he was present and a teetotaler, he was also pretty volatile and had bad temper. This is another thing that made me a peace-keeper. I’ve always had a hard time with conflict, confronting people. I get affected by stuff like that; it can set off the whole thing where I can’t sleep.
I was married pretty young at 21, and after I got pregnant my ex-husband started seeing another woman. The labor was hard because he wasn’t there. He came home in middle, and labor stopped. My husband and I split up, he left that week. It was very traumatic, I was a mess.
I’m also dyslexic. Dad and brothers, son, and grandfather are dyslexic, too. I really struggled in school and had low self-esteem. I was a good artist, got through that way. I loved to read because I could escape. I would draw and paint and sculpt.
Always have had little cracks in my fingers in winter time. And I had chicken pox as an adult: 27 years old. I was one big scab inside and out. They were in my throat and vagina. I felt like all the nerves going to my internal organs were on fire. I was hallucinating and hearing stuff.
My fever was 103 most of time for four days. I took something for the fever. I was sick a month from that. It left scars that are now brown but look like liver spots…the scars tanned the next summer and stayed tanned.
I love sugar, have always liked sweet treats/baked goods. Caffeine and chocolate I have to stay away from. Coffee makes me berserk: anxious, flushed, really feel hyped up by it. Chocolate does the same. Fatty foods disagree with me. Growing up I could eat anything, though. I was too skinny for a while: I could eat whatever and never gain weight, until high school.
I didn’t like being alone at night as a child. I would be afraid. I’d wake up around 8pm and be alone at home because mom would be at the bar. It wasn’t until adulthood that I realized there was something wrong with parents doing that. I was scared of the dark, too. I’m still not comfortable sleeping in pitch black alone.
I get along with a lot of people, but I’m pretty fussy: I need my space, need things to be just so. I’m controlling, but also at same time, can have a go with flow personality. In my house I like things to be attractive and pretty and kind of clean. It’s not that tidy, but I do get annoyed by things being totally cluttered, sloppy, messy. Even if I’m not feeling well, I’ll do the dishes. Can’t go to bed with the dishes dirty. I will test the dishes my husband did, because he didn’t do dishes right. My bed needs to make bed every day. I’ll make it before getting in it at night if it wasn’t made. But I’m not this way in everything.
Past and Family History
Mary indicated the use of suppressive drugs and allopathic medications in her history, including SSRI’s, a bi-polar medication, antibiotics at various times, as well as OTC meds as a child, birth control, and HRT more recently. She also noted that she drank heavily as a teen and did recreational drugs.
She was fifteen at onset of menses and on the birth control pill starting at age 16. She was off and on this for years.
- Father: allergies/hay fever, sinus infections and pneumonia.
- Mother: many rheumatological problems (arthritis); thyroid dysfunction (hypothyroidism), eczema, alcoholism.
- Sibling: Depression
- Grandparents: Alzheimer’s heart disease, cancer, arthritis, hypothyroidism.
Initial Assessment
As noted above, Mary’s main complaints are insomnia and heart palpitations related to menopause. She also notes a desire for thyroid and constipation support, although current thyroid symptoms are not clear in her case. She is not currently experiencing any major mental/emotional struggles, although she has had episodes of depression and anxiety in the past as well as a history when very young of drug and alcohol abuse.
She noted a history of grief, shock, and trauma. Mary is highly sensitive to energetic and physical stimuli; this especially shines through in many areas of her life and may be an obstacle to cure. The center of gravity in Mary’s case is currently in the physical realm. Her family history and physical symptoms suggest a number of possible miasmatic influences (psoric, syphilitic, tubercular) to consider as we work together. Currently Mary is on no prescription medications; rather, she takes various supplements to help with her complaints.
Repertorization
As this was one of my first clinical cases and I did not have a plethora of experience in repertorizing cases. In reflection, I would repertorize Mary’s case differently; however, I suspect the same top remedies would emerge. At the time I endeavored to create a broad totality with her physical symptoms/main complaints, mental/emotional characteristics, etiology, generals, and characteristic symptoms that emerged, which led me to include too many rubrics. However, you will see that the chosen remedy did offer much in the way of amelioration of symptoms.
Mary’s history of shock and trauma were notable in their intensity and impact on her life and wellness overall, so I included a combined rubric: Mind, Abandoned, forsaken feelings; ailments from being (17) AND Mind, Shock, emotional, mental, ailments from (32) to get the resulting rubric, Ailments from emotional shock and abandonment (45).
Her generally sensitive nature (to foods, temperatures, smells, noise, other people’s energy, touch, supplements, medications, overwork) is important to include, as this impacts all areas of her life and is reflected in the rubric Generalities, sensitiveness, acute, excessive (29). I considered menopause in general (she cites this as an etiology for her current symptoms) with Female, menopause (50) and her sleeplessness from palpitation with a combined rubric: Sleep; insomnia, sleeplessness; menopause, period, during (17) AND Sleep, insomnia, sleeplessness, palpitations, from (34) to get Sleeplessness from palpitations during menopause (44), as this was a main complaint with great intensity, and these were the main symptoms to support. Her constipation (Stool, constipation; inactive bowels, from (54)) was also included for this reason.
I included Mary’s notable food aggravations, coffee and fats, which are consistent and intense and impact her complaints of reflux and sleep. And I included a few notable mind symptoms, which I now feel could have been considered in my differential rather than in the rep chart (dyslexia, fear of dark/disease).
I did find it notable (and contradictory in some ways) that she avoids conflict/is a peacekeeper/goes with the flow AND she is finicky, controlling, and likes things just so, especially in certain areas (dishes must be done, bed must be made, teeth must be flossed well).
So ,you will see the rubrics Mind, fastidious and Mind, yielding, passive below. I considered the hot feet in bed as peculiar and her tendency to bladder affections notable also reflected below. Sleep-walking I would leave out entirely if I were to re-repertorize, as this is not a current symptom, even as it’s notable in her past.
Analysis
Sulphur was at the top of this chart, as it is for most charts with as many rubrics, so I was initially skeptical about whether Sulphur was the best remedy for Mary. I also gave very careful consideration to Pulsatilla, knowing the two remedies are compatible. As a student, I was required to do a differential on 3-5 remedies, so I also looked thoroughly at Nux Vomica, Natrum Muriaticum, and Ignatia Amara.
After careful consideration of all of the symptoms in the repertorization as well as other symptoms, I chose Sulphur to begin her treatment. Sulphur clearly covers her symptom of hot feet in bed as well as her many other skin symptoms (not repertorized).
It also is well indicated in menopause and for hot flashes in general. Sulphur has sleeplessness at night, palpitations (in evening in bed), and worse periodically, which are indicative of her main complaints. It covers many of her other symptoms (desires sweets, constipation), but one thing that drew me to Sulphur to start her case (other than that it covered her symptoms well) is that it is, of course, a great remedy for suppressions, for which there have been many.
Pulsatilla was also at the top of my considerations; however, I was concerned about the thirst in this case, as it seemed that she was a relatively thirsty individual. Looking back, I can see that her thirst was not notable enough to constitute a contradiction, but that has only come with additional learning and understanding of homeopathic philosophy and materia medica.
I liked that Pulsatilla resonated with her delayed onset of menses as well as her mental/emotional picture and her sensitiveness, palpitations, intolerance of fats, and affinity for genito-urinary organs.
Other remedies had at least one notable contradiction that led me to stay with my initial selection of Sulphur for Mary’s first prescription.
Remedy
Mary was instructed to take one dry dose of Sulphur 200C (three pellets) one time and to follow-up briefly within a week with any notable changes. A full follow-up was scheduled for one month after she took the remedy.
Given that Mary is very sensitive to many supplements and foods, I might have been inclined to start her on 30C versus 200C; however, I was doubtful that 30C would have offer enough of a nudge to her vital force. I believed 200C was a good match for her energy/vitality and a good starting place to see some effect but not too high a potency as to cause any major aggravations. Looking back and knowing what I know now, I would have started her on a water dose to minimize the likelihood of aggravations.
Follow-Ups
First Follow-Up: 1.6.20; Remedy taken 12.2.19
When Mary and I followed up in January, the first thing Mary shared is that her itchy eyes showed immediate improvement. In our initial session she shared that she gets irritation from eye make-up, but she added during this follow-up:
“Usually topical stuff aggravates my eye. But my eyes will also sometimes itch due to my cats, and that improved immediately. The only time they get itchy now is if I pet the cat and rub my eyes right away. Before even just being around cats would make them itch.”
She also noted:
“I forgot to mention before. I was having a problem with styes in my eyes quite a bit. They would pop when wiped with a wet washcloth. I haven’t had those in quite a while since starting the remedy. I even used to get these after I stopped wearing eye shadow. I had them constantly when wearing eye makeup and once or twice per week when not wearing eye make-up. The styes were itchy, would come up and go away with warm water. I’ve had none of those for a month now since on the remedy.”
Mary also indicated that her sleep, hot flashes, and constipation were improved, although not gone altogether. Heart palpitations seemed worse for a time and then back to more typical (they seem to be cyclical for her). Some complaints like reflux and heightened sensitivity in general remained unchanged.
Remedy: Re-dose Sulphur 200C as before and check-in with any changes as needed prior to following-up in one month.
Second Follow-Up: 2.25.20; Remedy taken 1.8.20
Mary and I spoke at length during her follow-up, as it had been a while since her last one. When we met again, she said, “Overall, symptoms are not as bad as they were; in the past I have had a lot more times not being able to sleep during a month. Hot flashes have improved. Right after taking the remedy I think I had a big aggravation. I had problems sleeping and heart palpitations.”
“Mentally I think I’m better than before, stronger. I can be more outspoken, I’m starting to feel like I have better fortitude, and it’s not the end of the world if someone is disappointed in me.”
I also asked her about her general sensitivity as this was a main complaint last time: “Overall sensitivity does feel kind of better, because I’m even forgetting how I talked about that last time.”
Mary also noted that her skin symptoms on her eyes worsened (after improvement from first dose) and did not improve (but no styes have come back). She did also share that her hot feet in bed have been gone.
Remedy: Given that Mary is having an aggravation of symptoms every time she takes a dry dose of the remedy, but she’s experiencing improvements overall, I decided to change her to a once per week water dose of 200C Sulphur (3 pellets dissolved in 6-8 ounces of water, take one teaspoon of the mixture), succussing between doses. Check in after two weeks.
Third Follow-Up: 4.6.20; Remedy taken weekly (four doses since last follow-up)
Upon our next meeting, the Coronavirus pandemic had begun. Mary noted: “Considering the obvious weirdness of coronavirus, I’ve been doing OK. I had a little eczema spot come up on my chest after the first dose, but no aggravation this last time I took the water dose.
The eczema patch seems to be going away now. I haven’t really had any palpitations or hot flashes, which is a big change. I’ve had only one day of reflux and constipation has been fine. My eyes still itch sometimes when I pet the cats. Feel like I’m still pretty sensitive overall. Any sleep disturbances haven’t been from palpitations or hot flashes. Most of the month I’m able to fall asleep.”
When asked about her mental/emotional state, fears, etc. Mary added: “With COVID it’s bad when I have to go shopping. Going shopping really freaks me out. I’m not wanting to break the rules or make others uncomfortable. I’m very concerned about what others will think and worried about offending someone.”
Mary reported consistency in her sleep is her main complaint at this follow-up.
Remedy: I noted in my case analysis to my supervisor that Sulphur still seems to be offering positive results. She’s had improvements on 1x/week water dose, and the only new symptom is the rash on her chest, which may be a sign of direction of cure. I’m still curious about pulsatilla for her, though, especially as it seems a good fit for her mentally/emotionally.
For now, I’m inclined to have her continue water dosing 200C once per week, succussing between doses. If after this time she is not seeing any further improvements, I would consider changing her remedy. My supervisor guided me that without going up in potency or frequency we would not want to move to a new remedy at the next follow-up. It was decided to have her take the water dose of 200C Sulphur twice per week.
Fourth Follow-Up: 5.18.20; Remedy taken twice weekly.
At our fourth follow-up when asked how she feels in general compared to before the remedy Mary shared, “Still better…the skin thing is so much better: being able to use more products without it being a disaster. I’m lot less constipated overall. Sleeping is better definitely, only issues now and then. I’d still say that my most important thing is the sleep. The hot flashes are not problematic or heart palpitations. Things aren’t much different from our last follow-up.”
When I inquired about her worry about her health/being toxic from her past exposures to chemicals she noted, “I’m not thinking about it quite as much during day, but at night especially is when it bothers me. I was wondering if my liver feels sore? I fear a bad disease that will make me have to change my whole life…it’s a fear of suffering.
Dying is OK, but a long drawn out suffering death sounds awful. A quick bad heart attack, fine. A long awful cancer, where I’m suffering and in pain, I’m really afraid of that. This underlies my ruminating thoughts about contamination/poisoning.”
Remedy: Sulphur has been helpful for her overall, but she didn’t have any notable shifts in her symptoms on a more frequent dose. She has a few remaining things that she wants help with (specifically sleep disturbances, general sensitivity to foods, and fear about health/toxins in her body).
Given the changes that have occurred to date, my initial assessment was that her symptom picture had changed and that a new remedy may be indicated. But after consultation with my supervisor, it seemed that her symptoms simply plateaued. So, we moved her up to a 1M water dose of Sulphur, one time, and instructed her to check in after a week.
Fifth Follow-Up: 6.29.20; Remedy taken once, then once per week, then up to twice per week during this period.
When I met with Mary for our fifth follow-up she shared, “I’m willing to put myself out there a bit more…considering everything that’s going on, I’m doing pretty good. I kind of plateaued with sleep. The sleep is the last component.”
Mary did note that she developed a stye after her first dose of 1M Sulphur.
Remedy: After consultation with my supervisor, we decided to move Mary up to 10M Sulphur, up to twice per week in water due the stalling of her improvement and the general resonance of this remedy for her to date. If nothing shifted after the 10M dose, then we would consider abandoning the remedy.
Sixth Follow-Up: 8.10.20; Remedy taken once the first week, then twice per week thereafter.
Mary returned for a follow-up after her 10M prescription reporting that she had another stye develop, but this time it did not go away. She also had a headache after taking the remedy initially and more reflux. Her sleep improved slightly.
She noted more restlessness and anxiety around bedtime and is feeling somewhat better about her sensitivity overall. She said, “Compared to the last month or two, maybe a hair better with the sleep. Compared to before the remedy overall, when I was not sleeping for whole week, I’m good. Even with some of the things going on, I feel like making micro improvement this month.”
I re-repertorized at this time, as it seemed her symptom picture had changed significantly, but after consultation with my supervisor it was also clear she was still making some headway, albeit slowly, on this remedy. We decided to give her a daily water dose of the 10M Sulphur before moving on.
Seventh Follow-Up: 9.14.20; August 11th started 10M daily dosing.
Mary offered, “I think daily doses did a good thing for sleep. I’m noticing more reflux this month overall though.” She also noted a significant increase in body aches and shared more about her anxiety: “I’ll get a stitch in my chest with reflux and get all anxious. Three times this month, it’s no longer about my liver. Anxiety about health is not new, but the focus is different, on the heart now.”
We decided to pause the remedy for seven days and check in after that time to assess the symptoms and see if there was still an increase in reflux and body aches. After a week off of any remedies she reported no bouts of reflux (which were spotty and hard to predict, but certainly greater in frequency and intensity recently), but otherwise all of her symptoms were about the same.
Having already re-repertorized her case based on her current symptom picture, we moved her to one water dose of 200C Arsenicum, as indicated in the rep chart below. I did a differential with the other highly indicated remedies, and while I felt very drawn to Pulsatilla for many reasons, her thirst was pulling me away from that remedy.
I ruled out the others for various contradictions and was left with Arsenicum, which I liked for its restlessness, anxiety about health at night, fastidiousness, sensitiveness, thirst, better head elevated/sitting erect, better motion and walking about, and her aggravation from meat and fatty things.
Additional Follow-Ups: Mary and I checked in frequently and briefly while she was taking the Arsenicum. Dates: 10.16.20, 10.29.20, and 11.9.20. We then did a full follow-up on 12.10.20.
Mary started with one dose and checked in regularly before changing frequency of dosing. She had notable styes and reflux that seemed to be more consistent, no noticeable improvements, and no new symptoms.
Mary did note, what she felt, were some old emotional symptoms of inappropriate guilt and depression coming up which did resolve. In this interim period, we had her re-dose the arsenicum but diluted twice so as to minimize any aggravations, given her sensitive nature.
At our final check-in on 11.9 she felt her reflux continued to be worse than it was before with her mental/emotional state relatively the same as when she was on the Sulphur. It also felt very notable that the styes keep returning, which is a symptom that did not receive the consideration they deserved until they kept coming back over and over again. It seemed that Arsenicum simply offered us the next right thing to consider: the remedy I’d been considering all along but overlooking for its thirst. Pulsatilla.
I liked Pulsatilla not only because it covered her symptoms well, but Sulphur (which worked well for her) is the chronic of Pulsatilla (Clarke) and they are complementary remedies. While she is not thirstless, Hering offers that pulsatilla drinks often, but little at a time.
I discussed her thirst and thermals at length during this follow-up to ensure they were not contradictory. Pulsatilla covers the recurring styes, her mild, yielding disposition, the etiology of abandonment/feeling forsaken, and her modalities (better continued motion, better erect posture, worse fats/meats/rich food, worse rest, better open air). It also resonated with her delayed onset of menses in her youth, her general sensitiveness, and it has an affinity for genito-urinary organs, where she has a history of symptoms, even recently during menopause.
Remedy: Pulsatilla 200C, one dose in water, check in after two weeks.
Last two follow-ups on Pulsatilla: 12.29.20 (brief check-in) and 1.26.21
Mary progressed from one dose of pulsatilla initially to two times per week by our January follow-up. Her initial main complaints never returned (no hot flashes or heart palpitations). She reported being “a lot better with aches and pains, but they’re still there.
Reflux is not keeping me up at night. It’s been fine. I do feel like Pulsatilla has helped me get out of some rut. My depression has been a lot better. I feel like it is making me face some things psychologically and helping me feel more confident, doing what I need to do, say what I need to say, setting boundaries. Like it’s giving me a bit more confidence.” She did note a couple of soft styes that came and went. Also notable is that her tolerance of fats has improved.
Remedy: Mary was instructed to continue on Pulsatilla 200C twice per week unless she notices a stalling of improvement or backslide in her symptoms. We will follow-up again in a month.
Conclusion
Mary continues to see me as of the last noted follow-up, even as her symptoms are much improved from when we first met. Nevertheless, I chose to share this case, because it seemed a fascinating study in both the resolution of menopausal symptoms and in the evolution of symptoms in general: how symptoms evolve on remedies and guide us to new remedies for deeper healing.
It seems possible that Pulsatilla could have been prescribed at the outset with good results; however, Sulphur did have many positive effects on her main complaints right away. The remaining symptoms that waxed and waned and intensified with a change in remedy eventually solidified my suspicion that Pulsatilla was a good match for her totality.
I look forward to seeing how she continues to evolve on this remedy. I had so much to learn from this case over the course of our 14 months together, and I know I will continue to learn as Mary’s case evolves.
References
Clarke, John H. (1900). Dictionary of Practical Materia Medica (Vol. 1-3).The Homeopathic Publishing Company.
Hering, Constantine (1890). The Guiding Symptoms of our Materia Medica (Vol. IX). Press of Globe Printing House.
McConnell, Thomas H. (2014). The Nature of Disease: Pathology for the Health Professions, Second Edition. Wolters Kluwer Health | Lippincott Williams & Wilkins Publishers.
