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Clinical Cases

Understanding Role of Homeopathy In PCOS Through Clinical Case Studies

Drs. Bipin and Anju Jethani discuss PCOS and offer three cases to illustrate cure by homeopathy.

 

PCOS: A BRIEF OVERVIEW

Polycystic ovary syndrome (PCOS) is an umbrella term used for a hormonal disorder common among women of reproductive age, characterized by infrequent or prolonged menstrual periods or excess male hormone (androgen) levels.

According to Rotterdam criteria, clinical diagnosis of PCOS is made when at least two of these signs are present:

  • Irregular periods:Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS.
  • Excess androgen:Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
  • Polycystic ovaries: Ultrasonogical examination reveals enlarged ovaries which contain multiple follicles.

It is important to note that other etiologies such as Congenital adrenal hyperplasia, Androgen secreting tumors, Cushing syndrome and Hyperprolactinemia must be excluded for PCOS diagnosis as per above criteria.

PCOS seems to arise as a complex trait that results from the interaction of diverse genetic and environmental factors. Heritable factors include hyperandrogenemia, insulin resistance, and insulin secretory defects. Environmental factors include prenatal androgen exposure and poor fetal growth, whereas acquired obesity is a major postnatal factor.

The variety of pathways involved and lack of a common thread attests to the multifactorial nature and heterogeneity of the syndrome. A metabolic syndrome of obesity-related and/or intrinsic insulin resistance occurs in about half of PCOS patients, and the compensatory hyperinsulinism has tissue-selective effects, which include aggravation of hyperandrogenism.

PCOS as a Lifestyle disorder & Role of Insulin Resistance in PCOS:

PCOS is a well-known Lifestyle disorder since it is intricately related with Insulin Resistance syndrome. This correlation can be explained as follows: Failure of the cells to respond adequately to stimulus from insulin initiates a vicious cycle in which blood sugar levels rise and, in response, the pancreas accelerates insulin production.

The increased insulin levels ultimately result in an en masse entry of blood sugars into the cells, a corresponding rapid drop in blood sugar levels, and a hypoglycemic state. The cycle repeats; the pancreas eventually becomes overextended and no longer is able to produce sufficient amounts of insulin. Insulin resistance is marked by simultaneously elevated levels of blood sugars.

The liver responds to the elevated blood sugar levels by rapidly converting the excess sugars to fat. The excess fat results in increased hormone load as more estrogen is stored in fatty tissue and synthesized via the aromatase enzyme. Aromatase enzyme synthesizes estrogen via the androstenedione pathway, which ultimately results in excess testosterone.

Complications of PCOS include Type 2 diabetes or prediabetes, Sleep apnea, Infertility, Gestational diabetes or pregnancy-induced high blood pressure, Miscarriage or premature birth, Nonalcoholic steatohepatitis, Depression, anxiety and Endometrial cancers.

LIFESTYLE MANAGEMENT: Studies comparing diets for PCOS have found that low carbohydrate diets are effective for both weight loss and lowering insulin levels. A low Glycemic Index (low-GI) diet that gets most carbohydrates from fruits, vegetables, and whole grains helps regulate the menstrual cycle better than a regular weight loss diet.

It is strongly advised to take high fiber intake, and low glycemic index foods and avoid trans-fat. Regular exercises along with better stress management can help in reducing Insulin resistance and consequently the symptoms of PCOS.

HOMOEOPATHIC APPROACH IN PCOS:

 The rational application of Hahnemann’s § 3 of Organon of the Art of Healing enlarges the scope of homoeopathy in cases of PCOS. In prescribing for cases of PCOS, we need to take a thorough anamnesis of cases as often h/o emotional trauma serves as an important guiding light in selection of the simillimum.

Master Hahnemann underscored the importance of this concept of anamnesis or longitudinal case study in §5 of his ‘Organon of Medicine’ wherein he stated that:

‘Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause,……’

Hahnemann further highlighted the significance of evolutionary case study in his article ‘Medicine of Experience’ whereby he emphasized that:

‘The internal essential nature of every malady, of every individual case of disease, as far as it is necessary for us to know it, for the purpose of curing it, expresses itself by the symptoms, as they present themselves to the investigation of the true observer in their whole extent, connection and succession.

The following three cases presented herewith, are supplemented with documented proof of clinical efficacy of Homoeopathic system of medicine in PCOS so as to provide fundamental ground for evidence-based medicine.

 CASE 1:  LARGE LEFT OVARIAN CYST

A 30year old wheatish complexioned female with sharp features, presented with primary infertility. She had c/o scanty, regular menses since 7-8 years and was ultrasonologically diagnosed as large left ovarian cyst (34 ml. in volume).   After failure of initial prescriptions, the anamnesis of case revealed mannish nature of female as evidenced by her way of talking and attitude which was actually a subtle manifestation of her mother’s desire for a male child during the period of pregnancy.

Further, she had recurrent tendency to ascending nose colds.  Keeping in view her mannish nature which was also manifested in her pathology of PCOS, and referring C.M. Boger in his ‘Synoptic Key to Materia Medica where he has mentioned ‘Ascending Nose Colds’ as a characteristic feature of Sepia; Sepia 30, in infrequent doses was prescribed and the patient reported marked symptomatic improvement which was corroborated by subsequent ultrasound which showed normal follicles in left ovary. (Serial ultrasound reports appended)

PRE-TREATMENT                                           POST-TREATMENT

CASE 2: This pertains to a 24 year old female suffering from PCOS with her complaints being delayed menses since puberty. The delay in interval gradually increasing to such an extent that her menses had not appeared for the last 8 months. She was also suffering from frequent attacks of sore throat especially in damp weather.

She had tendency to weight gain and gastric upsets occasioned by taking fried or spicy foods. Her mild mannerism and self-confessed weeping disposition led me to think of Pulsatilla which I prescribed in 200 potency. However; the results were far from satisfactory and the complaints remained at a standstill.

A deeper understanding of the case revealed her inner state of nervousness and brought to the fore an important symptom — dysuria appearing around the time that the menses were due to appear. This subtle vicarious expression of the patient of non-appearing menses led me towards a drug which has a marked action on the genito-urinary sphere —- Senecio aureus.

The very important indication of this drug in the form of catarrhal affections consequent upon suppression of the natural discharge (in this case menses) and elective affinity for female genitalia and urinary system served as a beacon in this case. But it was Boger’s ‘A Synoptic Key of the Materia Medica’ which opened a new panorama of approach in this case.

The first and foremost indication that he mentions in his section on location is female genito-urinary organs. Besides this, the first of the modifications that he mentions is worse puberty i.e. complaints tracing their origin since puberty. Both these aspects fitted the case so very well that it merited further in-depth study.

The hallmark of this drug is expressed by Dr. N.M. Choudhary as: ‘Great variety of conditions traceable to non-appearing menses.’ The same had been conceptualized by Boger as “better menstruation.” Furthermore, Boger impressed upon the vital import of the doctrine of concomitance through the study of drug Senecio when he describes its pathogenesis as:

‘dysuria; with dysmenorrhoea.’

 Viewed in the light of the Boenninghausen’s concept of analogy it may perceived that the association of menstrual irregularity with the urinary symptom makes for a strong ground for prescription of Senecio aureus.  With all these concepts in mind, Senecio was prescribed in 30 potency and the result was establishment of regular menstrual flow with subsequent normal USG study.

CASE 3: MULTIPLE FIBROIDS WITH RIGHT HYDROSALPINX

A patient reported with c/o protracted menses with severe dysmenorrhea right side of lower abdomen since nearly 1 year. Flow was dark red with slight clots. She also had complaints of frequent premenstrual right sided headache.

Case anamnesis revealed that about 1 year ago, her colleague was humiliated by the boss which she could not tolerate. She complained to higher authority about this behavior but it was of no avail. She still fought on her friend’s behalf who herself was too timid and shy. However, in spite of her best efforts, she couldn’t do anything in this matter. Consequently, she left the job.

Keeping in view the case analysis, the following symptoms were considered for prescribing:

  • INJUSTICE CANNOT TOLERATE
  • BOLD
  • REBELLIOUS
  • SENSITIVE TO SUFFERING OF OTHERS

Her other symptoms were chilly patient, thirsty and desire for salty food.

The above totality led to prescription of the remedy Causticum 200, which resolved the fibroid and right sided hydrosalpinx as evidenced by the ultrasound reports.

PRE-TREATMENT                                                    POST-TREATMENT

To sum up, we would just like to emphasize that the fore-mentioned case studies are a humble effort on our part to clinically verify the homoeopathic avenues of prescribing in cases of PCOS.

REFERENCES:

  1. Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS (2015). “Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome”.
  2. Mortada R, Williams T (2015). “Metabolic Syndrome: Polycystic Ovary Syndrome”. FP Essentials.
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045492
  4. Hahnemann, Samuel. The Lesser Writings of Samuel Hahnemann, ‘The Medicine of Experience’ Compiled by R.E. Dudgeon. New Delhi: Indian Books & Periodical Publishers.
  5. Hahnemann, Samuel. Organon of Medicine, Translated from 5th edition with an appendix by R.E. Dudgeon; with Additions & Alterations as per Sixth edition translated by William Boericke, B. Jain Publishers Pvt. Ltd., New Delhi.
  6. Boenninghausen, C.M.F. von. ‘Brief Directions for Forming a Complete Image of a Disease for the Sake of Homoeopathic Treatment’. The Lesser Writings of C.M.F. von Boenninghausen, Compiled by T.L .Bradford, B. Jain Publishers (Pvt.) Ltd., New Delhi.
  7. M. Boger. Synoptic Key to Materia Medica, B. Jain Publishers (Pvt.) Ltd., New Delhi.
  8. M. Choudhuri. A Study of Materia Medica (Upgraded edition), B. Jain Publishers (Pvt.) Ltd., New Delhi.

About the author

Bipin Jethani

Dr. Bipin Jethani M.D. (Hom) Professor, Department of Organon of Medicine, Nehru Homoeopathic Medical College, Govt. of NCT of Delhi

About the author

Anju Jethani

Dr. Anju Jethani M.D. (HOM.) Chief Medical Officer (NFSG) Dte of AYUSH, Govt. of NCT of Delhi

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Dr. Anju Jethani M.D. (Hom.) is working as Senior Medical Officer (Homoeopathy) at Medical Center, High Court of Delhi, Dte. of ISM & Homoeopathy and as Senior Lecturer in the Dept. of Organon of Medicine at NHMC &H, Govt. of NCT of Delhi.

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