{"paper_id":"57e4d3aa-f778-4dc1-9592-3b0d4906a892","body_text":"~ 406 ~ \nInternational Journal of Homoeopathic Sciences 2021; 5(1): 406-414\n \nE-ISSN: 2616-4493 \nP-ISSN: 2616-4485 \nwww.homoeopathicjournal.com \nIJHS 2021; 5(1): 406-414 \nReceived: 03-11-2020 \nAccepted: 19-12-2020 \n \nDr. Dhanaraj Kumar Rana \nResearch Officer/S-1, Assistant \nProfessor, Department of \nPsychiatry, National \nHomoeopathy Research \nInstitute in Mental Health, \nKottayam, Kerala, India \n \nDr. Jaseela Villan \nPost Graduate Trainee, \nDepartment of Psychiatry, \nNHRIMH, Kottayam, Kerala, \nIndia \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Jaseela Villan \nPost Graduate Trainee, \nDepartment of Psychiatry, \nNHRIMH, Kottayam, Kerala, \nIndia\n \n \nA case of endometriotic cyst treated with \nhomoeopathic medicines \n \nDr. Dhanaraj Kumar Rana and Dr. Jaseela Villan \n \nDOI: https://doi.org/10.33545/26164485.2021.v5.i1g.344  \n \nAbstract \nEndometrial ovarian cysts are one of the most common gynecological disorders found \namong reproductive-age women. They account for the commonest surgical interventions, undertaken \nnot only by gynecologists but also by pelvic surgeons in these age groups. In this context, endometrial \novarian cysts should be considered as an area of the interdisciplinary approach. Here we present a case \nof 22 years old female having irregular periods, dysmenorrhea with heavy menstrual bleeding for the \nlast 9 months, she had consulted with Gynecologist and was diagnosed with a left ovarian \nEndometriotic Cyst. She was treated with conventional medical therapies for the last 1year but had no \nsuccessful result. After she came under homoeopathic treatment (Pulsatilla followed by Medorrhinum) \nand showed normal USG findings within one year. This case demonstrates the positive role of \nconstitutional anti-miasmatic homoeopathic treatment in Endometriotic cysts.\n \n \nKeywords: Endometriotic cyst, homoeopathy, constitutional medicine, Pulsatilla, Medorrhinum \n \nIntroduction \nEndometriosis is one of the common benign gynecologic disorders characterized by the \npresence of uterine endometrial tissue, such as endometrial glandular epithelium and stroma, \noutside the normal location. The endometriotic cyst is an ovarian endometriosis that contains \nchocolate-like fluid due to the accumulation of menstruation-like hemorrhagic blood in the \ncyst during the woman's reproductive period. It is well-known fact that ovarian cancer arises \nin endometriotic cysts. However, the mechanism of malignant change potential of the \nendometriosis in the endometriotic cyst is not yet elucidated [1]. Endometriosis is a chronic \nbenign estrogen-dependent disease. It is present commonly in patients of reproductive age, \nand its prevalence in this age group is estimated at 5 –10%. Endometriosis is defined \nas the presence of active endometrial tissue outside the uterine cavity, especially \non the peritoneum of the minor pelvis, in the myometrium, ovaries, and fallopian tubes, \nas well as extraperitoneal sites. Endometriotic lesions can also be present in the intestines, \nurinary bladder, lungs, and brain tissues. Based on the site of the lesions, the disease \nis classified as peritoneal, ovarian, or deep infiltrating endometriosis [2]. \nEtiopathogenesis of endometriosis is still not fully understood. There are many theories \non the etiology of this condition. The most widely accepted one is Sampson’s theory, \naccording to which the formation of ectopic endometrial tissue is a consequence \nof retrograde menstruation. During this process, some of the endometrial debris leaves \nthe uterus with small volumes of menstrual blood, reaches the abdominal cavity via \nthe fallopian tubes, and is implanted into the peritoneum, usually within the pelvis [3]. \nFurthermore, immune and genetic factors are postulated to play a crucial role \nin the etiopathogenesis of endometriosis [4]. The common manifestations of endometriosis \nare dysmenorrhea with heavy menstrual bleeding, pelvic pain, dyspareunia, infertility, \nand sometimes pain during defecation. Ovarian endometriosis is the most common type of \nthis condition. Ovarian endometrial cysts (endometriomas) are found in 20 –55% of women \nwith endometriosis [5]. \nAn ovarian mass can be qualified as an endometrial cyst based on its features in \nultrasonographic presentation, based on the criteria that have been published \nby the International Ovarian Tumor Analysis (IOTA) collaboration in 2013. These criteria \ninclude size, shape, echogenicity of the lesion, the structure of its capsule, presence of any \nprojections to the cyst’s lumen, vasculature, and  relationship with surrounding anatomical \nstructures [6].\n\n\nInternational Journal of Homoeopathic Sciences http://www.homoeopathicjournal.com \n~ 407 ~ \nOvarian endometriotic cysts are more frequently located on \nthe left ovary ( ∼60%); this is justified by the menstrual \nreflux theory and the anatomical differences between the \nleft and right hemipelvis [7]. In hormonal therapies, the \novarian endometriomas may be decreased in their volume \n[8]. however, when these therapies are discontinued, ovarian \nendometriotic cysts frequently grow. Alternatively, \nendometriomas may be excised at laparoscopy. However, \nthe recurrence rate of endometriomas after surgical \nintervention is between 11.7 and 30.4% at 2–5 years follow-\nup [9]. Furthermore, surgical treatment of ovarian \nendometriotic cysts may decrease the ovarian reserve [10]. In \nthe case of surgical intervention, healthy ovarian tissue may \nbe inadvertently removed particularly when the procedure is \nperformed by surgeons with limited experience [11]. \nFurthermore, the changes in the ovarian reserve may also be \nrelated to the presence of the ovarian endometriotic \ncysts per se. A histopathological investigation of the \nfunctional morphologic features of the ovarian cortex \nsurrounding benign cysts demonstrated that endometriomas \nare associated with reduced follicular number and activity \ncompared with teratomas or other benign cystadenomas [12]. \nIt is observed that women with endometriomas have lower \nanti-Mullerian hormone (AMH) levels and antral follicle \ncount compared with women who do not have ovarian cysts, \nsuggesting that the presence of endometrioma per se is \nassociated with a reduction in ovarian reserve [13]. Ovarian \nendometrioma rarely exceeds 10 – 15 cm in diameter [14, 15] \nApproximately 0.7% to 1.0% of patients with endometriosis \nhave lesions that undergo malignant transformation [16]. \nWhen the diameter of an ovarian cyst exceeds 10 cm, \nmalignancy must be suspected [17]. \n \nCase report \nA 22 years old female presented at OPD of NHRIMH, \nKottayam in January 2020, with complaints of having \nirregular menses for the last 9 months. Her menstrual cycle \nwas irregular with profuse dark, clotted bleeding associated \nwith severe vomiting, lower abdominal pain, and weakness \nof the body. Flow lasts for 5 to 6 days. She consulted the \ngynecologist and was diagnosed with an endometriotic cyst \non the left ovary. (USG Findings on 09/02/19 showed \nenlarged left ovary with two cystic lesions measuring \n4.5x4.2 cm and 3.0x3.0 cm (Fig.1). She was under \nallopathic treatment for the last year. Then she stopped \nmedications when there was no improvement in the \nsymptoms. She had complaints of hemorrhoids with \nbleeding and burning pain during stool for 2 years. \n \nHistory \nThere was a history of Dengue fever at the age of 18 yrs. \nTook allopathic treatment and got relief. \nFamily history  \nFather – Diabetes Mellitus, Hypertension  \nMother – Hypothyroidism \nBrother - Diabetes Mellitus. \n \nMental generals  \nReserved, Affectionate, Sensitive. \n \nPhysical generals \nHer appetite was good. Thirst reduced. There was a desire \nfor spicy things+++ & aversion to meat++; She had \nconstipation with dry hard stool and hemorrhoids with \noccasional bleeding. Thermally patient was hot. Menarche \nat the age of 13 th year. Menses was regular and without pain \nfor the first 2 years, later dysmenorrhea with profuse \nbleeding started.  The nature of the blood was dark and \nclotted for 5-6 days, associated with severe abdominal pain, \nvomiting, and weakness of the body.  \n \nRegionals \nWarty growth on the back of neck, face, and both axilla. \nHead – Hair fall and Dandruff  \n \nGeneral Physical Examination \nThe patient is moderately built and nourished, No Pallar, \nCyanosis, Icterus, Clubbing, Oedema, Lymphadenopathy, \nTemperature: 98.6º F. (Afebrile), Height:160 cms, \nWeight:55 kgs, Pulse rate:70 bpm, Respiratory cycle: \n18cpm. Bp-110/80 mm of hg. \n \nInvestigations  \nR/E Blood Examination –All parameters were within the \nnormal limit. \nUSG Abdomen and Pelvis- enlarged left ovary with two \ncystic lesions measuring 4.5x4.2 cm and 3.0x3.0 cm (on 09-\n02-2019) \n \nClinical Diagnosis: Endometriotic Cyst. \n \nAnalysis of the case \nPulsatilla was selected based on the totality and reportorial \nresult followed by placebo with the general improvement of \nthe patient. To complete the cure, MEDORRHINUM was \nselected as an anti sycotic nosode. There was a slight \naggravation of the uterine symptoms followed by the rapid \nimprovement of the patient which was evident by USG \nfindings. \nUSG Reports of various stages during the treatment are \nattached in Fig 1-5. \nFollow up of the case given in table 1. \n \n\nInternational Journal of Homoeopathic Sciences http://www.homoeopathicjournal.com \n~ 408 ~ \n \n \nFig 1: Pelvic USG Before treatment \n \n\nInternational Journal of Homoeopathic Sciences http://www.homoeopathicjournal.com \n~ 409 ~ \n \n \nFig 2: Pelvic USG during treatment \n\nInternational Journal of Homoeopathic Sciences http://www.homoeopathicjournal.com \n~ 410 ~ \n \n \nFig 3: Pelvic USG during treatment \n \n\nInternational Journal of Homoeopathic Sciences http://www.homoeopathicjournal.com \n~ 411 ~ \n \n \nFig 4: Pelvic USG during treatment \n \n\nInternational Journal of Homoeopathic Sciences http://www.homoeopathicjournal.com \n~ 412 ~ \n \n \nFig 5: Pelvic USG during treatment \n \nRepertorial totality  \n1. Mind – Reserved \n2. Mind -Affectionate  \n3. Mind - Sensitive  \n4. Rectum – Hemorrhage from anus-stool-during \n5. Female genitalia -Menses, Dark. \n6. Female genitalia -Menses-Copious  \n7. Stomach-Vomiting-Accompanied by menses \n8. Stomach – Thirst less \n9. Skin-Warts \n10. Generalities – Food and drinks-Spices-Desire \n11. Generalities – Food and drinks-Meat-Aversion \n \n\n\nInternational Journal of Homoeopathic Sciences http://www.homoeopathicjournal.com \n~ 413 ~ \nRepertorial analysis  \nPuls -57/22 \nPhos   -49/22 \nSulph -48/22 \nNatrum mur -47/22 \nArs   -43//22 \nNitric-acid -42/22 \nSepia   -38/22 \nLyco -36/22 \nNuxvomica -52/21 \n \nSelection of medicine \nAfter reportorial analysis, PULSATILLA was selected as \nsimilimum, which covers reserved, affectionate, sensitive, \nthirstless, irregular, and painful menses, desire spices, and \naversion meat. \n \nPrescription:  PULSATILLA 1M/1D on (18/1/2020) \n \nTable 1: Prescription with follow-up \n \nFollow- up \ndate Indications for prescription Medicine with \ndose \n16/3/20 \nLMP- 8/2/20 Dysmenorrhea slightly reduced than before. \nVomiting, lower abdominal pain and weakness during menstruation are also reduced. \nNo bleeding per rectum, but burning pain persists. \nPlacebo \n24/4/20 \nThe intensity of dysmenorrhea was reduced. \nVomiting and abdominal pain were also reduced. \nNo bleeding per rectum, burning pain slightly reduced. \nBowel movements improved LMP- 10/4/20 \nUSG Findings (21/4/20)- left ovarian endometriotic cyst. The size of the cyst compared to the previous \nscan is decreased. (Figure 2.) \nPlacebo \n22/5/2020 \nLMP-10/4/20 Menses not appeared \nBurning pain during stool remains. \nHair fall persists Warts on the nape of the neck- No change \nPulsatilla 10M/1D \n24/7/20 \nThe patient feels generally better. \nLMP-13/6/20 Vomiting during menses reduced. \nSlight cramping pain on the lower abdomen during menstruation. \nWeakness during menses reduced. \nBurning pain during stool slightly reduced. \nUSG Findings on 22/7/20 (Figure.3) \nPlacebo \n13/11/2020 \nLMP-18/9/20 Menses not appeared \nDysmenorrhoea and associated complaints got reduced \nWarts on the neck and back persist \nHairfall and dandruff persist \nMedorrhinum \n1M/1D \n18/12/20 LMP-23/11/20 Slight lower abdominal pain during the first two days. \nUSG Findings-Enlarged left ovary with a hemorrhagic cyst and endometriotic cyst. (Fig.4) Placebo \n12/2/20 \nGeneral improvement LMP - 08/02/21 Menses regular Dysmenorrhea reduced. \nStool –Regular, no bleeding, and pain \nWarts on the back of the neck and axilla are starts to reduce in size. \nUSG Findings- No significant sonographic abnormalities were detected. (Fig- 5) \nPlacebo \n \nDiscussion  \nHomoeopathy is a wholistic system of medicine and the \ntreatment is based on the totality of symptoms. In this case, \nPULSATILLA [18, 21]  1M  was prescribed as the similimum \n[19] by considering prominent mental symptoms such as \nreserved, affectionate, sensitivity, thirstlessness, and also by \nconsidering the characteristic menstrual complaints. As we \nall know ovarian cysts are sycotic in nature and \nMEDORRHINUM [20, 21] was selected as an anti sycotic \nnosode to complete the cure. \n \nConclusion  \nResults of this case indicate that constitutional and anti-\nmiasmatic treatment is effective in the endometriotic cyst.  \n \nReferences \n1. 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Boericke W. Boericke’s New Manual of Homoeopathic \nMateria Medica with Repertory, Third Revised & \nAugmented Edition.","source_license":"CC0","license_restricted":false}