{"paper_id":"a07909a0-0339-475e-8b4a-ed87ab29782a","body_text":"~ 8 ~ \nInternational Journal of Homoeopathic Sciences 2024; 8(2): 08-13\n \nE-ISSN: 2616-4493 \nP-ISSN: 2616-4485 \nwww.homoeopathicjournal.com \nIJHS 2024; 8(1): 08-13 \nReceived: 21-01-2024 \nAccepted: 25-02-2024 \n \nDr. Amit Nayak \nProfessor, H.O.D., \nDepartment of Materia \nMedica, State National \nHomoeopathic Medical College \nand Hospital, Lucknow, Uttar \nPradesh, India \n \nDr. Pooja Dubey \nAssociate Professor, \nDepartment of Materia \nMedica, Sophia Homoeopathic \nMedical College, Gwalior, \nMadhya Pradesh, India \n \nDr. Tatheer Fatima \nPGT, Department of \nRepertory, State National \nHomoeopathic Medical College \nand Hospital, Lucknow, Uttar \nPradesh, India \n \nDr. Shalini Singh \nPGT, Department of Organon \nof Medicine & Homoeopathic \nPhilosophy, State National \nHomoeopathic Medical College \nand Hospital, Lucknow, Uttar \nPradesh, India \n \nDr. Jaimala Yadav \nPGT, Department of Materia \nMedica, State National \nHomoeopathic Medical College \nand Hospital, Lucknow, Uttar \nPradesh, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Amit Nayak \nProfessor, H.O.D., \nDepartment of Materia \nMedica, State National \nHomoeopathic Medical College \nand Hospital, Lucknow, Uttar \nPradesh, India\n \n \nHolistic healing: Ovarian endometrioma managed \nwith homeopathy- a case report \n \nDr. Amit Nayak, Dr. Pooja Dubey, Dr. Tatheer Fatima, Dr. Shalini \nSingh and Dr. Jaimala Yadav\n \n \nDOI: https://doi.org/10.33545/26164485.2024.v8.i2a.1112  \n \nAbstract \nIntroduction: An ovarian endometrioma is a cystic lesion which arises from ectopic endometrial tissue \nwithin the ovary, and is a common cause of incessant pelvic pain,  difficult sexual intercourse, and \ninfertility. Although it is usually benign, but large cystic lesions have potential for malignant \ntransformation. Studies have shown the presence of ectopic endometri al tissue at distant sites outside \npelvic cavity, e.g., peritoneal cavity, thoracic cavity, brain, an d even sciatic nerve. Laparoscopy and \ntransvaginal endoscopy in sexually active adults are the investigatio ns of choice. Genetic and \nenvironmental factors play an important role in the development of endometriosis.  \nCase summary: A case of endometrioma treated with standalone Homoeopathic medicin e is reported. \nThe case presented with pelvic pain and abdominal bloating, alon g with scanty and dark menstruation. \nThe patient was treated with individualised homoeopathic medicine. The  case was followed up \nregularly and assessed using clinical symptoms and radiological investigatio ns. The patient showed \nmuch improvement within four months of treatment, and was completely cured within one year. \n \nKeywords: Endometrioma, ovary, infertility, homoeopathy \n \nIntroduction \nEndometriosis is defined as the aberrant presence of endometrial glands and stroma outside \nthe uterine cavity [1]. Fluid filled, cystic lesion that develop in the ovary as a result of \nendometriosis is known as chocolate cyst or endometrioma. Endometrioma af fects \napproximately 10% –15% of all women of reproductive age [2]. Up to 50% of women with \ninfertility have endometriosis and 44% of such cases are due to ovarian en dometrioma, \nmaking ovaries the most common site [1, 3]. 10% of premenopausal women also suffer from \nendometriosis [4]. Between 1860 and 1920s, fewer than 20 cases of endometriosis wer e \nreported in literature, but there has been a dramatic increase since then [5]. Endometriosis is a \nprevalent cause of persistent pain, dyspareunia, dysmenorrhea, and infer tility [6]. Women \nsuffering from endometriosis often experience difficulties achieving their education or \nemployment goals. Depression, anxiety, and low self-esteem are frequently  associated [7]. A \ncross sectional study reported that 59% of women with endometriosis h ad some form of \npsychiatric illness, the symptoms being more profound in patients with sev ere pain [8]. \nSampson presented his theory of retrograde menstruation and implantation  in 1925, however \nwith this theory, it was challenging to explain that despite retrograde menstrua tion occurring \nin 90% of women, not all develop endometriosis [9]. Also, the theory could not explain the \noccurrence of endometriosis at distant sites outside the pelvic cavity or incidence in pre-\npubertal females. Later, for extra pelvic endometriosis, theory of microemb olization via \npelvic veins was proposed. Peritoneal-pleural migration of endometrial tissue via \ndiaphragmatic defects has been linked to thoracic endometrial syndrome [10]. Hence, a high \ndegree of suspicion is needed when dealing with patients who report  of having cyclical \ndiscomfort during their menstrual periods as endometrial tissue responsi ve to oestrogen, has \nbeen found at distant, unsuspecting sites of the body [6]. Consequently, endometriosis should \nbe frequently considered as differential diagnosis in pubertal females as cha nces of disease \nonset is relatively higher due to increased availability of oestrogen, beginning  of menstrual \ncycle and sexual activity [9]. Trans-vaginal sonography is the routine, non-invasive \ninvestigation of choice, however laparoscopic assessment and histologic confirmation  of \nbiopsy specimen is considered gold standard [11]. Although both medicinal and surgical \ntreatments are available for the management of endometriosis, endometriotic tissue  \n\n\nInternational Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com \n~ 9 ~ \nsuppression for reduction of pain often has adverse \neffects and requires careful monitoring [13]. The need of \nsurgery arises due to lack of effective conventional medical \ntreatment available [12].  \n \nCase Report \nOn 11 th May 2023, a 31 years old female presented with \npelvic pain and abdominal bloating for the past one year.  \n \nHistory of presenting complaints \nThe patient started experiencing mild intermittent pelvic \npain in April 2022, which gradually became constant by the \nend of September 2022. Eventually, her menses became \nscanty and the flow was dark and clotted.  \n \nPast History \nThree years ago, the patient suffered from haemorrhoids and \nmigraine which was treated with allopathic medication. \nThere is no history of trauma or any other major chronic \nillness.  \n \nFamily History \nFather was diabetic and mother had bronchial asthma. \n \nPhysical Generals \nThe patient was more affected by cold. She had ravenous \nappetite. She was generally thirsty, craved sweets and did \nnot like sour foods. Her bowel movements were irregular \nand she suffered from constipation. She felt better after \npassing flatus. Menstrual flow was scanty, thick, dark, and \nclotted. She was intolerant of tight clothing. \n \nMental Generals \nThe patient was weak willed and had low confidence. She \nwas introverted and irritable. Although she was usually not \nexpressive of her anger but sometimes, she had sudden \noutbursts of anger where she threw and broke objects. She \nwas also very anxious about her health. \n \nLife space investigation \nThe patient lived in a nuclear family belonging to middle \nsocioeconomic strata. She had been married for four years \nand had no children. She was an only child and had good \nrelations with her parents. She was good at studies but was \nnot very diligent. Since childhood, she had been very \nreserved but after marriage, she had become more \nextroverted. The patient did not have good sexual relations \nwith her husband as she felt concerned that she was not able \nto fulfil her responsibilities towards her marriage.  \n \nGeneral physical examination \nNo abnormality was detected on general physical \nexamination. \n \nLocal Examination \nThere was slight distention of abdomen with normal bowel \nsounds. \n \nInvestigation findings \nUSG Follicle Monitoring (09.02.2023)- Right ovary shows a \nwell-defined smooth marginated rounded cyst with \nhomogenous internal echoes measuring approximately 1.8 x \n1.7 x 1.5 cms suggestive of endometrioma. (Figure 1) \nPatient did not agree for further laparoscopic investigation. \n \nClinical Diagnosis: Right ovarian endometrioma \n \n \n \nFig 1: USG Follicle Monitoring on 09.02.2023 \n \nTotality of symptoms \n▪ Anxiety about one’s own health \n▪ General amelioration from discharge of flatus \n▪ Ravenous appetite \n▪ Weak willed \n▪ Changeable mood \n▪ Reserved person \n▪ Suppressed anger \n \nRepertorization and remedy analysis \nRepertorium Homeopathicum Syntheticum (Edition 9.1) \nwas consulted using R.A.D.A.R. software as the case \npresented with characteristic mind and physical symptoms. \nLycopodium (36/15), Staphysagria (30/15), Ignatia amara \n(26/15), Monilia albicans (25/15) and Natrum muriaticum \n(25/15) were the medicines in the top gradation (Figure 2).  \nLycopodium clavatum was selected as the indicated remedy \nin consultation with materia medica. \n \n\nInternational Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com \n~ 10 ~ \n \n \nFig 2: Repertorial analysis \n \nRemedy selection and administration \nLycopodium 200c three medicated globules number 10 was \ndispensed, each to be taken at an interval of 10 minutes \nearly morning on empty stomach, followed by Sac Lac four \nglobules thrice daily, for 2 weeks. \n \nPatient education and general management \nThe patient was advised to increase intake of water, citrus \nfruits, and dietary fibre; and to reduce dietary fat and avoid \ndairy products. The patient was educated  \n \nFollow up and outcome: The patient was followed up \nmonthly for 1 year. There was initial improvement of \ngeneral symptoms and the pain was reduced but mild pain \nwas persistent even after three months. Thereafter a single \ndose of Lycopodium 1M was prescribed and marked \nchanges in symptomatology were elicited by four months \n(Table 1). Although the symptoms improved significantly \nafter 4 months, the patient was followed up for 1 year to \nobserve any relapse of symptoms. \nOn 24.01.2024, USG of whole abdomen showed normal \nstudy (Figure 3, Figure 4). \nThe CECT whole abdomen done on 24.01.2024 also \nshowed normal study (Figure 5). \n \n \n \nFig 3: USG (whole abdomen) \n\nInternational Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com \n~ 11 ~ \n \n \nFig 5: USG Scan of whole abdomen \n \n \n \nFig 4: CECT (whole abdomen) \n\nInternational Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com \n~ 12 ~ \nDiscussions \nOvarian endometriomas are significantly associated with \nfollicle loss with or without surgery and infertility is a \nfrequent cause of concern in women with endometriosis [13]. \nDestruction of ovarian tissue due to cysts or surgical \ninterventions significantly diminishes ovarian reserve [14]. \nDiagnosis of endometriosis is usually delayed as the cyclical \npain is often misunderstood and ascribed to other causes \nspecially in puberty or young women. Longer the delay in \ndiagnosis, more extensive is the disease diagnosed on \nlaparoscopy [15]. The case reported here was approached \naccording to the concept of individualisation. The patient \nwas of reproductive age and the persistent pain and \ninfertility was causing her physical, mental, and emotional \ndistress. Initially, a single dose of Lycopodium 200C was \nprescribed and there was some improvement of symptoms. \nThe generals improved drastically but after 3 months of \nfollow up, the improvement had come to a standstill. \nEventually the case was reanalysed and Lycopodium 1 M \nwas prescribed, and there was a marked improvement in the \nlocal symptoms as well as the general condition of the \npatient. HOM-CASE CARE Extension case reporting \nguidelines were followed for reporting the case. Modified \nNaranjo Criteria score was 9, thus showing the causal \nattribution of the single homoeopathic medicine \nLycopodium clavatum  towards cure of the ovarian \nendometrioma in this case (Table 2). \n \nConclusion \nIn this case, the individualised homoeopathic treatment not \nonly cured the ovarian endometrioma, but also helped in the \ngradual improvement of general well-being. Thus, this case \nhints at the positive role of homoeopathy in the treatment of \nendometriosis, and ovarian endometrioma. \n \nDeclaration of patient consent  \nInformed patient consent was obtained to disseminate the \nclinical information on a scientific platform. \n \nConflict of Interest \nNot available  \n \nFinancial Support \nNot available \n \nReferences \n1. Cranney R, Condous G, Reid S. An update on the \ndiagnosis, surgical management, and fertility outcomes \nfor women with endometrioma. Acta Obstetricia et \nGynecologica Scandinavica [Internet]. 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Available from: \nhttps://ovarianresearch.biomedcentral.com/articles/10.1\n186/s13048-019-0582-5 doi:10.1186/s13048-019-0582-\n5 \n \n \nHow to Cite This Article \nNayak A, Dubey P, Tatheer F, Singh S, Yadav J . Holistic healing: \nOvarian endometrioma managed with homeopathy- a case rep ort. \nInternational Journal of Homoeopathic Sciences. 2024; 8(2): 08-13. \n \n \nCreative Commons (CC) License \nThis is an open access journal, and articles are distributed under the  \nterms of the Creative Commons Attribution-NonCommercial-\nShareAlike 4.0 International (CC BY-NC-SA 4.0) Lice nse, which \nallows others to remix, tweak, and build upon the work  non-\ncommercially, as long as appropriate credit is given a nd the new \ncreations are licensed under the identical terms.","source_license":"CC0","license_restricted":false}