{"paper_id":"b978c931-c5bd-4476-ae55-e0e371600c3e","body_text":"Introduction\nUterine adenomyosis is the benign invasion\nof endometrial glands and stroma into the\nmyometrium. Most cases (90 %) occur in\nmultiparous women, and about 80 % of\nwomen with adenomyosis are 40 to 50\nyears old. The most frequent symptoms are\nmenorrhagia, dysmenorrhoea, and metror-\nrhagia. Classically the uterus is diffusely en-\nlarged and tender to palpation. The role of\nadenomyosis in the pathogenesis of meno-\nmetrorrhagia is perplexing, in part because\nit frequently occurs in asymptomatic wom-\nen [1]. Adenomyosis has been found in 54 %\nof uteri examined at autopsy [2]. In a pro-\nspective study of patients undergoing hys-\nterectomy, there was no difference in dura-\ntion of menstrual bleeding or presence of\ndysmenorrhoea in the 28 patients found to\nhave adenomyosis and 157 without adeno-\nmyosis or endometriosis [3]. On the other\nhand, adenomyosis is often associated with\nabnormal uterine bleeding. Adenomyosis\nwas found in hysteroscopic biopsy speci-\nmens in 37% of 90 menorrhagic women.\nHowever, if the uterine cavity was normal,\nthe number of patients who had significant\nadenomyosis increased to 66% [4]. Adeno-\nmyosis was found in 20 of 43 women with\nan enlarged uterus without evidence of\nleiomyomata on ultrasound who had a hys-\nterectomy for persistent menorrhagia [5].\nUltimately, the role of adenomyosis in ab-\nnormal uterine bleeding may prove to be\nquantitative, with more extensive disease\nand greater depth of myometrial invasion\nmore likely to cause abnormal bleeding [1].\nAdenomyosis typically affects women of re-\nproductive age. In general, affected women\nare multiparous, and the condition is seen\nwith higher frequency in woman with a\nhistory of surgical uterine procedures (e.g.,\nCaesarean section, dilatation and curett-\nage). It has a reported incidence ranging\nwidely from 5 to 70% [6]. Diagnosis can be\nmade with the help of transabdominal and\ntransvaginal ultrasound, hysteroscopy and\nMRI. Homeopathy offers a better alterna-\ntive for the treatment of uterine adeno-\nmyosis. The below presented case is one\nsuch example where homeopathic medi-\ncine proved to be safe and effective in the\ntreatment of uterine adenomyosis by not\nonly improving the general health of the in-\ndividual but also preserving her uterus.\nCase Presentation\nA female patient of 27 years of age has come\nto the OPD complaining of bleeding per va-\ngina continuously for the past fifteen days.\nThe blood was dark red and clotted. The\npatient was suffering from irregular men-\nstrual cycles with protracted and profuse\nbleeding for almost a year. The patient has\nbeen on allopathic medication for almost\nthe past six months with no relief. As the\npatient had already two children and the\nmenorrhagia was devastating and not re-\nsponding to treatment she was advised to\nundergo a hysterectomy by the consulting\ngynaecologist. As the patient was reluctant\nto undergo surgery and had previously\nbenefitted from homeopathy, she opted for\nhomeopathic therapy. She was referred to\nthe OPD of the Extension Clinical Research\nUnit, Princess Durru Shehvar Children ʼs&\nGeneral Hospital, Hyderabad by the consul-\ntant gynaecologist of the said hospital. Her\npresenting complaints were:\na) Menstrual cycles appeared every fifteen\ndays.\nb) Each cycle lasted for about ten days.\nc) Severe pain, abdomen and back, felt dur-\ning the flow with much exhaustion and\nfainting.\nPast history\nShe had an attack of chikun-gunya two\nyears back and had taken an allopathic\ntreatment with relief. The pains subsided\nwithin a month. Family history was un-\nremarkable. Parents were not alive and\nmother died one year back. Patient had four\nsiblings – three sisters, one brother – who\nwere all clinically normal.\nShe was the third child of non-consangui-\nneous parents. She was educated up to\ntenth class and discontinued as she was\nmarried early. She attained menarche at\nthe age of twelve years. Her menstrual\ncycles were regular every thirty days,\nbleeding lasting for five days. She was a\nhousewife and had two children – one male\nand one female, one was a normal delivery\nand the second one an emergency caesar-\nean. Her first childbirth was five years back\nand her last childbirth was three years\nback.\nPhysical generals\nl Thermal reaction: Hot patient, desire\nfor cold weather and air\nl Desire: Salty food and salt\nSUMMARY\nUterine adenomyosis is considered benign and even though not a life-\nthreatening condition, the frequent pain and heavy bleeding associated\nwith it can have a negative impact on a woman ʼs quality of life. This is a\ncondition seen with higher frequency in women with a history of surgical\nuterine procedures (e.g., Caesarean section, dilatation and curettage). The\nonly definitive cure for adenomyosis is a hysterectomy. This is often the\ntreatment of choice for women with significant symptoms. This surgical in-\ntervention can be avoided through homeopathic treatment. A case of uter-\nine adenomyosis in a twenty-seven-year-old female who presented with\ncontinuous heavy bleeding showed the efficacy of homeopathic medicines\nin giving not only symptomatic relief to the patient but also helping in the\ncomplete cure of the adenomyosis of the uterus.\nKEYWORDS Menorrhagia, Uterine adenomyosis, Trillium pendulum,\nNatrum muriaticum\nMATERIA MEDICA AND CASES\nA Case of Adenomyosis\nof the Uterus\nHima Bindu Ponnam & Y. S. Suryanarayana, India\nHima Bindu Ponnam & Y. S. Suryanarayana, A Case of – Homœopathic Links Summer 2014, Vol. 27: 96 – 99 © Thieme Medical and Scientific Publishers Private Ltd.96\nThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.\n\n\nl Aversion: Nonspecific\nl Intolerance: Milk\nl Appetite: Diminished\nl Thirst: Extreme dryness of mucous\nmembranes and thirst extreme\nl Stool: Constipated, alternate days with\nburning in anus\nl Urine: Normal (complained of involun-\ntary urine on sneezing and coughing for\nthe past three months)\nl Perspiration: Profuse especially in hot\nweather, oily\nl Sleep: Disturbed due to thoughts of her\ndead mother\nMental generals\nl Desires to be alone\nl Sensitive to noises and trifles\nl Never weeps before others, but broods\nwhen alone secretly\nl Consolation by others aggravates her\ntroubles\nl Very much stressed after the death of\nher mother, observed that the present\ncomplaint started after the death of\nher mother\nGeneral physical examination\nShe is medium complexioned, normal built.\nHeight: 5 ”6′, Weight: 65 kg, BMI (body\nmass index): 23.\nAnaemic – Nil, Jaundice – Nil, Cyanosis –\nNil, Generalised lymphadenopathy – Nil.\nPulse – 72/min, Temperature – 98.6 °F, Res-\npiratory rate – 12/min, BP – 110/70 mmHg.\nRespiratory system: lungs are clear.\nCardiovascular system: S1, S2 normal, no\nadded sounds.\nGastrointestinal system: NAD.\nLocomotor system: NAD.\nPelvic examination: Bleeding present.\nRoutine haemogram: Haemoglobin 8 gms/dl.\nUSG pelvis shows bulky uterus diagnosed\nwith adenomyosis of uterus (Fig. 2).\nTreatment\nInitially Trillium pendulum 30 C, one dose\nevery four hours has been prescribed to con-\ntrol bleeding per vagina with pain, severe\npain in back, and much exhaustion with\nfainting as presented by the patient. The case\nwas repertorised on the basis of the Com-\nplete Repertory [7] taking into consideration\nthe totality (Fig. 1). Natrum muriaticum was\nthought to be appropriate for the case, as it\nwas found suitable after repertorisation\nand in consultation with materia medica.\nFollow-Up Criteria\nThe case was followed for a period of one\nyear post-menstrually with USG pelvis\ndone at entry and at the end of one year as\nper the protocol.\n1st follow-up: The patient had reported\nafter two days with cessation of bleeding\nafter taking Trillium pendulum 30 C.\nPlacebo continued for fifteen days.\nFig. 1 Repertorisation of the case (Complete Repertory in Hompath Classic).\nHima Bindu Ponnam & Y. S. Suryanarayana, A Case of – Homœopathic Links Summer 2014, Vol. 27: 96 – 99 © Thieme Medical and Scientific Publishers Private Ltd. 97\nMATERIA MEDICA AND CASES\nThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.\n\n\n2nd follow-up: At this juncture, the case\nwas analysed, evaluated and repertorised.\nNatrum muriaticum 30 C in a single dose\nwas prescribed based on the totality, with\nplacebo daily, one dose for a month.\n3rd follow-up: After a month with the first\ndose of Natrum muriaticum 30 C, the\nmenses appeared on the 29th day and\nbleeding lasted for five days. Weakness re-\nduced. Pain in back and abdomen relieved.\nShe was therefore given placebo, daily, one\ndose for a month.\n4th follow-up: The patient reported in the\nnext month post-menstrually. She had\nmenses on the 28th day and bleeding lasted\nfor five days. Pain in back and abdomen re-\nappeared during menses. Natrum muriati-\ncum 30 C, one dose was repeated with\nplacebo for one month.\n5th follow-up: The patient reported in the\nnext month post-menstrually; had menses\non the 30th day and bleeding for five days.\nPain in abdomen and back relieved. She\nwas therefore given placebo, daily, one dose\nfor a month.\n6th follow-up: The patient reported in the\nnext follow-up post-menstrually; had\nmenses on the 27th day and bleeding for five\ndays. Pain in abdomen and back reappeared.\nNatrum muriaticum 200 C, one dose with\nplacebo for one month was prescribed.\n7th follow-up: The patient reported in the\nnext month post-menstrually; had menses\non the 30th day and bleeding for five days.\nPain in abdomen and back relieved. She\nwas therefore given placebo, daily, one dose\nfor a month.\n8th follow-up: Next month, the menses ap-\npeared on the 31st day, bleeding lasted for\nfive days, no complaints. Placebo for one\nmonth.\n9th follow-up: Next follow up, the patient\nreported after two months. The last menses\ncame early by two weeks, bleeding was\nprofuse, lasted for five days and spotting\nlasted for five days. Now Natrum muriati-\ncum 200 C, one dose was repeated with\nplacebo, daily, one dose for a month.\n10th follow-up: Next follow up, the patient\nreported after two months. Menses had\nbeen all three months every 30 days, bleed-\ning lasted for five days. No other complaints.\nIn this follow-up, USG pelvis has been done\nfor the final assessment of the case.\nImpression of the report : Uterus is normal,\nno evidence of any mass lesion inside the\nuterus, normal pelvic scan (Fig. 3).\nDiscussion\nThe patient presented with adenomyosis\nuterus in the reproductive age group i.e.,\n27 years of age and with abnormal uterine\nbleeding as per the version of McCausland\n[8]. There is no family history reported in\nthe present case. Abnormal uterine bleed-\ning is the most frequently cited symptom\nin women with adenomyosis of the uterus\nas per Stewartʼs classification system [9] of\nclinical presentation of uterine adenomyo-\nsis and the present case reported with con-\ntinuous bleeding per vagina as the chief\ncomplaint for fifteen days.\nWhen initially the subject approached with\nthe complaint of continuous bleeding per\nvagina with severe back pain and much ex-\nhaustion with fainting, Trillium pendulum\nwas thought to be appropriate as per Boer-\nicke [10] and Allen [11]. After giving Trillium\npendulum 30 C, bleeding per vagina stopped.\nAt this juncture, the case had been taken in\ndetail, analysed, evaluated and repertorised\nto select a similimum. In the case along with\nthe totality much emphasis was observed on\nthe mental general and causation i.e., ail-\nments after the death of the mother became\nthe guiding symptom. The selection of\nNatrum muriaticum is thus based on the\ntotality of characteristic symptoms further\nguided by the keynote that is the prominent\nmental general. The dose of Natrum muria-\nticum was administered post-menstrually\nin this case in accordance with Allen [12].\nFig. 2 USG pelvis at entry.\nHima Bindu Ponnam & Y. S. Suryanarayana, A Case of – Homœopathic Links Summer 2014, Vol. 27: 96 – 99 © Thieme Medical and Scientific Publishers Private Ltd.98 MATERIA MEDICA AND CASES\nThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.\n\n\nInitially Natrum muriaticum 30 C, single\ndose was given. In the subsequent follow-\nups, the same was repeated once and later\nalso prescribed in a higher potency (i.e.,\n200 C potency) as per the requirement of\nthe case. Finally, at the end of one year,\nUSG pelvis revealed no evidence of mass le-\nsion in the uterus. As rightly said by Thomas\nSkinner [13], “Constitutional treatment\nalone was and is all that is necessary for suc-\ncessful treatment of all vaginal, uterine and\novarian diseases ”. The same holds true in\nthis case of uterine adenomyosis too.\nConclusion\nIn the present case, a striking peculiarity in\nterms of mental general and causation, i.e.,\nailments from the death of her parent\n(mother), was taken into consideration for\nthe prescription. Though the totality of the\nsymptoms was considered for the prescrip-\ntion but much emphasis has been given to\nthis mental general which in turn proved\nto be successful in not only providing\nsymptomatic relief to the patient but also\nin the complete elimination of the adeno-\nmyosis of the uterus at the end of one yearʼs\ntreatment. Therefore, it can be concluded\nthat in this case the homeopathic constitu-\ntional approach is highly effective in the\ncure of uterine adenomyosis.\nConflict of Interest\nWe declare no conflict of interest.\nReferences\n1 Ferenczy A. Pathophysiology of adeno-\nmyosis. Hum Reprod Update 1998; 4:\n312 – 322\n2 Emge LA. The elusive adenomyosis of the\nuterus: its historical past and its present\nstate of recognition. Am J Obstet Gynecol\n1962; 83: 1541 – 1563\n3 Kilkku P, Erkkola R, Gronroos M. Non-\nspecificity of symptoms related to adeno-\nmyosis, a prospective comparative survey.\nActa Obstet Gyn Scan 1984; 63: 229 – 231\n4 McCausland AM. Hysteroscopic myome-\ntrial biopsy: its use in diagnosing adeno-\nmyosis and its clinical application. Am J\nObstet Gynecol 1992; 166: 1619 – 1626\n5 Fedele L, Bianchi S, Dorta M et al. Trans-\nvaginal ultrasonography in the diagnosis\nof diffuse adenomyosis. Fertil Steril\n1992; 58: 94 – 97\n6 Arora A, Bhutani R, Gupta R et al. MRI\nfindings in uterine adenomyosis – Case\n8488; 2010, European Society of radiolo-\ngy teaching files, radiological case data-\nbase. Online: http://www.eurorad.org/\ncase.php?id=8488 [accessed May 1, 2014]\n7 van Zandvoort R. Complete Repertory. In\nHompath Classic 8.0; 2000 – 2005, by\nShah Jawahar, West Mumbai\n8 McCausland AM. Hysteroscopic myome-\ntrial biopsy: its use in diagnosing adeno-\nmyosis and its clinical implication. Am J\nObstet Gynecol 1992; 166: 1619 – 1626\n9 Stewart EA. Uterine fibroids. Lancet\n2001; 357: 293 – 298\n10 Boericke W. Trillium Pendulum. New\nManual of Homoeopathic Materia Medi-\nca and Repertory. New Delhi: B. Jain (P)\nLtd.; 2001: 463, 628 – 629\n11 Allen HC. Genitalia Female. H.C. Allen ʼs\nKey Notes and Characteristics with Com-\nparisons with Bowel Nosodes. New Del-\nhi: B. Jain (P) Ltd.; 2004: 295 – 296\n12 Allen JH. The Chronic Miasm Psora and\nPseudopsora. New Delhi: B. Jain (P) Ltd.;\n1988: 37\n13 Skinner T. The Diseases of Females. New\nDelhi: B. Jain (P) Ltd.; 1997: 131\nDr. Y. S. Suryanarayana\nDr. Hima Bindu Ponnam\nExt. Clinical Research Unit\nPrincess Durru Shehvar Childrenʼs&\nGeneral Hospital\nPurani Haveli\nHyderabad 500 002, Andhra Pradesh\nIndia\nE-mail: drbindu_hima@yahoo.com\nFig. 3 USG pelvis at end (after 1 year of treatment).\nHima Bindu Ponnam & Y. S. Suryanarayana, A Case of – Homœopathic Links Summer 2014, Vol. 27: 96 – 99 © Thieme Medical and Scientific Publishers Private Ltd. 99\nMATERIA MEDICA AND CASES\nThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.","source_license":"CC0","license_restricted":false}