Individualized homoeopathic treatment of adenomyosis: A case report

Adenomyosis is a myometrial lesion characterised by endometrial glands and stroma located haphazardly and deep within the myometrium. The exact cause of the ingrowth of tissues is unknown. It may be due to repeated childbirths, vigorous curettage or excess hormones level. The common symptom is heavy, painful menstrual bleeding, typically occurring in multiparous women. It has an association with infertility. This case study suggests homoeopathic treatment as a promising complementary or alternative therapy, emphasizes the significance of repertorization with Synthesis Repertory and individualized homoeopathic prescription in a patient suffering from Adenomyosis.

Adenomyosis, homoeopathic treatment, case report, synthesis repertory, repertorization, lycopodium

Most women are suffering from one or more menstrual problems in their lives, Adenomyosis is also one among them [1]. Adenomyosis is a common benign gynaecologic disorder that affects 8.8-61.5% of women undergoing a hysterectomy and 20-34% of women referred for pelvic imaging [2, 3]. It is characterised by ectopic endometrial glands or stroma in the uterine myometrium [3, 4]. The first description of the condition initially referred to as “Adenomyoma” was provided in 1860 by the German pathologist Carl von Rokitansky, who found endometrial glands in the myometrium and subsequently referred to this finding as “cystosarcoma adenoids uterinum”. The modern definition of Adenomyosis was provided in 1972 by Bird who stated: “Adenomyosis may be defined as the benign invasion of the endometrium into the myometrium, producing a diffusely enlarged uterus which microscopically exhibits ectopic non-neoplastic, endometrial glands and stroma surrounded by the hypertrophic and hyperplastic myometrium” [5-7]. This condition seems very rare before age 20, a cystic form has mainly been reported in young women [8]. It’s diagnosis appears more common in women between 40 and 50 years old (70-80%) [9]. In India, the prevalence of Adenomyosis is 23.5% of which 80% were seen in the age group of 31-50 years [10]. Adenomyosis is classified into focal and diffuse based on histopathological examinations, focal is characterised by nodules of endometrial glands, and stroma surrounded by normal myometrium are found in the specimens. Diffuse Adenomyosis is characterised by endometrial glands and stroma distributed throughout the myometrium [11]. The aetiology of Adenomyosis is not known. It may be due to repeated childbirths, vigorous curettage, or excess estrogen level [12]. Risk factors are middle age, multi-parity, surgical disruptions of the endo-myometrial border, elevated levels of both FSH and prolactin (PRL), smoking habits, and history of depression [13, 14]. In about 50%, it remains asymptomatic being discovered on histological examination. Patients present with some common symptoms:- 1) Menorrhagia (70%)-heavy menstrual bleeding 2) Dysmenorrhea (30%)- pain in the lower abdomen during menses 3) Dyspareunia-painful coition International Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com ~ 241 ~ 4) Frequency of urination due to enlarged and tender uterus. 5) Associated with Infertility [13-17]. In a recent cross-sectional study on infertile women, Adenomyosis prevalence was 24.4% in women at least 40 years old and 22% less than 40 years old. This percentage increased to 38.2% in cases of recurrent pregnancy loss and to 34.7% in previous ART failure [12, 18], whereas, in those with a history of endometriosis, the percentage is widely variable, ranging from 20% to 80% [19, 20, 12]. Pelvic endometriosis co-exists in about 40 % of cases [13], and uterine fibroids [6, 12, 21] . In 15% to 57% of cases, uterine Leiomyomas and Adenomyosis coexist in the same uterus, and women with both conditions are more likely to experience pelvic pain [12, 22]. As imaging techniques further developed, a non-invasive approach for diagnosing Adenomyosis became feasible, allowing for the earlier clinical detection of the disease. Magnetic Resonance Imaging (MRI) and Transvaginal Ultrasonography (TVUS) are reported to have similar sensitivities and specificities in the detection of Adenomyosis and have increasingly been used to identify the presence of Adenomyotic lesions, and to plan subsequent treatment [23, 24] . Three‐Dimensional (3D) TVS has been reported to improve diagnostic accuracy, because it enables visualization of changes in the junctional zone in greater detail than Two‐Dimensional (2D) ultrasound [25, 26]. The choice of treatment depends on the woman’s age, reproductive status, and clinical symptoms. However, so far, few clinical studies have been performed on medical or surgical treatment for Adenomyosis, and no drugs labelled for Adenomyosis are currently available [27]. It has a negative impact on women’s quality of life in a high percentage of cases because of abnormal uterine bleeding and pain requiring a lifelong management plan through medical or surgical treatment [28]. The definitive treatment for Adenomyosis is hysterectomy, but this surgical intervention can be avoided through individualized homoeopathic treatment. Various homoeopathic medicines, such as Arsenicum album , Nux vomica, Secale cor , Lachesis mutus , Medorrhinum, Pulsatilla, Sepia officinalis , Thuja, etc., can be useful in treating patients suffering from Adenomyosis [29, 30] . Homeopathy can also be integrated into a broader treatment plan alongside conventional medical care, providing a holistic approach to managing Adenomyosis cases [30]. Case proper A 27-years-old female, from Murshidabad visited Obs. & Gyn. OPD of National Institute of Homoeopathy on 22 nd March 2022. She presented with complaints of excessive menstrual bleeding for the last 3-4 months. It was a known case of Diffuse Uterine Adenomyosis, as detected by USG of the whole abdomen on 30th Jan 2022. History of present complaints 1) Excessive menstrual bleeding for the last 3-4 months.  Cycle: 8-9 days/ 30-34 days  Flow-heavy, uses 5-6 pads/ day  Pain in the lower abdomen during menses (3+)  Weakness during menses Menstrual history-menarche at 12 years of age and cycle was 3-4 days/ 28 days LMP-19th Feb 2022 Past history  Appendectomy-7 years ago  Tubectomy-6 years ago Family history: Nothing significant Personal history 1) Addiction-Nothing significant 2) Diet-Irregular 3) Marital status-Got married 13 years ago 4) Number of children-2 Boys-NVD 5) Any regular medication-Nill Physical generals  Appetite-Less, 2 times/ day.  Thirst-less, 1L/ day  Desire-Mushrooms (3+)  Aversion-Sour food (3+)  Intolerance- Nothing significant  Urine-D (3-4) N (1), no complaints  Stool-constipation, once in 2-3 days.  Perspiration-Moderate, no staining and no odour  Sleep-delay but sound sleep  Dreams-Dreams of wild animals  Thermal reaction-Hot  Tongue-Cracked, moist and clean. Mental generals  Easily gets offended  Irritated mood due to health issue  Likes to stay with people  Consolation aggravation  Anxiety about her health Analysis & evaluation of symptoms S. No. Symptoms Common/ Uncommon Grade Easily gets offended Uncommon 3 Irritated mood due to health issue Common 2 Likes to stay with people Uncommon 3 Consolation aggravation Uncommon 3 Anxiety about her health Uncommon 1 Less appetite Common 3 Less thirst Common 1 Aversion to sour food Uncommon 3 Desire for mushrooms Uncommon 3 Constipation common 2 Moderate Perspiration Common 1 Delay but sound sleep Common 1 Dreams of wild animals Uncommon 3 Thermal reaction is hot Common 3 Cracked tongue Uncommon 3 Excessive menstrual bleeding Common 3 Pain in lower abdomen during menses Common 3 Weakness during menses Uncommon 3 Menses last for 8-9 days Uncommon 3 International Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com ~ 242 ~ Totality of symptoms a) Likes to stay with people b) Consolation aggravation c) Easily gets offended d) Less appetite e) Aversion to sour food f) Desire for mushrooms g) Dreams of wild animals h) Thermal reaction is hot i) Cracked tongue j) Excessive menstrual bleeding k) Pain in lower abdomen during menses l) Weakness during menses m) Menses last for 8-9 days Selection of repertory Synthesis Repertory was selected on the basis of totality of symptoms. Conversion of symptoms into rubrics S. No. Symptoms Chapters Rubrics 1. Likes to stay with people Mind MIND- Company- desire or 2. Consolation aggravation Mind MIND- Consolation-agg. 3. Easily gets offended Mind MIND-Offended-easily 4. Less appetite Stomach STOMACH-Appetite-wanting 5. Aversion to sour food Generals GENERALS-Food and Drinks-sour food- aversion 6. Desire for mushrooms Generals GENERALS-Food and Drinks-Mushrooms- desire 7. Dreams of wild animals Dreams DREAMS-Animals-wild 8. Thermal reaction is hot Generals GENERALS- Warms-agg. 9. Cracked tongue Mouth MOUTH-Cracked-tongue fissured 10. Excessive menstrual bleeding Female genitalia/ Sex FEMALE GENITALIA/ SEX-Menses-copious 11. Pain in lower abdomen during menses Female genitalia/ Sex ABDOMEN- Pain- Menses during 12. Menses last for many days Female genitalia/ Sex FEMALE GENITALIA/ SEX-Menses- protracted- eight to nine days 13. Weakness during menses GENERALS GENERALS-Weakness-Menses Repertorization [31] Repertorial result 1. Lycopodium-22/ 11 2. Nux Vomica-19/ 10 3. Sulphur-19/10 4. Natrum Muriaticum -21/ 9 This case was repertorized with the help of Synthesis Repertory using RADAR. The repertorial result was analysed, giving more priority to mental symptoms as well as physical general symptoms for selection. According to repertorization, the most indicated remedy was Lycopodium. Prescription After considering the totality of symptoms and analysing the repertorial result, Lycopodium 0/1, 16 doses of each potency was prescribed in 100 ml of aqua dist. Orally, on alternate days for 32 days. The potency was gradually increased up to Lycopodium 0/11 with the improvement of symptoms during menses and other symptoms. International Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com ~ 243 ~ Before treatment After treatment

Homoeopathic treatment of Adenomyosis, a case report of a patient who was suffering from pain in the lower abdominal region with profuse menstrual bleeding. This case was presented with radiological evidence (USG) of a bulky uterus, irregular endo-myometrial junction and the presence of a small sub-endometrial cyst posteriorly. After proper case taking, Lycopodium was prescribed based on the totality of symptoms with the help of Synthesis Repertory [Radar opus version 3.1.5]. Lycopodium 0/1 to Lycopodium 0/11, 16 doses of each potency on alternate days were administered to the patient. The medicine was given in fifty millesimal potency. The patient started feeling better after a few months of treatment as the intensity of pain and flow of menstrual blood decreased with the relief of other symptoms. The patient was completely cured after eleven months of treatment. Adenomyosis responded well to individualized homoeopathic medicine after repertorization with Synthesis Repertory. In this case report, homoeopathic treatment is recommended as a promising complementary or alternative therapy.

A 27-year-old lady from Murshidabad visited Obs. & Gyn. OPD of National Institute of Homoeopathy on 22 nd March 2022, presented with complaints of excessive menstrual bleeding for the last 3-4 months. Menstrual cycle flow was heavy for 8-9 days. It was a known case of Diffuse Uterine Adenomyosis, as detected by USG of the whole abdomen on 30 th Jan 2022. After proper case-taking and repertorization with the help of Synthesis Repertory, Lycopodium was selected. Lycopodium 0/1 to 0/11, 16 doses of each potency on alternate days were administered to the patient based on the totality of symptoms. The patient was completely cured after 11 months of treatment. This case report also emphasises the significance of repertorization with Synthesis Repertory and individualized homoeopathic prescription in a patient suffering from Adenomyosis.

1. Shivakumaraswamy P, et al. Ayurvedic management of adenomyosis-A case report. Int Ayurvedic Med J., 2021. 2. Kho KA, Chen JS, Halvorson LM. Diagnosis, evaluation, and treatment of adenomyosis. JAMA. 2021;326(2):177-178. 3. Shi J, Wu Y, Li X, et al . Effects of localization of uterine adenomyosis on clinical features and pregnancy outcome. Sci Rep. 2023;13:14714. 4. Lax S. Mesenchymal uterine tumors. Stromal tumors and other rare mesenchymal neoplasms. Pathologe. 2009;30(4):284-291. 5. Taran FA, Stewart EA, Brucker S. Adenomyosis: epidemiology, risk factors, clinical phenotype and surgical and interventional alternatives to hysterectomy. Geburtshilfe Frauenheilkd. 2013;73(9):924-931. DOI:10.1055/s-0033-1350840. 6. Benagiano G, Brosens I. History of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):449-463. DOI: 10.1016/j.bpobgyn.2006.01.007. 7. Renner SP, Lermann J, Hackl J, et al . Chronische Erkrankung. Endometriose. Geburtsh Frauenheilk. 2012;72:914-919. 8. Brosens I, Gordts S, Habiba M, Benagian o G. Uterine cystic adenomyosis: a disease of younger women. J Pediatr Adolesc Gynecol. 2015;28(6):420-426. 9. Pados G, Gordts S, Sorrentino F, et al . Adenomyosis and infertility: A literature review. Medicina (Kaunas). International Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com ~ 244 ~ 2023;59(9):1551. DOI:10.3390/medicina59091551. 10. Sharma R. A case report on Ayurvedic management in adenomyosis. J Ayu Int Med Sci. 2022;7(11):191-194. 11. Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000Res. 2019;8:283. 12. Konar H. DC Dutta’s textbook of gynec ology. 8th ed. JP Medical Ltd, 2020. 13. Parazzini F, Panazza S, Chatenoud L, et al. Risk factors for adenomyosis. Hum Reprod. 1997;12:1275-1279. DOI:10.1093/humrep/12.6.1275. 14. Taran FA, Weaver AL, Coddington CC, Stewart EA. Understanding adenomyosis: a case-control study. Fertil Steril, 2009. DOI: 10.1016/j.fertnstert.2009.06.049. 15. Peric H, Fraser IS. The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):547-555. DOI: 10.1016/j.bpobgyn.2006.01.006. 16. Naftalin J, Hoo W, Pateman K, et al. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynecology clinic. Hum Reprod. 2012;27:3432-3439. DOI: 10.1093/humrep/des332. 17. Azziz R. Adenomyosis: Current perspectives. Obstet Gynecol Clin North Am. 1989;16(1):221-235. 18. Puente JM, Fabris A, Patel J, et al . Adenomyosis in infertile women: Prevalence and the role of 3D ultrasound as a marker of severity of the disease. Reprod Biol Endocrinol. 2016;14(1):60. 19. Donato DN, Montanari G, Benfenati A, et al . Prevalence of adenomyosis in women undergoing surgery for endometriosis. Eur J Obstet Gynecol Reprod Biol. 2014;181:289-293. 20. Eisenberg VH, Arbib N, Schiff E, et al . Sonographic signs of adenomyosis are prevalent in women undergoing surgery for endometriosis and may suggest a higher risk of infertility. Biomed Res Int. 2017;2017:8967803. 21. Brucker SY, Huebner M, Wallwiener M, et al. Clinical characteristics indicating adenomyosis coexisting with leiomyomas: A retrospective, questionnaire-based study. Fertil Steril. 2014;101(1):237-41.e1. DOI: 10.1016/j.fertnstert.2013.09.038. 22. Taran FA, Weaver AL, Coddington CC, et al . Characteristics indicating adenomyosis coexisting with leiomyomas: A case-control study. Hum Reprod. 2010;25(5):1177-1182. 23. Dueholm M, Lundorf E. Transvaginal ultrasound or MRI for diagnosis of adenomyosis. Curr Opin Obstet Gynecol. 2007;19:505-512. DOI: 10.1097/GCO.0b013e3282f1bf00. 24. Moawad G, Fruscalzo A, Youssef Y, et al . Adenomyosis: an updated review on diagnosis and classification. J Clin Med. 2023;12(14):4828. DOI: 10.3390/jcm12144828. 25. Tellum T, Nygaard S, Lieng M. Noninvasive diagnosis of adenomyosis: A structured review and meta-analysis of diagnostic accuracy in imaging. J Minim Invasive Gynecol. 2020;27:408-18.e3. 26. Harmsen MJ, Bosch VDT, Leeuw DRA, et al . Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol. 2022;60(1):118-131. DOI: 10.1002/uog.24786. 27. Vannuccini S, Luisi S, Tosti C, et al. Role of medical therapy in the management of uterine adenomyosis. Fertil Steril. 2018;109(3):398-405. DOI: 10.1016/j.fertnstert.2018.01.013. 28. Tosti C, Troìa L, Vannuccini S, et al . Current and future medical treatment of adenomyosis. JE. 2016;8:127-135. DOI: 10.5301/je.5000261. 29. Salauddin M, Singh PK, Singh S, Chhabra APS. Adenomyosis and its homoeopathic management. Int J Homoeopath Sci. 2020;4(4):15-16. 30. Pandey S. A case report on adenomyosis. J Ayu Int Med Sci., 2024. 31. Synthesis Repertory (RADAR opus 3.1.5). How to Cite This Article Anand GRDJ, Gautam M, Lalhmangaihsangi C, Srivastava BP. Individualized homoeopathic treatment of adenomyosis: A case report. International Journal of Homoeopathic Sciences . 2025;9(1):240-244. Creative Commons (CC) License This is an open-access journal, and articles are distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 International (CC BY-NC-SA 4.0) License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.