Ovarian chocolate cyst treated successfully with homoeopathic constitutional remedy: A case report

Adnexal lesions are fairly common in women of reproductive age; they are often detected accidentally but may present with symptoms. The ovarian involvement is seen in approximately 50% of cases, where endometrial cysts, also referred to as chocolate cysts, are the most prevalent lesions.[1,2] These cysts are normally filled with menstrual blood, and according to a hypothesis, the uneven surface of the ovaries encourages endometriosis spread.[3] One of the uncommon side effects of a chocolate cyst is gynaecological emergencies, such as bleeding, torsion and rupture, as well as adhesion to other intra-abdominal organs and fistula formation.[4] Among the reproductive age group, approximately 17–44% of women with endometriosis are diagnosed with chocolate cysts.[5] While the cause of ectopic endometrium is still unknown, some gynaecologists believe that it comes from endometrial tissue in monthly bleeding that backflows, while others assume that coelomic metaplasia is to blame. [6] Functional or physiological cysts, such as corpus luteal cysts and follicular cysts, can develop when follicles fail to mature during ovulation because of excessive follicle-stimulating hormone levels or the absence of a luteinising hormone surge right before ovulation. The diameter of follicle cysts is typically >2.5 cm. Granulosa cells produce excess oestrogen, which leads to less frequent menstruation. Haemorrhagic cysts can develop from corpus luteal cysts and follicle cysts.[7,8] While laparoscopy is the gold standard diagnostic technique, ultrasound screening has become popular for detecting ovarian pathology. Ovarian lesions have high specificity (73–83%) and sensitivity (89–100%) when scored sono graphically.[9,10] An ovarian endometriotic cyst often has

Endometriomas (ovarian endometriotic cysts), commonly referred to as chocolate cysts, represent the most frequent ovarian manifestation of endometriosis. This report describes the case of a 22-year-old woman diagnosed with endometriosis and a right ovarian endometrioma who was managed in an outpatient setting in 2021. A detailed case evaluation was performed, and an individualized homoeopathic prescription was formulated based on the totality of symptoms. Thuja was prescribed initially, followed subsequently by Medorrhinum. Complete remission was observed during the course of treatment. This case suggests the potential role of individualized homoeopathic management in the treatment of ovarian endometrioma. Further well-designed clinical studies are warranted to evaluate the effectiveness of this therapeutic approach.

Amenorrhoea, Corpus luteal cysts, Endometrioma, Homoeopathy, Ovarian cyst This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. ©2026 Published by Scientific Scholar on behalf of Journal of Integrated Standardized Homoeopathy *Corresponding author: Dr. Arpita Sen, Department of Organon of Medicine, National Institute of Homoeopathy, Kolkata, West Bengal, India. [email protected] Received: 27 March 2024 Accepted: 18 September 2025 EPub Ahead of Print: 11 August 2026 Published: DOI 10.25259/JISH_22_2024 Quick Response Code: www.jish-mldtrust.com Journal of Integrated Standardized Homoeopathy Article in Press Sen: A case of ovarian cyst treated successfully with homoeopathic constitutional remedy Journal of Integrated Standardized Homoeopathy • Article in Press | 2 a diffuse, low-echoic look, with sporadic hyperechoic foci in the wall of the cyst, which can range in diameter from 3 to 6 cm. [11] It is typically described as having inner echoes that resemble ground glass and show up on ultrasono graphy as a complex mass.[12] In this report, we present a case of a unilateral chocolate cyst that changed to a bilateral ovarian cyst and was completely treated with homoeopathic remedies. CASE REPORT A 22-year-old married woman presented to the outpatient department of the National Institute of Homoeopathy, Salt Lake, Sector 3, Kolkata, on 08  September 2021, with an ultrasound report showing a diagnosis of endometriosis containing a right ovarian chocolate cyst. Present complaints • Menses have been irregular for 4–5 months • Last menstrual period: 15 July 2022 • Pain cutting in the lower abdomen 2  days before menses, which aggravates significantly during the flow, accompanied by backache and is ameliorated after menses • Scanty flow of menses • Itching of the vulva during menses • Offensive menstrual discharge • Menstrual blood stains clothes and is difficult to wash off • Painful small eruptions on the scalp along the hairline, itching when dry • Pain in the vertex and sensation of burning in the eyes • Itching vesicular eruptions over the buttocks for 1 month, itching < on applying water • Flatulence, sour taste of the mouth • Coition painful, sensitive vagina. Menstrual history • Onset: 12 years of age • Duration: 3 days • Cycle: Early and scanty • Colour: Blackish menstrual discharge. Medical history • Jaundice: 6 years of age • Measles: 20  years of age and 2 nd  time, 3  months after delivery • Shoulder dislocation after a fall: 5 years prior • Chicken pox: 21 years of age. Family history Paternal side • Father: Diabetes, carbuncle • Grandmother (dead): Diabetes mellitus. Maternal side • Mother: Uterine tumour (operated), appendicitis (operated). Personal history Patient has no addictions; she lives in a well-ventilated house. She consumes a mixed diet and eats at regular intervals. Generalities Physical generals • Appetite: Moderate • Desire: Sour (++) • Aversion: Nothing in particular. • Intolerance: Meat (++), fatty foods (+) • Thirst: Moderate • Tongue: Coated white in the middle • Perspiration: Profuse with strong odour • Urine: Clear • Stool: Constipated, not clear • Sleep: Disturbed • Dreams: Falling from height (++), of dead (+) Mental generals • Short tempered • Cries when angry • Thoughts of suicide • Desire to be alone • While walking alone feels as if someone is behind her • Hallucinations as if someone were passing by • Aversion to music that makes her sad. Investigations Patient brought an ultrasound report [refer Figure 1]: Right ovary: Chocolate cyst measuring 3.88 cm × 3.55 cm in size, with the right ovary measuring 5.35 cm × 4.27 cm. Left ovary normal in size, shape, and parenchymal echo pattern. Impression: Thickened endometrium 1.55  cm. Bulky right ovary with right ovarian chocolate cyst. Sen: A case of ovarian cyst treated successfully with homoeopathic constitutional remedy Journal of Integrated Standardized Homoeopathy • Article in Press | 3 Evaluation of symptoms Mental • Desire to be alone • While walking alone feels as if someone is behind her • Hallucinations as if someone were passing by • Aversion to music, which makes her sad. Physical • Scanty flow of menses • Itching of the vulva during menses • Menses are difficult to wash off • Coition painful, sensitive vagina • Desire for sour foods • Intolerance to meat, fatty foods • Pain in the vertex and sensation of burning in the eyes • Disturbed sleep • Dreams of falling from a height, of dead • Perspiration profuse and strong odour. Particulars • Pain in lower abdomen 2 days before menses, aggravates significantly during the flow, accompanied by backache, and is ameliorated after menses. Totality of symptoms • Desire to be alone • While walking alone feels as if someone behind her • Aversion to music, which makes her sad • Coition painful, sensitive vagina • Pain in lower abdomen before menses • Difficult to wash off • Scanty flow of menses Based on the above miasmatic explanation of symptoms [Table 1], we can infer that the individual has a Psora-Sycotic background.[13] • Itching of genitalia during menses • Desire for sour • Intolerance to meat • Disturbed sleep • Dreams of falling from height, of dead • Sensation of burning in eyes. Rubrics for reportorial analysis 1. Mind – Company – aversion to 2. Mind – Delusions – people – behind him; someone is 3. Mind – Music – agg 4. Female genitalia/sex – coition – painful 5. Female genitalia/sex – pain- menses – before- agg 6. Female genitalia/sex – sensitiveness 7. Female genitalia/sex – menses – wash off, difficult to 8. Female genitalia/sex – menses – scanty 9. Female genitalia/sex – itching – vagina 10. Generals – food and drinks – meat- agg 11. Generals – food and drinks – sour foods, acids – desire 12. Sleep – disturbed 13. Dreams – dead bodies 14. Dreams – falling 15. Eye-pain – burning. Analysis of repertorial result The synthesis repertory was consulted, and the symptoms were repertorised using the RADAR software.[14] Kali carb, Calcarea carb and Thuja covered all 13 symptoms, followed by sulphur covering 12 symptoms and sepia 11 symptoms [Figure 2]. Final selection of medicine Though Kali carb secured the highest score, Thuja seems to be indicated as the patient concerned has a sycotic inclination which we can see from her family history where her mother had a uterine tumour and appendicitis. Thuja also covers the sphere of action of the ailment i.e., genito-urinary organs. After considering the entire case, including the patient’s current complaints, medical and family history, and consulting the Materia Medica, Thuja was the final prescription. Prescription • Thuja 0/2, 16 doses Figure  1: Ultrasound report of whole abdomen before treatment (21  August 2021). (USG: Ultrasonography, VU: Vesicoureteral, SOL: Space-occupying lesion, POD: Pouch of Douglas). Sen: A case of ovarian cyst treated successfully with homoeopathic constitutional remedy Journal of Integrated Standardized Homoeopathy • Article in Press | 4 Table 1: Follow-up. Date Complaints Medicine 28 September 2021 LMP 20 August 22. Pain before menses slightly reduced, with reduction in itching eruption on buttocks and genitalia, also improvement seen in vertex pain. However, her menstrual flow remains scanty and painful coition persists Thuja 0/3, 16 doses, 1/day Potency raised to Thuja 0/4, 16 doses, 1/day 20 October 2021 LMP 25 September 22. Pain before menses reduced, flow scanty, itching in vulva during menses reduced, coition painful, eruption along on hairline margin much reduced significantly, itching eruption on buttocks ameliorated, burning eyes reduced, sleep slightly disturbed, dreams of dead Thuja 0/5, 16 doses, 1/day Thuja 0/6, 16 doses, 1/day 26 November 2021 LMP 25 October 2022. Pain before menses reduced but still present, itching in vulva reduced, coition painful, eruptions along on hairline margin ameliorated, burning eyes present remains, sleep slightly disturbed Thuja 0/7, 16 doses, 1/day Thuja 0/8, 16 doses, 1/day 3 January 2022 LMP 22 December 2022. Pain before menses now slight, but more when flow starts, itching in vulva reduced, coition painful, burning eyes persists remains, sleep slightly disturbed, dreams of falling Thuja 0/9, 16 doses, 1/day Thuja 0/10, 16 doses, 1/day 14 March 2022 LMP 19 February 2022. Pain before menses now only in the small of the back, itching in vulva much reduced and coition painful reduced, burning eyes reduced, sleep slightly disturbed Thuja 0/11, 16 doses, 1/day Thuja 0/12, 16 doses, 1/day 09 May 2022 LMP 16 April 2022. Some backache before menses, pain during menses reduced, menses stain difficult to wash off, offensiveness present, itching in vulva no more, coition painful much reduced, burning eyes ameliorated, sleep better, hallucinations of someone beside her Thuja 0/13, 16 doses, 1/day 21 June 2022 LMP 15 May 2022. Some backache before menses, pain during menses reduced but remains, menses stain difficult to wash off, offensiveness present, hallucinations of someone beside her, thirst much, especially of fridge water. Itching genitalia returned again. Aversion to company. Much desire for sour. Burning of feet present. All these symptoms finds Medorrhinum in its simillimum [refer Figure 3] 1. Medorrhinum 200, 2 doses, 1/day. 2. Placebo, in 1 drachm globules/day for 1 month. 04 August 2022 LMP 11 July 2022. Overall better, menstrual troubles reduced but offensiveness of discharge present, difficult to wash off, hallucinations of someone beside her now less often, thirst much, especially of fridge water 1. Medorrhinum 1M, 1 dose/ day 2. Placebo, in 1 drachm globules/day for 1 month. 15 October 2022 LMP 13/09/22. Patient is better overall [refer Figure 4] Placebo LMP: Last menstrual period Figure 2: Repertorial chart 1. Sen: A case of ovarian cyst treated successfully with homoeopathic constitutional remedy Journal of Integrated Standardized Homoeopathy • Article in Press | 5 • One medicated globule no. 10 in 120 mL of aqua dist • Add 10 drops of rectified spirit • Mark 16 doses • Take one dose every morning on an empty stomach for 16 days. Administer 10 uniform downward strokes before each successive administration. Take one teaspoon of the solution from the stock bottle and put it in the glass. Add four ounces of distilled water to the glass. Stir briskly. Take only one teaspoon from this glass and place it in your mouth, holding it under your tongue if possible, for a moment before swallowing. Discard the remainder of the remedy solution left in the glass. To be taken early in the morning on an empty stomach. Every day, go for a vigorous 30-min walk in the morning and perform Surya Namaskar. In the evening, practice the following yoga poses: Padmasana, Bhadrasana, Bhujangasana, Naukasana, Sukhasana, and Chakrasana. If possible, take a 30-min brisk walk in the evening as well. Get enough rest–7 or 8 h. Diet: Steer clear of all fast food, greasy foods, chocolates, bread, pasta, biscuits, soft drinks and alcoholic beverages. Food amounts should be consistent, as should regular eating and snacking in between meals. Mealtimes should also be consistent and well-managed. Response The patient reported a remarkable reduction in pain before menses, with a gradual and steady improvement in her dysmenorrhoea, as well as changes in the colour and consistency of her menstruation, including less staining and regular menstrual cycles. The patient also reported improvements in her overall health and mental well-being. An ultrasound done [refer Figure 5] on 06 May 2022 revealed right ovary - 2.96 cm × 1.98 cm with a 2.30 cm × 1.63 cm cyst and left ovary - 2.42 cm × 2.20 cm, with a 1.63 cm × 1.38 cm cyst. Bilateral ovarian cyst was diagnosed without chocolate cyst; the endometrial echo texture was homogenous. Thuja was the first prescription and the potency was increased to 0/13. During the patient’s visit on 21 June 2022, no further improvement was noticed, and some new symptoms appeared, including increased thirst for cold water and burning of the feet. Therefore, the case was redefined based on the new symptoms. The following symptoms were taken into consideration: • Aversion to company • Delusion of someone behind her • Menses stain difficult to wash off • Itching of genitals • Desire for sour • Thirst for cold drinks • Burning of feet. Repertorial analysis on follow-up The synthesis repertory was consulted and the symptoms were repertorised using RADAR [14] software. Medorrhinum Figure 3: Repertorial chart 2. Figure  4: Ultrasound report of whole abdomen: Normal study (15  October 2022). (USG : Ultrasonography, CMD: Corticomedullary differentiation, ET: Endometrial thickness, SOL: Space-occupying lesion, POD: Pouch of Douglas). Sen: A case of ovarian cyst treated successfully with homoeopathic constitutional remedy Journal of Integrated Standardized Homoeopathy • Article in Press | 6 and Calcarea carb had the highest scores. Ovarian cyst is sycotic in nature, due to which Medorrhinumwas selected as an anti-sycotic nosode to complete the cure.[15,16]

We present a case of right ovarian chocolate cyst followed by bilateral ovarian cysts successfully treated with evidence- based homoeopathic medicine. Several studies have demonstrated the effectiveness of homoeopathy in the treatment of ovarian cysts, including endometriomas. A case report presents two cases of women diagnosed with ovarian cysts, who responded to treatment with the homoeopathic remedy Sepia that was prescribed based on individualisation of symptoms.[17] A study by Gupta et al., compared pre- and post-treatment ultrasonography reports. The difference in the mean maximum dimension of ovarian cyst was found to be statistically significant.[18] This is another case report of a 27-year-old woman with a cortical cyst (19  mm diameter) in the upper pole of the right kidney, multiple small cysts at the periphery of both ovaries with increased parenchymal echogenicity and a bulky uterus with thickened endometrium. She was treated successfully with the individualised homoeopathic remedy.[19] Another case report by Mahajan and Tayade presents the case of a 31-year-old woman diagnosed with a chocolate cyst of the ovary who was treated successfully with the individualised homoeopathic medicine Lachesis in centesimal potency.[20] Another case report by Rana and Villan describes the case of a 22-year-old woman diagnosed with an endometriotic cyst on the left ovary. She was treated with Pulsatilla 1M as the similimum.[21] In this case, the ovarian chocolate cyst associated with thickened endometrium was successfully managed with Thuja, prescribed as a constitutional remedy [refer Table 1]. A  second prescription is often required when the patient’s condition does not improve, accompanied by the addition of new symptoms. In this instance, the patient’s chocolate cyst was treated, but she thereafter developed bilateral ovarian cysts and some additional symptoms, necessitating a second prescription of Medorrhinum to fully resolve her issue.

While conventional medicine focuses on hormone therapy and surgical procedures, homoeopathy takes a holistic approach in treating the patient. The case study provided here, together with other documented cases of effective therapy found in the literature, demonstrates the effectiveness of homoeopathic management in the treatment of ovarian chocolate cysts. However, a multicentric study using a randomised controlled trial with an adequate sample size would elucidate the effectiveness of homoeopathic remedies in such disorders. Ethical approval: Institutional Review Board approval is not required. Declaration of patient consent: The author certifies that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understand that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest. Use of artificial intelligence (AI)-assisted technology for manuscript preparation: The author confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

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