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Management of uterine fibroid with homoeopathy: A case report
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Received: ,
Accepted: ,
How to cite this article: Maiti BP, Khadim AI, Jamatia S. Management of uterine fibroid with homoeopathy: A case report. J Intgr Stand Homoeopathy. 2023;6:137-43. doi: 10.25259/JISH_22_2023
Abstract
In women of reproductive age, uterine fibroids (UF) are among the most prevalent benign tumours. A female patient of 35 years of age presented with complaints of irregular, profuse menstrual flow with dull, aching pain in the whole abdomen during menses, having previously been diagnosed as ‘Uterine fibroid’ for one year. Homoeopathic medicine was prescribed on the basis of the totality of symptoms which restored the patient’s health. Initially, Calcarea carbonica 200C was given, and later, the potency was increased to 1M. Rhus Toxicodendron 30C was prescribed during the course of treatment for viral fever. The assessment of significant improvement was done using UF symptoms and a health-related quality of life questionnaire every three months. The Modified Naranjo Criteria for Homoeopathy (MONARCH)-causal attribution inventory was also used to evaluate the response of homoeopathic medication and further clarify the importance of individualised treatment in homoeopathy. This case study demonstrates the value of individualised homoeopathic treatment in the treatment of UFs.
Keywords
Uterine fibroid
Calcarea Carbonica
Homoeopathy
Individualisation
UFS-QOL
MONARCH
INTRODUCTION
The most common benign solid tumour or benign uterine tumour in females is fibroids. Uterine leiomyoma, myoma, or fibromyoma are the histological names for this tumour, which is made up of smooth muscle and fibrous connective tissue.[1] Fibroids are primarily asymptomatic, which leads to poor rates of clinical detection.[2] Myoma prevalence varies from 4.5% to 68.6% based on study demographics and diagnostic techniques.[3] It usually affects 20–25% of women over 30 years old.[4] Race, age, premenopausal age, high blood pressure, family history, using food additives, and drinking soybean milk are all risk factors for fibroid. The use of oral or injectable contraceptives, smoking among low-body mass index (BMI) women, and parity all minimise the risk factors.[1,3]
The majority of fibroid cases are asymptomatic; however, a symptomatic fibroid can vary greatly, including menorrhagia, metrorrhagia, dysmenorrhea, dyspareunia, infertility, and abdominal enlargement. Radiographs, transabdominal and transvaginal ultrasonography (USG), magnetic resonance imaging, and hysteroscopy can all be used to make a diagnosis. The most effective treatment for uterine fibroid (UF), especially in pre-menopausal women, is hysterectomy, which comes at a significant financial cost to the public health system.[5,6] According to a study, India had a substantially lower frequency of hysterectomy (10–20%) than other nations.[7] The risk of parity loss and several complications are both connected to hysterectomy.[4] As a result, women in the reproductive age group have avoided it.
Homoeopathy plays a key role in managing fibroid of the uterus judiciously through its individualistic approach to treatment. According to the World Health Organization, homoeopathy is the second most useful healthcare system in the world.[8] Many patients opt Homoeopathy as an alternative option of treatment due to side effects of modern medicines or to avoid surgical procedure. The rising use of homoeopathic remedies in the modern era has proved its effectiveness in clinical practice. There is no specific remedy for UF in homoeopathy. Despite the fact that we choose our medications based on individualisation, the following medicines have excellent effects on the UF such as – Calcarea carb., Calcarea flour., Conium., Thuja., Lycopodium, Phosphorus, Salix nigra, Lapis albus and Kali iod.[9,10]
However, there is limited research which is conducted that describes the effectiveness of homoeopathic medicines in UFs. The objectives of this case report are to describe the role of individualised homoeopathic medication for the management of UFs in accordance with the guidelines in the Hom-CASE (an extension to the CARE guideline for homoeopathic case report) regulation.[11]
CASE REPORT
Preliminary information
Age: 35 years, Sex: Female, Occupation: Govt. School Teacher, Education qualification: Graduate
Religion: Hinduism and belongs to Brahmin community. Marital status: Married and had two sons aged 18 years and 15 years, respectively—family members: Six (parents, husband and two children).
Chief complaints
A 35-year-old female patient came to our outpatient department on 03 March 2020, having complaints of irregular menses 8–10 days intervals of the previous last menstrual period (LMP), profuse menstrual flow with dull+++ aching pain in the abdomen during menses for the past 12 months. The flow was profuse+++, and had to change 8–10 pads daily for the first 5–6 days. Due to the profuse bleeding, she was irritable. Complaints were generally aggravated by slight physical exertion. In addition, she felt tired after the menses.
History of presenting complaints
The patient has been suffering from these complaints for one year. It was a known case of Intramural UF, as the patient was already under treatment of an allopathic doctor with a USG report showing the size of fibroid 41 × 30 mm, located at the fundoposterior wall of myometrium. In addition, the USG report also reveals mild hepatomegaly. Although she had not exhibited any symptomatology of hepatomegaly. After three months of treatment for UF, there was no symptomatic improvement. Hence, the patient was advised to have surgery. As the patient did not want to undergo surgery, she came to us for homoeopathic treatment.
Past history
She had suffered from typhoid fever in the year 2005, and with conventional treatment, she recovered well.
Family history
Father and mother both have been diagnosed with hypertension in the years 2000 and 2001, respectively. Both were taking the conventional medicine for their ailments.
Personal history
She is a teacher belonging to a middle class Hindu family. She has been married for ten years, at the age of 25 years. She has two sons; both of them were healthy and had normal deliveries—no history of abortion or miscarriage.
Mental generals
The patient was religious and visited different religious places every year to offer prayers. On enquiring, the patient was having a fear of darkness+++; she could not even sleep without turning on the light. The patient’s husband said that she was a strong personality, does not wish to change her opinion, and even gets offended easily.
Physical generals
On enquiring about her general physical symptoms, it was found that she is ambi thermal, prefers all seasons, and can bathe in both cold and hot water. Her appetite was less, with moderate thirst (2–3 L/day). She had a sound sleep of 6–7 hours. She had a desire for cold things, especially ice-cream+++, and used to take it every night before sleeping and had no specific aversion. She perspires a lot, especially on her forehead, even in the winter season. She had unsatisfactory urination passes 9–10 times a day with moderate quantity. Bowel movements were irregular, with hard, offensive stool passed every two days intervals. In the menstrual history, she had menarche at the age of 15 years. Her LMP was 15/01/2021 with profuse and aggravated on exertion, lasting for 6–7 days. The colour of the bleeding was bright red.
On examination, she was obese (78 kg) with a fair complexion. Her BMI was 26.8 kg/m2, and blood pressure was 110/90 mm of Hg. There was no sign of anaemia, jaundice, cyanosis, or oedema; lymph nodes are not palpable. However, on local examination, mild pain presents in the lower abdomen with no sign of any swelling or inflammation.
ANALYSIS OF THE CASE
To construct the complete set of symptoms, thorough case-taking was carried out for analysis and evaluation. The following mental general, physical general, and specific characteristic symptoms were considered for repertorisation using Dr. Kent’s method of gradation [Table 1]. Repertorisation was done by Kent’s repertory using ZOMOEO PRO software [Figure 1].
| Symptom classification |
Symptoms | Gradation |
|---|---|---|
| Mental generals | Religious | +++ |
| Headstrong/obstinate | ++ | |
| Easily offended | ++ | |
| Fear of darkness | +++ | |
| Physical | Desire for ice-creams | +++ |
| generals | Hard stool | ++ |
| Unsatisfactory urination | ++ | |
| Weakness during menses | +++ | |
| Heavy bleeding menses less | +++ | |
| than by exertion. | ||
| Characteristic | Perspiration on forehead | +++ |
| particular | Dull aching pain in the | +++ |
| abdomen during menses | ||
| Uterine fibroid | +++ |
- Repertorial sheet.
DIAGNOSIS AND CLINICAL ASSESSMENT
The diagnosis of the case was made based on the history, symptomatology (ICD-10-D25.1), and physical examination. In addition, the USG report revealed that it was a case of Intramural UF [Figure 2].
- Before treatment ultrasonography report.
UF symptom and health-related quality of life questionnaire (UFS-QOL) was used to assess the symptom severity and quality of life of the patient every three months (from baseline to end of the treatment) [Figure 3]. This questionnaire was used because, due to this disease, she felt very irritable, anxious, and worried about her health. She did not want to travel from one place to another place and felt drowsy and sleepy. It could hinder her daily physical activities, and she felt embarrassed. In addition, she had diminished sexual desire due to these complaints. Furthermore, the Modified Naranjo Criteria for Homoeopathy (MONARCH)-causal attribution inventory have been used to assess the response of the homoeopathic medicine; the score was 10, which further shows the relation of individualised homoeopathic medicine with the outcome [Table 2]. Objective evidence of the case was documented by the USG report at baseline and after treatment.
- Changes in UFS-QOL score in every three month (from baseline to last visit).
| Domain | Yes | No | Not sure or not available |
|---|---|---|---|
| Was there an improvement in the main symptom or condition for which the homoeopathic | +2√ | −1 | 0 |
| medicine was prescribed? | |||
| Did the clinical improvement occur within a plausible timeframe relative to the drug intake? | +1√ | −2 | 0 |
| Was there an initial aggravation of symptoms? | +1√ | 0 | 0 |
| Did the effect encompass more than the main symptom or condition (i.e., were other symptoms | +1√ | 0 | 0 |
| ultimately improved or changed) | |||
| Did overall well-being improve? (suggest using a validated scale or mention changes in physical, | +1√ | 0 | 0 |
| emotional, and behavioural elements) | |||
| Direction of cure: Did some symptoms improve in the opposite order of the development of | +1 | 0√ | 0 |
| symptoms of the disease? | |||
| Direction of cure: (Did at least two of the following aspects apply to the order of improvement of | +1 | 0 | 0√ |
| symptoms) | |||
| From organs of more importance to those of less importance? | |||
| From deeper to more superficial aspects of the individual? | |||
| From the top downward? | |||
| Did ‘old symptoms’ (defined as non-seasonal and non cyclical symptoms that were previously | +1 | 0√ | 0 |
| thought to have resolved) reappear temporarily during the course of improvement | |||
| Are there alternate causes (other than the medicine) that – with a high probability – could have | −3 | +1√ | 0 |
| caused the improvement? (consider known course of disease, other forms of treatment, and | |||
| other clinically relevant interventions | |||
| Was the health improvement confirmed by any objective evidence? (e.g., laboratory test, clinical | +2√ | 0 | 0 |
| observation, etc.) | |||
| Did repeat dosing, if conducted, create similar clinical improvement | +1√ | 0 | 0 |
| Total score: 10. |
MONARCH: Modified Naranjo Criteria for Homoeopathy
THERAPEUTIC INTERVENTION
The symptoms of the patient were analysed and evaluated. Prominent mental, physical, and particulars were taken into consideration for the formulation of the totality. The repertorisation was done with the help of ZOMEO PRO using Kent’s repertory[12] [Figure 1]. After repertorisation, Calcarea carbonica was the leading remedy that covered all the rubrics and obtained the highest marks (i.e., - 28/12). Although on repertorising the case, a few other medicines were running close, the medicines were – Phosphorus (21/10), Nux vomica (19/9) and Sulphur (18/8). The patient was obese with a fair complexion; mentally, she was obstinate and offended easily. She had a fear of the dark; she perspired more on her forehead and had a desire for ice cream; her menses were aggravated on exertion, and she complained of pain in the lower abdomen during menses. All these symptoms were prominent in this case. But, depending on repertorial totality and consultation with the Materia medica, Calcarea carbonica was the final selected remedy of the case. Calcarea carbonica 200C, two doses (one dose each day in the early morning on an empty stomach; each dose consists of four medicated globules) followed by a placebo was prescribed on the first visit (08 October 2021). The medicine was procured from GMP-certified SBL Pvt. Ltd. and dispensed from the institutional pharmacy.
Concomitant care
Along with individualised homoeopathic medicine (Calcarea carbonica), patients were advised on lifestyle management (LSM) such as – regular physical exercise (at least 30 min-1 h daily), maintaining a balanced diet (rich in green leafy vegetables, salads, tomato, beans, cucumber, lemon, etc.) avoid fat-rich diet and consume a sufficient amount of fluids.
POTENCY SELECTION
The potency selection depends on the seat, nature, intensity, stage, and duration of the disease. In this case, the disease was chronic in nature, and she suffered for a long time, as well as intensity was also high. Dr. Close has stated that ‘Susceptibility is the general quality or capability of the living organism to receive impressions and the power to react to stimuli.’ Susceptibility is greatest in young, vigorous persons, women, and children. The clear, finer, and more characteristic symptoms of the remedy were found in this case; hence, higher potency is selected.[13] Hence, in a nutshell, due to the clearer, finer, and characteristic symptoms of the medicine, it was decided to start with high potency in this case.
FOLLOW-UP
For a year, the case was followed up on at 1-month intervals, and over that time, a gradual improvement was observed [Table 3]. After taking her medication at the second visit, she complained of severe lower abdominal pain, but overall, she felt better. Because it appears to be an aggravation caused by homoeopathy, the medication is allowed to work, and a placebo was given. The fact that the frequency of the pain decreased on the subsequent visit further demonstrates that the medication was chosen appropriately. Due to the viral fever, Rhus toxicodendron 30C was administered at the fourth visit. However, the same complaints surfaced once more at the subsequent visit, so the same medication with a higher potency was prescribed. The patient’s overall condition improved steadily over the subsequent visits, and no new symptoms surfaced. Calcarea carbonica 1M was given at the fifth visit due to the standstill in the improvement. In addition, menses were regularised after the eighth visit, lasting 4–5 days with normal flow.
| Date of visit | Change of symptomatology | Treatment | Justification |
|---|---|---|---|
| September 08, 2021 | After three days of taking the medicine, she had her usual menstruation, and bleeding was more than previous (Using four pads in a day), with pain in the abdomen also increased. (LMP: 02/09/2021) However, she felt better. | Placebo for 15 days | Initial aggravation of the present complaint, but the intensity was less, and patient felt better overall. Hence, medicine was allowed to act. |
| October 09, 2021 | Occasional pain in the lower abdomen with hard and offensive stool. Stool passes every two days intervals. Urine passes frequently (7–8 times a day) |
Placebo for 15 days | To wait and allow the medicine to act |
| November 03, 2021 | From the past week, the intensity of pain in the abdomen was so violent that she could not tolerate it and she took a painkiller also. But, no menstruation sets in (Although the date was over) | Calcarea carbonica 200/2 dose for two days, followed by a placebo | The intensity of the pain has increased in the last one month. Hence, again, the same medicine is repeated with the same potency. |
| November 12, 2021 | After five days of taking medicine, menstruation sets in. However, this time, bleeding was less, with mild pain in the lower abdomen, lasting for five days. In addition, for the last two days she was suffering from mild fever with cough. Two days earlier, she had consumed cold drinks after that complaint occurred. LMP: 09/11/2021 (Bright red colour blood with no clot) |
Rhus Toxicodendron 30/6 dose; twice daily for three days | On the basis of acute totality |
| December 14, 2021 | Overall, she felt better. However, constipation is still present (every two days intervals)—however, no menstruation set in (Although the date was over). Frequency of urination reduced. |
Placebo for 15 days | To wait and allow the medicine to act |
| January 18, 2022 | Improvement remains the same, with no changes in bowel movement. LMP: 18/12/2021 (Regular menstrual cycle, bright red colour blood with clot). However, perspiration on the forehead has reduced for the last one week. |
Calcarea carbonica 1M/1 dose |
The condition remains the same; the same medicine is repeated but increases the potency due to the intensity of symptoms. |
| February 21, 2022 | Moderate improvement; overall better. The stool passes every one-day interval. LMP: 23/01/2022 (Bright red colour, lasts 5 days and moderate pain in the abdomen) |
Placebo for 15 days | No new complaints |
| March 21, 2022 | She was very happy and overall better. LMP: 27/02/2022 (Bright red colour blood, moderate amount with no clot and moderate feeling of weakness). Stool passes every day, but sometimes hard or sometimes soft. Urine was normal and passed 5–6 times daily. |
Placebo for 15 days | Improvement |
| April 22, 2022 | The patient felt better and had no new complaints. Stool passes every day with no difficulty. LMP: 30/03/2022 (Bright red colour blood, moderate amount with no clot; lasting five days). She perspired while she was going outside, but no perspiration while she was staying in the room. |
Placebo for 15 days | No new complaints |
| May 26, 2022 | She felt better and did all household activities without any problem. LMP: 02/05/2022 (Bright red colour blood, moderate amount with no clot; lasts four days) All the generals were normal. |
Placebo for 15 days | Marked improvement |
| June 27, 2022, up to the last visit, September 12, 2022 |
She had no new or old complaints; she was very satisfied with the treatment. During this time period, she had a regular menstrual cycle lasting 3–4 days (using two pads daily). Her bowel movement was regular, and her urine was also normal. In addition, Ultrasonography (USG) was advised on 30/08/2022. USG report revealed a normal study dated 09/09/2022. |
Placebo for one month Advice to visit if there is any recurrence of symptoms. | Advice to visit once every 6 months. |
LMP: Last menstrual period
RESULTS
The patient’s response to treatment was monitored every three months using UFS-QOL for symptom severity and quality of life of the patient (UFS-QOL total score, at baseline +112 and at the end of treatment +39) [Figure 3]. The curative response of homoeopathic medicine was assessed through the MONARCH inventory. The total score was 10 (in −6– +13 scales), which suggests a ‘definite’ association between medicine and outcome. Furthermore, the USG report also revealed that there was no intramural fibroid [Figure 4].
- After treatment ultrasonography report.
DISCUSSION
Fibroid is an abnormal growth that develops in the uterus, which hinders daily activity and affects the quality of life of an individual. Due to the prolonged, expensive, and surgical treatment, an increasing number of the patients turn toward homoeopathy for a safe and cost-effective mode of treatment. The above case showed the classical symptoms of UF, which was treated with the help of individualised homoeopathic medicine Calcarea carbonica in increasing potencies (200, 1M) according to the response of the patient over ten months and no adverse drug reaction or event were encountered during the period of treatment. Although, in this case, the USG report revealed that she also suffered from mild hepatomegaly but had not experienced any symptoms that corresponded with this pathology. Hence, only diet and LSM, along with indicated medicine, make the patient revert to her normal life.
Calcarea carbonica was found not only homoeopathically the most indicated remedy for this particular case of disease but also inhibited tumour cell growth and was observed in vivo experiments. It is a mineral-origin drug prepared from the soft middle layer of the oyster shell that is composed of fine crystalline calcium carbonate. The experiment was done on tumour-bearing mice. Calcarea carbonica helps to deplete CD4 CD8 cells and also inhibits T-cell proliferation. In addition, Calcarea carbonica helps in the activation of the immune system and induces cancer cell apoptosis through the immune-modulatory circuit.[14] Hence, the pharmacological action of the drug has been strongly correlated with the similimum of this case, apart from other symptomatology as described earlier. The potency selection and repetition were done based on the homoeopathic principles, susceptibility of the individual, and homoeopathic philosophy.[13,15,16]
Homoeopathy is a rational system of medicine that promotes the general well-being of the individual. This case report signifies that the more the similarity between a disease picture and a drug picture; the results are more likely to be promising. The speedy recovery of this case reduced the period of suffering, produced cost-effectiveness, and also improved the quality of life within a plausible time frame of medicine intake. This case also signifies the importance of individualisation in homoeopathy.
However, there is a paucity of studies on UF. Few published studies have shown promising results. An observational study conducted on 71 patients has shown positive results in terms of reduction and resolution of UF.[4] A case report published by Vishwakarma shows the positive result of the homoeopathic medicine Calcarea carbonica in the treatment of UF.[17] However, the scope and effectiveness of homoeopathic remedies have to be explored with more well-planned documented case reports or randomised clinical studies.
CONCLUSION
This case report demonstrates that individualised homoeopathy can effectively treat UF in a short amount of time. Although this single case report does not provide conclusive evidence, additional documented cases and scientific research may contribute to the development of evidence regarding the efficacy of homoeopathic medicines in the management of UF.
Acknowledgement
The author gratefully acknowledged the patient for her active cooperation and support.
Ethical approval
The Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm 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.
Financial support and sponsorship
Nil.
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