Minton’s uterine therapeutics and its utility in common obstetrics and gynaecological conditions

Dr Shriraksha B

INTRODUCTION
Obstetrics and Gynaecology are the two branches of medical science that specialize in the care of women during pregnancy, childbirth, post partum and in the diagnosis and treatment of diseases of female reproductive organs respectively.

Uterine Therapeutics by Henry Minton published in 1883 is a regional repertory which is mainly focused on uterine disorders. It is a useful monograph on the problems of menstruation and other female complaints.

Uterine therapeutics is a repertory that contains many rubrics that can be used in treating various Obstetrical and Gynaecological conditions

It  is divided into 2 parts

Part I contains ‘Remedies and their indications’ in which remedies are discussed under the following headings

• Menstruation
• Before menstruation
• During menstruation
• After menstruation
• Amenorrhoea
• Metrorrhagia
• Lochia
• Leucorrhoea
• Concomitants
• Aggravations
• Ameliorations

Last paragraph of each remedy deals with the constitution and adaptability of the remedy in brief.

Part II contains the Repertory part. It has following sections

• Menstruation: Before menstruation

                          During menstruation

                          After menstruation

• Amenorrhoea
• Metrorrhagia
• Lochia
• Leucorrhoea
• Concomitants
• Aggravations
• Ameliorations

In the modern days due to lifestyle, increasing stress and some habits women are facing a lot of Obstetrical and Gynaecological problems.

Since Homoeopathy is a holistic system and focuses on the person as a whole by taking into consideration of the mental, physical and lifestyle aspects of a person along with the disease conditions it has a great scope in treating and curing many of these health conditions and thereby improving the health and wellbeing as well as the quality of life of the individuals.

In this article there is an attempt made to understand some of the common conditions related to OBG and the application of uterine therapeutics in those conditions.

DYSMENORRHOEA
It is painful menstruation of sufficient magnitude so as to incapacitate day to day activities.

It is of 2 types

• Primary
• Secondary

a)Primary dysmenorrhoea (Spasmodic): It is the one where there is no pelvic pathology.

Causes of pain: Mechanism of initiation of pain is difficult to establish. Some related factors are

• Confined to adolescents
• Confined to ovulatory cycles
• Pain is related to dysrhithmic uterine contractions and uterine hypoxia.

Clinical features:

• Pain is spasmodic and confined to lower back
• Begins with the onset of menstruation, lasts for few hours up to 24 hours.
• Systemic discomforts like nausea, vomiting, fatigue, diarrhea, headache, fainting maybe associated.

Rubrics:

During menstruation, concomitant symptoms

• Abdomen, pains in, spasmodic
• Abdomen pains in, extending to thighs
• Colic
• Diarrhea
• Fainting, fits or spells of
• Headache, pain in the head
• Nausea

b) Secondary Dysmenorrhea (Congestive): It is menstruation associated pain occurring in the presence of pelvic pathology.

Causes of pain:

• Chronic pelvic infection
• Pelvic endometriosis, adenomyosis
• Pelvic adhesions
• Uterine tumors, fibroids

Clinical features:

• Dull pain in the lower back and abdomen
• Begins 3-5 days prior to the onset of menses, relieves once the bleeding starts.
• Discomfort in between the periods
• Pain and other symptoms depending upon pathology.

Rubrics:

Before menstruation, concomitants

• Abdomen, pains in, spasms in
• Back pain in
• Pelvis congestion of

During menstruation, concomitants

• Pains in general, dysmenorrhoea
• Uterus, congestion of
• Uterus, displacements of
• Uterus enlargement of

DYSFUNCTIONAL UTERINE BLEEDING (DUB)
It is a state of abnormal uterine bleeding without any clinically detectable pelvic pathology.

Also known as abnormal uterine bleeding (AUB).

Causes:

• The abnormal bleeding is most likely due to local causes in the endometrium.
• Disturbance of endometrial blood vessels and capillaries and coagulation of blood in and around these vessels.
• Secondary to incordination in hypothalamo- pituitary- ovarian axis.
• Emotional influences, worries, anxieties or sexual problems.

Clinical features:

• Epimenorrhoea
• Oligomenorrhoea
• Functional menorrhagia
• Metrorrhagia

Rubrics:

Menstruation, time and quality of menstrual discharge

• Irregular
• Periods, discharge of blood between the
• Premature, returning too soon or too early
• Premature and profuse
• Protracted, continuing too long
• Profuse, menorrhagia
• Retarded, delaying
• Scanty, too
• Short duration, of too

FIBROID UTERUS:

It is the benign smooth muscle tumor of the uterus.

Also known as leiomyoma, myoma or fibromyoma.

Types:

• Body or corporeal
• Cervical

Clinical features:

• Menorrhagia
• Metrorrhagia
• Dysmenorrhoea
• Infertility
• Pain abdomen
• Abdominal lump or swelling

Rubrics:

Menstruation, time and quality of menstrual discharge

–     Periods, discharge of blood between the

–    Profuse, menorrhagia

During menstruation, concomitants

• Pains in general, dysmenorrhoea
• Uterus, congestion of
• Uterus enlargement

General concomitants- Uterus

• Polypi in

Generalities

• Sterility

Persons- remedies especially suited for

• Uterine disorders, who suffer from

MENORRHAGIA
It is the cyclical bleeding at normal intervals, where the bleeding is either excessive in amount or duration or both.

Causes:

• Pelvic pathologies like uterine fibroid, adenomyosis, pelvic endometriosis,
• Systemic disorders liver dysfunctions, congestive cardiac failure, severe hypertension
• Endocrinal causes like hypothyroidism, hyperthyroidism
• Blood dyscrasias like idiopathic thrombocytopenic purpura
• Emotional causes

Clinical features:

• Long duration of flow
• Passage of big clots or usage of more, thick sanitary pads
• Pallor or low level of hemoglobin due to excessive bleeding.

Rubrics:

Menstruation, time and quality of menstrual discharge

• Profuse, menorrhagia
• Profuse and protracted
• Profuse in women, hysterical
• Profuse in women, plethoric
• Profuse when frightened
• Protracted, continuing too long

During menstruation, concomitants, paleness of face

ABNORMAL VAGINAL DISCHARGES:Vaginal discharges range from normal excessive discharge to a wide spectrum of ailments.

Causes:

• Leucorrhoea: it is an excessive normal vaginal discharge during puberty, pregnancy, premenstrual phase, non infective cervical and vaginal lesions
• Infections: Trichomonas, Candidial, Monilial infections
• Pelvic inflammations
• Foreign body: Tampoons, IUCDs
• Neoplasms

Clinical features:

• Vaginal discharge: white/ yellow/ green or purulent depending on the cause

                               Offensive/ odorless

• Pruritus
• Pelvic pain
• Low Back pain

Rubrics: This chapter includes rubrics related to leucorrhoea as well as other abnormal vaginal discharges under one heading, Leucorrhoea.

Leucorrhoea, character of discharge

• Acrid
• Chronic
• Greenish
• Offensive
• Profuse
• Yellow

Leucorrhoea, cause, time, aggravation, and amelioration of the discharge

• After abortion
• After the menopause
• Menstruation before

Leucorrhoea, concomitants

• Abdomen pains in
• Back pains in
• Debility and lassitude

ABORTION
Abortion is the expulsion or extraction from its mother an embryo or fetus when it is not capable of independent survival.

Abortion can be spontaneous or induced.

Spontaneous abortion can be classified into

• Threatened
• Complete
• Inevitable
• Incomplete
• Missed
• Septic

Causes for spontaneous abortion:

• Genetic factors
• Infection
• Endocrine or metabolic factors
• Immunological
• Anatomical factors

Clinical features:

• Bleeding per vagina
• Pain abdomen
• Complications like fever, infections, sepsis.

Rubrics

Abortion- miscarriage

• Abortion, predisposition to
• Abortion, threatened

Abortion, causes

• Anemia
• Fright
• Inertia, uterine
• Spinal affections

Character of discharge

• Black
• Bright red
• Coagulated
• Continuous
• Intermittent

Character of pain- Hypogastric and Uterine region

• Pain above the umbilicus, passing off into the uterus
• Pain, labor like
• Pain, labor like, alternating with haemorrhage
• Sinking, empty feeling in

Other than these there are certain rubrics related to time of abortion

• Second month
• Third month
• Fifth to seventh month
• Pregnancy in the early months of
• Pregnancy in the last months of

This Repertory apart from these clinical sections also consist of a separate section called General concomitants which is dedicated to entire parts of the body. It starts with ‘Mind and mood’ and ends with ‘Generalities’ within which all parts of the body along with their symptoms or complaints are included.

This chapter also includes a section called as ‘Persons- remedies especially suited for’ in which there are rubrics related to different constitutions, stages of life, body types, tendencies and nature of individuals

Eg:

• Abdomen with large
• Anaemic
• Choleric
• Elderly
• Flabby
• Hysterical
• Widows

All these rubrics help in individualization and final selection of the remedy.

CONCLUSION
These are some of the commonly seen conditions in Obstetrics and Gynaecology and the application of Minton’s Uterine therapeutics in those conditions.

This repertory even though a regional repertory, can be used in constitutional prescription also because of the last section.

The part I Remedy indications also help in reference work and thereby aids in the selection of similimum.

REFERENCE

1. Minton H. Uterine therapeutics. New Delhi: B. Jain; 2005.
2. Tiwari S K, Essentials of Repertorization, New Delhi: B Jain publishers; 2012.50,59.
3. Konar H. D.C Dutta’s textbook of Gynaecology. 6th ed. Kolkata, India: JAYPEE Publishers; 2013.
4. Dutta D C, Konar H. DC Dutta’s textbook of Obstetrics. 6th ed. Kolkata; New central book agency (P) Ltd 2004.

Dr Shriraksha B
MD Part II
Department Of Repertory
GHMC&H Bengaluru