Polycystic ovary syndrome and homoeopathic management- case report

Dr Chanda Gupta

ABSTRACT:
Polycystic ovary syndrome is the most common endocrinopathy affecting up to 10% of women of reproductive age and accounts for 72-84% of adult hyperandrogenism. The incidence is increasing because of the change in lifestyle including sedentary habits, increasing intake of junk food, and higher stress levels¹. A case of 14 years female suffering from PCOS was treated successfully by single individualised homoeopathic medicine Lachesis Mutus 30 to 1M potency. The improvement is evident from regular menstrual cycle and ultrasonography reports.

INTRODUCTION:
PCOS is the most common health issue in Adolescence now a days due to sedentary habits. Prevalence of PCOS in Indian Adolescents is 9.13%². Young women with PCOS present with amenorrhea or oligo-menorrhea and signs of hyperandrogenism, including hirsutism, acne, scalp hair loss, seborrhoea, or hyperhidrosis. They are often, but not always overweight. The diagnosis of PCOS has lifelong implications with increased risk for metabolic syndrome, type 2 diabetes mellitus, and possibly cardio vascular disease (CVD) and endometrial carcinoma. Over diagnosis of PCOS can lead to unnecessary investigations and interventions, and can create early and unwarranted anxiety about future fertility for the young women and her family. 

Establishing a diagnosis of PCOS is problematic in adolescents because of an overlap between normal pubertal development and characteristic features of PCOS. Hyperandrogenism is central to the presentation in Adolescents. It should be considered in Adolescents who present with unwanted hair growth in a male-like pattern (hirsutism), moderate to severe inflammatory acne, and/or menstrual irregularities. 

Different diagnostic criteria for polycystic ovary syndrome: 

Criteria	Hyperandrogenism	Oligo/anovulation	Polycystic ovaries
National Institute of Health (NIH)	+	+	±
Rotterdam criteria (if 2 of 3 present)	+	+	+
Androgen Excess society criteria	+	± (either of two)	± (either of two)
Amsterdam criteria (all 3 should be present)	+	+	+

Generally, the National Institute of Health (NIH) criteria are preferred in Adolescents, which include patients with anovulatory cycles and clinical or biochemical evidence of hyperandrogenism, with or without polycystic ovaries on ultrasonography, in whom other diagnosis (e.g. late-onset congenital adrenal hyperplasia and thyroid disease) have been excluded. 

Following is a case of PCOS in Adolescence age group treated successfully with Homoeopathy.

CASE:   A 14 year old female of height 148cm and weight 50kg with the clinical history of irregular menses for 2 years reported to the outpatient department (OPD) of government homoeopathic medical college, Bengaluru on 14^th January 2019. Her duration of cycle was 45-60 days. Character of flow was dark red colour with large clots with profuse flow for 15-16 days with 3-4 pads/day. No pain before, during and after menses, LMP-17/12/2018. She was also having hair fall since 2 years. Also complaints of black discolouration in nape of the neck, bilateral axillary region, bilateral groin region since 1 ½ years.

Treatment history: she took allopathic medicine for 2 months for irregular menses, then left and found the same irregularity.

INVESTIGATION REVEALED:
Haemoglobin- 8.4 gm/dl [figure 1], Normal glucose tolerance test (GTT), fasting blood glucose – 98 mg/dl and thyroid stimulating hormone (TSH) – 0.55 mIU/ml. A pelvic ultrasound revealed bilateral polycystic ovarian morphology. [figure 2]. Investigation for testosterone and follicle stimulating hormone was not done.

figure 1: Before treatment                                                          figure 2: Before treatment

PAST HISTORY: Nasal polyps (left side), taken homoeopathic treatment 4 years back- cured

FAMILY HISTORY: Family history revealed hypertension in father and paternal grandmother, hypothyroidism and bilateral PCOD in mother. Others were apparently healthy.

PHYSICAL GENERALS: She was non vegetarian, her appetite was good, had desire for sour food, aversion for milk. Thermally she was hot. She was thirst less (1/2 – 1 litre water per day). Bowel movements were regular. Micturition satisfactory. Perspiration not marked. 

MENTAL GENERAL: she was found to be very talkative and jealousy was marked.

BASIS OF PRESCRIPTION: Following symptoms were repertorised, Loquacity, jealousy, desire for sour food, aversion for milk, thirst less, menses protracted, menses clotted and cystic ovaries by Radar software. After repertorisation, Lachesis Mutus scored the highest score. [Figure 3].

FIRST PRESCRIPTION ON 15/1/2019

Lachesis mutus 30, 3 dose OD for 3 days and placebo for 15 days was given. Advised to avoid junk food and regular brisk walk for 20 to 30 minutes per day.

Follow up of the case is given in below table. 

Follow up date	Symptoms	Medicine, potency and doses
30/01/2019	LMP-20/01/2019 Duration of flow-5 days  Black discoloration on neck little better. Acne since 2-3 days	Placebo 4-4-4 for 30 days
25/02/2019	No menses yet. Hairfall increased, pimples reduced in size.	Placebo for 15 days
13/03/2019	No menses. No change in discoloration	Lachesis 200, 1 dose Placebo for 15 days
1/04/2019	LMP- 20/03/2019 Duration of flow- 5 days Hairfall reduced	Placebo for 30 days
27/05/2019	LMP- 24/04/2019 Duration of flow- 5 days No new complaints.	Placebo for 1 month
26/06/2019	No menses in May month. LMP- 21/06/2019 Duration of flow 6 days	Placebo for 1 month
28/07/2019	LMP- 23/07/2019 No clots, flow for 5 days	Placebo for 1 month
27/08/2019	LMP- 15/08/2019 6 days flow, clots present	Placebo for 1 month
05/11/2019	LMP- 18/09/2019 No menses in October month Hairfall again started	Lachesis Mutus 1M, 1 month Placebo for 1 month
25/11/2019	LMP- 11/11/2019 6 days flow, hairfall reduced Discoloration reduced	Placebo for month
20/02/2020	In December 2019 menses regular (LMP-27/01/2020). No new complaints.	Placebo for 1 month

 

After treatment: Haemoglobin-11.2 mg/dl                          USG: Ovaries echogenicity is normal on both side 

CONCLUSION:
PCOS can be successfully treated with Homoeopathic treatment based on detailed individual case analysis with lifestyle management. 

DECLARATION OF PATIENT CONSENT: parents consent and patient’s assent was taken for images and clinical information to be reported for this article.

REFERENCES:
Gupta Piyush, Menon PSN, Ramji Siddarth, Lodha Rakesh. PG Textbook of Pediatrics. 2^nd/e. Jaypee Brothers Medical Publishers (P) Ltd, New Delhi; 2018; 1190.

Nidhi Ram, Padmalatha Venkatram, Nagarathna Raghuram and Amritanshu Ram. Prevalence of Polycystic Ovarian Syndrome in Indian Adolescents. Journal of Pediatric & Adolescent Gynecology, 2011 May.

Dr.Chanda Gupta
MD Part 1- PG Department of Paediatrics,
Government Homoeopathic Medical College & Hospital,
Bengaluru.