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A Tricky Case of Dysfunctional Uterine Bleeding

‘Shruti’ a 32 year old lady came with complaints of irregular menses since past two years, protracted with heavy flooding. The flow would continue for 10-12 days and was more on certain occasions.

A couple of months back she had developed horrible low abdominal pain during menses with heavy bleeding with clots which doubled her up and led her to consult her gynecologist who suggested her hysterectomy for which she and her husband were not ready. Complete bed rest was advised as there was excessive flooding.

Along with all these the problem which she presented with was one of troublesome urinary frequency and urgency. There was soreness all over, in vagina, in abdomen & even in urethra.

As regards her other systems, she had a lifelong tendency to constipation which had worsened in the last two years. She had a history of uterine prolapse 4-5 years back but was well managed by the external use of pessaries as suggested by local gynaecologist.

In general she was not especially sweaty, tended to be chilly in cold weather and enervated by the sun. Thunderstorms did not worry her; in fact she rather enjoyed them. Food preferences were for spicy, salty food and she loved pickles. She was averse to fat and moderately thirsty. Her favourite pastimes were walking, swimming and most of all, dancing!

As a person, Shruti came over as a sweet, gentle person, very neat and polite but warm and caring. She admitted to a tendency to excitability especially in the context of her work, when she would rush around in a flap being somewhat less than productive at times.

She was saddened by the effect of her problem on her sex life with her husband, although she admitted that she had never been highly-sexed. She was not especially keen on comforting and consolation when upset and saw herself as fairly self-sufficient emotionally.

The psychological profile presented me with a little difficulty in terms of choosing a medicine for Shruti. She had been through the standard diagnostic and therapeutic procedures for her problem and, indeed, homoeopathy seemed to offer her hope where all else had failed. Many of her features were those of the medicine Sepia, which is cuttlefish ink prepared homoeopathically. In particular, the history of prolapse, the pain on passing water and on intercourse, the craving of salt and pickles, the love of dancing and the tendency to constipation, fitted well. Against Sepia was her lack of obvious emotional reaction to hormonal changes.

Sepia women are generally very susceptible to severe premenstrual syndrome. The archetype is described by M.L. Tyler in her Drug Pictures as an exhausted mother, worn out, hating everyone, especially her children and husband and just wanting to run away and escape. These drug pictures, although a useful aide-memoire can be a little dangerous if taken too literally.

I overcame my doubts and prescribed Sepia 1M for three doses separated by twelve hours. On review a month later, Shruti had made remarkable progress. The soreness had gone from the vagina and abdomen and was now localised to the urethra itself. The urgency had improved and she now slept all night. She could also resist the urge to pass water on occasion and in general felt less as if her life was being ruled by her bladder. However, she was feeling emotionally generally depressed and weary.

I felt that the Sepia had definitely had an action. Undeterred by the low mood, I repeated the dose and arranged to see Shruti again after three months. Good news again! She'd had a minor headache this time after the dose but no other ill effects. The low mood had lifted and she said that she felt generally calmer and better able to cope in her job. The bladder symptoms, though not completely resolved, were better again and she was slightly less constipated. Her menstrual cycle seems to be regular with normal flow & without any discomfort. She'd had no menstrual problem at all since starting the treatment and, amazingly, had managed to make love with her husband on two occasions, for the first time in eighteen months.

We were both delighted and encouraged by this process and agreed that the best thing to do at this stage would be nothing. The Sepia was probably still acting in Shruti's system and it was best not to give any more until the action of the last dose had ended. I feel confident that she will continue to improve steadily It is, of course, possible that she may require further doses or a different potency in the future, but we will cross that bridge when we come to it. What is important at this stage is that the subtle cuttlefish had once again acted, and in a person who would not have struck one instantly as a "Sepia type".


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Comment by H Dr Sana-Ullah Ranjha on December 8, 2010 at 10:31pm
It is a very knowledgeable forum, not only for me, but for entire homoeopathic cummunity. Thank you for providing a great case and thanks to Homoeopathy that always gives excellent results.
Comment by Dr.Vikas Verma on December 5, 2010 at 11:54pm
Excellent Selection of similimum, And very nice presentation too.
Comment by Dr Ravindra Saraswat on December 5, 2010 at 12:13pm

We can save many patients from unnecessary hysterectomy by properly selected medicines. A detailed case taking is essential to know the constitutional remedy. The acute remedy will check the bleeding which has to be controlled and the deep acting constitutional and miasmatic remedy will prevent the recurrence. A regular estimation of Hb level, blood pressure, USG, and if necessary endometrial biopsy would ensure the physician and the patient, of the progress and prognosis.

The homoeopathic remedies with their indications are :

CALCAREA CARB.- A plump, female of any age, having too early, too profuse and too long lasting periods, if complains of gushing of blood after physical exertion, is chilly with perspiring cold hands and feet is sure to be a calc. carb patient. DUB in calc. pt. can occur because of over lifting, excitement, shock, fear, emotional disturbances or from straining the muscles.

PHOSPHORUS- Bright red hemorrhage from the uterus lasting too long. The concomitants are thirst for icy cold water, with dry tongue, backache, blue rings around the eyes. The oversensitive females, susceptible to external impressions like sound, light, odors, touch, electrical changes, anxious, fearful in dark and when alone. A young phos. girl has grown too rapidly, has delicate skin, long silky eyelashes, with graceful manners and excellent mental development with weak physique, having hereditary tendency to tuberculosis or history of some bone disease in early childhood.

SABINA- Frequent, profuse and prolonged menses, flow continuous till the next period. Liquid bright red blood intermingled with clots. Pain from sacrum to pubes or from vagina upto uterus and to umbilicus. Labour like pains appear and a clot is passed again followed by bright red blood. DUB during the peri and premenopausal phase in females who have become weak by overwork or much childbearing, has suffered from repeated hemorrhages, have become anemic and exhausted, regain health till broken down by another hemorrhage.

BELLADONNA- Sensation of hot blood gushing out with oversensitiveness to jar, touch and sudden appearance and disappearance of pain shooting in every direction.

IPECAC - Nausea and vomiting with the hemorrhage, out of proportion to the amount of blood lost.
SECALE COR.- Expulsion of dark clots with bearing down pains followed by thin watery offensive blood oozing as if uterus has lost the power to contract. The secale pt. is thin, scrawny, never takes on fat, cold, yet dislikes covering.

CINCHONNA- It will help pt. to regain strength, after loss of blood in those having vertigo, noises in the ears, and all the symptoms of anemia, insomnia after bleeding. Cinchona patient is chilly, sensitive to noise, building castles in the air, planning in the bed at night. .

CARBO VEG.- Atony of uterus, when after delivery or menses, the uterus does not contract and dark passive hemorrhage continues almost till the next period, with dragging down sensation in uterus as if everything would escape Concomitant symptoms may be flatulence, eructations, internal burning with external coldness, cold breath, tongue and face but she wants to be fanned.

ARNICA - where injury is the cause of bleeding.

USTILAGO- Blood half liquid half clotted, spongy cervix easily bleeding, at slightest provocation. Hypertrophy of the uterus, it feels drawn into a knot.

NIT. ACID - Muddy water like blood oozing after parturition or curetting.
Whenever, the best selected remedy fails to control DUB, psora is at the background. One or two doses of sulphur, in high potency will always check the bleeding and when Sulph. has exhausted its action Psor. comes to help. The indications of Sul. are DUB after a history of suppressed menses, heat and burning of palms and soles, vertex. feeling of hunger at 11 a.m..

HELONIAS- DUB at puberty, with consciousness of uterus, tired backachy females.

Other small remedies are Millifolium, Trillium, Thlaspi bursa, Erigeron, Hammamelis.

A word of caution - There should always be a set time period to watch the action of the indicated remedy and if there is no improvement necessary investigations should be done. The chances of carcinoma in a lady at climaxes with prolonged DUB should always be kept in mind.
Comment by Debby Bruck on December 31, 2009 at 4:37am
This is why I love HWC. Learning from the experience of masters.
Comment by Hans Weitbrecht on December 29, 2009 at 3:52pm
Dear Dr. Bidani

Good choice -- indeed, if one knows, that Sepia is one of the few remedies which is better during thunderstorms.

And i have seen Sepias thrive on emotional thunderstorms, they cannot tolerate emotional stalemate, they quickly loose interest, to the point, that they get an aversion against boring family members. if there is no dynamic, they feel the weight of the world on their shoulders which crushes them.

In general, the patients symptoms have to be found in the proving symptoms of the remedy, not the other way around.
Therefore, you did right to give sepia, despite: >>her lack of obvious emotional reaction to hormonal changes.

Nux-v is in many aspects complementary to Sepia
Comment by Dr. Navneet Bidani on December 29, 2009 at 1:13pm
Dear Gina you are absolutely right. I always repeat the medicine (if required) after giving atleast 10 succusions to the previous potency.
Comment by Gina Tyler DHOM on December 29, 2009 at 1:01pm
Dear Dr. Naveet Good subject for discussion-
Thanks for posting this -Sepia has worked on many of my patients with 'female imbalances'. Taking into consideration all aspects of the mental/emotional state not only the physical. One thing i noticed in posting your case, a repetition of repeated similar potencies were used.
This is something i never do, If I may share- I start with the lowest potency and gradually work up to the higher potencies (ONLY WHEN NEEDED) close monotoring and case follow up with these patients presents positive results. As the gradual process of increased potency acts on the patients vital force there is verry little aggravation in the healing process.
Comment by Debby Bruck on December 29, 2009 at 10:13am
NOVA | Kings of Camouflage

Amazing footage of two TRUE Giant Cuttlefish. Filmed on the Wreck of the Kelloe Sydney Australia. Very Meditative to watch this one. Reminds me of a skirt or curtain flowing in the wind.

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