Evidence-based homoeopathic management of ovarian cysts – A case series

INTRODUCTION

Ovarian cysts are a common occurrence in women within the reproductive age group, and they remain a prevalent cause of gynaecological surgery across all age groups. These cysts can stem from various factors. Ovarian cysts related to endocrine disorders are generally benign and typically do not necessitate surgical intervention unless they manifest acute features such as torsion, haemorrhage or rupture.^[1] The aetiology of ovarian cysts or adnexal masses varies, ranging from physiologically normal (follicular or luteal cysts) to ovarian malignancy.^[2] While ovarian cysts can emerge at any age, they are more frequently observed during reproductive years, becoming more prevalent in menarche females due to endogenous hormone production.^[3] From the beginning of a menstrual cycle, the follicles of an ovary start proliferating; approximately 20 follicles are recruited at a time, out of which one follicle is selected to become the dominant follicle. This dominant follicle starts growing under the influence of follicular stimulating hormone (FSH), and the size of the ovary increases.^[4] Amongst the different types, simple cysts are the most common in all age groups, whereas mixed cystic and solid as well as completely solid ovarian lesions carry a higher risk of malignancy compared to simple cysts. Although most ovarian cysts are benign, age remains a critical, independent risk factor. Therefore, postmenopausal women with any cyst should receive appropriate follow-up and treatment due to the elevated risk for malignancy.^[5,6] The exact prevalence of ovarian cysts is uncertain, as many patients are thought to be asymptomatic and undiagnosed, and the prevalence can vary depending on the studied population. Approximately 4% of women will undergo hospitalisation for ovarian cysts by the age of 65. In a random sample of 335 asymptomatic women aged 24–40 years, the prevalence of an adnexal lesion was found to be 7.8%.^[7] In a study of 15,735 women, 14.1% had simple cysts initially. Detection varied by age, with 8.3% developing new cysts after a year. Incidence rates remained consistent over 3 years (8.4%, 7.4% and 7.3%).^[8] Another study that investigated ovarian cysts in postmenopausal women revealed a prevalence of 2.5% for simple unilocular adnexal cysts.^[9] Various treatment options are available, but the management ultimately depends on factors such as the patient’s age, menopausal status, cyst size, and whether the cyst exhibits suspicious characteristics of malignancy. Asymptomatic patients can be conservatively monitored with serial transvaginal ultrasound, as most cysts tend to resolve spontaneously without intervention. However, if a cyst persists beyond several menstrual cycles and is unlikely to be a functional cyst, further investigation is warranted.^[10] Pregnancy-associated cysts, including both corpus luteal and follicular cysts, typically resolve on their own by 14–16 weeks of gestation, allowing for conservative management.^[11] The likelihood of cyst resolution decreases when the cyst is larger than 5 cm or displays complex morphology. Simple cysts smaller than 6 cm carry a risk of malignancy of <1%.^[12] Surgical intervention is indicated in cases of suspected ovarian torsion, persistent adnexal masses, acute abdominal pain, and suspected malignancy. For pre-menopausal women, surgery prioritises fertility preservation, with efforts made to remove minimal ovarian tissue. Pregnant patients may also require surgical management of cysts. While laparoscopy is considered safe in all trimesters of pregnancy, it is generally recommended to perform surgery during the second trimester.^[13] In the realm of homoeopathy, Dr. Oscar E. Boericke, in his repertory under the rubric “Ovaries - Pain”, mentioned some very specific medicines like Argentum metallicum, Cimicifuga racemosa, Colocynthis, Lachesis, Lil-tig, Naja T, Thuja, etc. Regarding complete repertory, authored by Roger Van Zandvoort, we find in the chapter female genitalia in the rubric, pain stitching left, through uterus to right ovary, the drugs like Lac-can, Phos, Thuja and in Gentry’s concordance repertory in the chapter of uterus and appendages under the rubric region of left ovary we get single medicine Murex. Besides that, there have been a few compelling case reports^[14-18] demonstrating the efficacy of homoeopathic remedies in managing ovarian cysts. One such case report^[14] authored by Kumari, highlights the successful treatment of an ovarian cyst patient using the homoeopathic medicine Conium maculatum. Another case report^[15] describes the management of ovarian cysts with homoeopathy by Chakma and Sarangi. The report mentions that while several drugs such as Arsenicum album, Natrum muriaticum and Lycopodium Clavatum were considered, Pulsatilla Nigricans appeared to be the simillimum and eventually led to the cure of the case. In this particular context, the present case series is presented to assess the effectiveness of homeopathic remedies chosen based on the totality of symptoms in treating ovarian cysts.

CASE SERIES

Case 1

A 29-year-old female patient presented to the outpatient department on December 07, 2020, complaining of tearing pain in the abdomen during menstrual periods, accompanied by a sense of fullness, congestion or pressure in the pelvic region. In addition, the patient reported experiencing a burning pain, particularly in the lower left abdomen near the left ovary. Furthermore, the menstrual cycle was irregular with scanty menses for approximately the last 8 months. The ultrasonography reports confirmed the existence of a left ovarian cyst, which was measured at 32.1 mm × 24.7 mm [Figure 1].

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Figure 1:

Ultrasonographic (USG) report before treatment.

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Patient information

The patient exhibited a diverse array of symptoms, impacting both her mental and physical well-being. On the mental front, she faced difficulties with concentration and prominent feelings of jealousy. Upon waking in the morning, she experienced profound sadness. During the case assessment, it was observed that she exhibited an aversion to answering questions. On the physical side, the patient displayed a strong desire for highly seasoned food, indicative of specific cravings. She frequently experienced flashes of heat on her face and felt distention in her stomach after eating, leading to discomfort and bloating. In addition, she expressed a specific intolerance to clothing.

Totality of symptoms

• Lack of attention

• Jealous

• Sadness aggravates in the morning

• Desires for spicy foods

• Cannot bear tight clothing

• Burning pain in the left ovaries

• Tearing pain in the abdomen during menses

• Irregular menses

• Sense of fullness and congestion in the uterus during menses

• Hot flushes in the face

• Distension in the stomach after eating.

On repertorisation, Lachesis covered maximum number of rubrics, followed by other remedies such as Nux vomica, Lycopodium, Pulsatilla nigricans, etc. Lachesis was selected on the basis of the totality of symptoms and it also covered the marked characteristics of symptoms such as intolerance of tight clothing and peculiar hot flushes. During the initial visit on December 07, 2020, following repertorisation [Figure 2] and consultation with Materia Medica, a prescription of Lachesis 30C was administered as a single dose. This was followed by a placebo treatment for a duration of 1 month because the patient was better than before. The treatment progress was meticulously monitored through follow-up visits, as outlined in Table 1. The definitive outcome, as clearly depicted in Figure 3, demonstrates that the left ovary has returned to a normal size and echo pattern, with some features suggestive of pelvic inflammatory disease (PID). The current measurements of the left ovary are recorded at 27.5 mm × 16.9 mm, which further confirms the positive response to the treatment. The patient was advised to continue with regular follow-up visits, but no new complaints were reported after that for the last 2 months after restoration of the normalcy of ovarian morphology.

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Figure 2:

Repertorisation sheet (Case: 1) Pink colour (point 3) indicates grade 1, saffron (point 2) indicates grade 2, light green colour (point 1) indicates grade 3 remedy.

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Figure 3:

Ultrasonographic (USG) report after treatment.

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Table 1: Follow up details of case 1.

Date	Status of patient	Prescription
January 12, 2021	Improvement. Reduction in tearing pain, pelvic pressure decreased	Placebo for 30 days
February 15, 2021	Improvement. Continued reduction in tearing pain, emotional symptoms eased	Placebo for 30 days
March 15, 2021	Improvement. Further alleviation of pelvic pressure, stabilisation of cycles	Placebo for 30 days
April 05, 2021	Improvement. Decreased burning pain near ovary, emotional stability	Placebo for 30 days
May 10, 2021	Improvement	Placebo for 30 days
June 21, 2021	Improvement	Placebo for 30 days
July 19, 2021	Symptoms persisted without notable improvement. Tearing pain during menstruation, pelvic pressure and emotional symptoms	Lachesis 30C/1 dose Placebo for 30 days
August 09, 2021	No such improvement in burning pain near the ovary or irregular cycles.	Lachesis 30C/1 dose Placebo for 30 days
September 20, 2021	Persistent symptoms despite ongoing treatment	Lachesis 200C/1 dose Placebo for 30 days
October 04, 2021	Improvement of menstrual pain, stabilisation of emotional symptoms	Placebo for 30 days
November 08, 2021	Improvement. Continued reduction in menstrual pain and emotional stability	Placebo for 30 days
December 06, 2021	Further alleviation of menstrual pain, stabilisation of cycles	Placebo for 30 days
January 17, 2022	Sustained relief from menstrual pain, improvement in emotions	Placebo for 30 days
February 21, 2022	Improvement	Placebo for 30 days
March 14, 2022	Status quo. Menstrual pain reappear	Lachesis 200C/1 dose Placebo for 30 days
April 18, 2022	Menstrual pain persisting	Lachesis 1M/1 dose Placebo for 30 days
May 02, 2022	Improvement was seen in reduced menstrual pain	Placebo for 30 days
June 13, 2022	Improvement. Continued reduction in menstrual pain, emotional stability	Placebo for 30 days
July 04, 2022	Further alleviation of menstrual pain, stabilisation of cycles	Placebo for 30 days
August 01, 2022	Improvement	Placebo for 30 days
September 05, 2022	Improvement	Placebo for 30 days
October 07, 2022	Continued improvement, reduction in menstrual discomfort	Placebo for 30 days

Case 2

An 18-year-old female patient presented on June 10, 2019, with the following complaints: frequent and early menstrual cycles accompanied by discharges of clotted blood. She experienced pain in the right lower abdomen, near the right ovary, extending downwards and radiating towards her limbs. The ultrasonography conducted on May 31, 2019, revealed cystic changes in the right ovary, measuring 36 mm × 21 mm [Figure 4].

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Figure 4:

Ultrasonographic (USG) report before treatment.

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Patient information

In the realm of mental aspects, the patient displayed a strong aversion to work due to laziness, leading to a sense of indolence. During her menstrual period, she felt fearful and frightened, particularly before the menses. There was a deep-seated fear of death affecting her emotional state. Regarding her physical well-being, the patient exhibited an aversion to coffee and meat while having a craving for salty foods. In addition, she was intolerant to milk and experienced heartburn after eating. Notably, she suffered from a sore throat that worsened with changes in weather. Moreover, the patient faced a challenge with obesity, which could be impacting her overall health and well-being.

Totality of symptoms

• Indolent

• Fear of death

• Excessive fear before menses

• Discharge of clotted during menses

• Early and frequent menstruation

• Desire for salt

• Aversion to meat

• Aversion to coffee

• Intolerance to milk

• Disposition to grow fat

• Heartburn after eating

• Pain in the right ovary

• Pain in the ovaries extending downwards the lower extremities

• Throat pain on little change of weather.

After repertorisation, it was found that Calcarea carb covered most of the rubrics and scored maximum, followed by other remedies such as Natrum mur, Lycopodium, and Nux vom. However, this case was a typical Calcarea Carbonicum having the characteristics of indolence, tendency to become obese, desire for salt, etc., the patient was neither introverted such as Natrum mur nor too much of a careful, zealous type of personality. Hence, we finally chose Calcarea Carb.

During the first visit on June 10, 2019, after careful repertorisation as illustrated in Figure 5 and consultation with Materia Medica, the patient was prescribed a single dose of Calcarea Carbonicum 30C. Subsequently, a placebo treatment was administered for a period of 1 month because of improvement. The treatment’s progress was diligently tracked through regular follow-up visits, as comprehensively documented in Table 2. The conclusive outcome, as discerned from the ultrasonographic (USG) results displayed in Figure 6, demonstrates a restoration of the right ovary to a normal size and echo pattern. The current measurements of the right ovary stand at 31 mm × 17 mm, which serves as further confirmation of the treatment’s favorable response. In addition, no sonological abnormalities were observed in the visualised organs, indicating overall improvement and normalisation in the patient’s condition.

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Figure 5:

Repertorisation sheet (Case: 2) Point 3 indicates grade 1, Point 2 indicates grade 2, Point 1 indicates grade 3 remedy.

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Figure 6:

Ultrasonographic (USG) report after treatment.

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Table 2: Follow up details of case 2

Date	Status of patient	Prescription
June 24, 2019	Symptoms persisted: Menstrual irregularities and abdominal pain.	Calcarea Carbonicum 200/1 dose Placebo for 15 days
July 15, 2019	Reduced menstrual irregularities and alleviation of abdominal pain.	Placebo for 15 days
July 29, 2019	Unchanged symptoms: Continued menstrual issues and persistent pain.	Calcarea Carbonicum 200/1 dose Placebo for 15 days
August 05, 2019	Further reduction in menstrual problems and decrease in abdominal pain.	Placebo for 15 days
August 19, 2019	Continued improvement in menstrual cycles and relief in abdominal discomfort.	Placebo for 15 days
September 02, 2019	Improvement	Placebo for 30 days
September 30, 2019	Menstrual issues and abdominal pain persist.	Calcarea Carbonicum 200/1 dose Placebo for 30 days
October 21, 2019	Improvement observed. Decreased menstrual irregularities and reduced discomfort.	Placebo for 30 days
November 18, 2019	Sustained improvement. Further alleviation of menstrual issues.	Placebo for 30 days
November 16, 2019	Consistent improvement: continued relief in menstrual irregularities.	Placebo for 30 days
December 16, 2019	Continued improvement: persistent relief in menstrual symptoms.	Placebo for 30 days
January 13, 2020	Improvement	Placebo for 30 days
February 17, 2020	Improvement	Placebo for 30 days
March 16, 2020	Improvement	Placebo for 30 days

Case 3

A 38-year-old female patient visited our outpatient department on May 15, 2022, with a complaint of cutting pain in the lower abdomen, particularly experienced during urination, along with frequent and early menstrual cycles. The ultrasonography conducted on May 12, 2022, revealed significant findings related to both ovaries. It was observed that both ovaries were bulky. Moreover, containing multiple small cysts located in the periphery of each ovary along with cervicitis. The measurements of the right ovary were recorded as (5 6mm × 26 mm) whereas the left ovary measured (48 mm × 22 mm) as depicted in Figure 7.

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Figure 7:

Ultrasonographic (USG) report before treatment.

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Patient information

In the realm of mental aspects, the patient experiences confusion of the mind, with various thoughts crowding in. Excessive anxiety about her health is also notable. Regarding her physical condition, before the onset of menstruation, the patient feels sadness or emotional distress. She is strongly averse to coition. In addition, she craves salty foods, but her symptoms worsen when consuming farinaceous food, such as flour-based or starchy foods. The patient suffers from constipation and faces difficulty in passing stools. Weakness in the lumbar region of the back affects her mobility and daily activities. Furthermore, the patient’s experience of foetor oris might be adding to her discomfort.

Totality of symptoms

• Hypochondriacal

• Sadness and mental depression before menses

• Confusion

• Aversion to sex

• Early menses

• Desire for salt

• Intolerance to farinaceous foods

• Irregularity of bowel hard stool constipation

• Cutting pain in the ovaries when urination

• Weakness in the lumbar region

• Foetor oris.

After repertorisation, it was found that the medicine Natrum muriaticum covered most of the rubrics and scored maximum, followed by other remedies such as Phosphorus, Sepia, etc., but after careful study of this case, we got marked sadness in the patient together with an aversion to sexual relationship so characteristics of Natrum Muriaticum along with the desire for salt which is again a prominent feature of Natrum Muriaticum.

During the initial consultation on May 15, 2022, the patient’s case was thoroughly analysed through repertorisation, as illustrated in Figure 8. In addition, a detailed consultation with Materia Medica was conducted to identify the most suitable remedy for the patient’s condition. Based on this assessment, a single dose of Natrum Muriaticum 30C was prescribed to the patient. Following the administration of Natrum Muriaticum 30C, a placebo treatment was given to the patient for a duration of 1 month. The progress of the treatment was meticulously monitored through regular follow-up visits, and comprehensive records were documented in Table 3. The conclusive outcome, as determined from the USG results depicted in Figure 9, showcases a complete restoration of both ovaries to normal size, shape and parenchymal echo pattern. The current measurements of the right ovary indicate a size of 19.5 mm × 16.3 mm, whereas the left ovary measures 35.8 mm × 21.3 mm, providing further confirmation of the treatment’s favourable response. The report mentions hepatomegaly along with grade 1 changes in the liver for which the patient was kept under continuous observation even after the complete restoration of the ovarian morphology, but the patient was symptomless after that.

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Figure 8:

Repertorisation sheet (Case: 3) Point 3 indicates grade 1, Point 2 indicates grade 2, Point 1 indicates grade 3 remedy.

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Figure 9:

Ultrasonographic (USG) report after treatment.

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Table 3: Follow up details of case 3.

Date	Status of patient	Prescription
June 11, 2022	Positive response observed and symptomatic relief noted	Placebo for 30 days
July 08, 2022	Continued improvement in symptoms. Further reduction in cutting pain and considerable improvement in menstrual cycle regularity. Reduced anxiety and mental confusion.	Placebo for 30 days
July 06, 2022	Continued relief from cutting pain during urination and normalised menstrual cycles were observed. Marked reduction in anxiety and mental confusion.	Placebo for 30 days
August 03, 2022	Sustained improvement in cutting pain and menstrual cycles remained regular. Significant alleviation in anxiety and mental confusion.	Placebo for 30 days
September 14, 2022	Symptoms consistently improved, minimal or no cutting pain was noted and regular menstrual cycles. Continued relief from anxiety and mental confusion	Placebo for 30 days
October 05, 2022	Symptoms persisted,	Natrum Muriaticum 30/1 dose Placebo for 30 days
November 02, 2022	Resumption of improvement in symptoms after targeted treatment initiation. Reduced cutting pain and maintenance of regular menstrual cycles.	Placebo for 30 days
December 14, 2022	Continued relief from cutting pain during urination and sustained regularity in menstrual cycles. Further decrease in anxiety and mental confusion.	Placebo for 30 days
January 04, 2023	Continued reduction in cutting pain, sustained regular menstrual cycles. Consistent improvement in anxiety and mental confusion.	Placebo for 30 days
February 15, 2023	Symptoms consistently improved, minimal to no cutting pain and maintained menstrual regularity. Stable mental state with reduced anxiety and confusion.	Placebo for 30 days
March 13, 2023	Symptoms persisted, Natrum Muriaticum 30/1 dose was reintroduced for targeted treatment based on the symptoms’ manifestation.	Natrum Muriaticum 30/1 dose
April 12, 2023	Improvement was observed following the reintroduction of targeted treatment. Reduced cutting pain and maintenance of regular menstrual cycles.	Placebo for 30 days
May 10, 2023	Continued relief from cutting pain and sustained regularity in menstrual cycles.	Placebo for 30 days
June 09, 2023	Further decrease in cutting pain during urination, ongoing maintenance of regular menstrual cycles.	Placebo for 30 days
July 13, 2023	Symptoms consistently improving, minimal or no cutting pain and sustained regularity in menstrual cycles.	Placebo for 30 days
August 15, 2023	Continued relief from cutting pain and stable regular menstrual cycles.	Placebo for 30 days
September 16, 2023	Maintained improvement in symptoms, minimal to no cutting pain during urination and sustained regularity in menstrual cycles.	Placebo for 30 days

Case 4

A 25-year-old female patient on May 31, 2021, presents with irregular, late and scanty menstrual cycles. On ultrasonography done on May 24, 2021, one clear cyst measuring 44 mm × 36 mm is seen in the right ovary [Figure 10].

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Figure 10:

Ultrasonographic (USG) report before treatment.

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Patient information

In terms of mental aspects, the patient appears to have a very mild temperament and also exhibits a fear of ghosts. She is short-tempered and easily gets angry, although consolation brings relief. The patient feels chilly, as evidenced by her desire for hot summer weather and aversion to cold. In addition, she experiences fear and discomfort in crowded places, leading to apprehension. The patient has a lack of thirst. Furthermore, the patient suffers from sleeplessness, likely attributed to uncontrolled mental activity.

Totality of symptoms

• Fear of crowd

• Weeping mood

• Fear of ghosts

• Irritability and consolation aggravate

• Mild temperament

• Chilly patient

• Thirstless

• Scanty menses

• Irregular menses

• Sleeplessness from mental activity.

After thorough repertorisation, it was found that the medicine Pulsatilla covered most of the rubrics and scored maximum followed by other remedies such as Lycopodium, Sulphur, and Ars Alb. However, the weeping mood, mildness of temperament and thirstlessness could not lead us to think of any remedy other than Pulsatilla nigricans. After thorough repertorisation, it was found that the medicine Pulsatilla covered most of the rubrics and scored maximum, followed by other remedies like Lycopodium, Sulphur, Arsenicum. However, the weeping mood, mildness of temperament and thirstlessness could not lead us to think of any remedy other than Pulsatilla nigricans.

During the patient’s first visit on May 31, 2021, the case was thoroughly analysed through repertorisation, as depicted in Figure 11. In addition, consultation with Materia Medica was conducted to identify the most suitable remedy for the patient’s condition. Based on this comprehensive assessment, a single dose of Pulsatilla Nigricans 30C was prescribed to the patient. Following the administration of Pulsatilla Nigricans 30C, a placebo treatment was given to the patient for a duration of 1 month because she was better than before with regard to her chief complaints. The progress of the treatment was meticulously monitored through regular follow-up visits, and comprehensive records were documented in Table 4. The conclusive outcome, as determined from the USG results depicted in Figure 12, showcases a complete restoration of the right ovary to normal size and echogenicity, with no presence of cystic or solid masses. The current measurements of the right ovary indicate a size of 31 mm × 12 mm, while the left ovary measures 29 mm × 15 mm, providing further confirmation of the treatment’s favourable response.

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Figure 11:

Repertorisation sheet (Case: 4) Pink colour (point 3) indicates grade 1, saffron (point 2) indicates grade 2, light green colour (point 1)indicates grade 3 remedy.

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Figure 12:

Ultrasonographic (USG) report after treatment.

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Table 4: Follow up details of case 4.

Date	Status of patient	Prescription
June 28, 2021	Symptoms persisted: Irregular menstruation and scanty cycles continued.	PulsatillaNigricans 200C/1 dose Placebo for 30 days
July 19, 2021	Noticeable improvement: Regularisation of menstrual cycles observed.	Placebo for 30 days
August 09, 2021	Continued improvement: Sustained regularity in menstrual cycles.	Placebo for 30 days
September 13, 2021	Further relief observed: Continued improvement in menstrual irregularity.	Placebo for 30 days
October 25, 2021	Consistent improvement: Ongoing regularity in menstrual cycles	Placebo for 30 days
November 15, 2021	Continued alleviation: Sustained regular menstrual cycles.	Placebo for 30 days
December 20, 2021	Symptoms continued to improve: Maintenance of regularity in menstrual cycles.	Placebo for 30 days
January 10, 2022	Symptoms consistently alleviated: Sustained regular menstrual cycles.	Placebo for 30 days
February 14, 2022	Continued positive response: Maintenance of regularity in menstrual cycles.	Placebo for 30 days
March 14, 2022	Symptoms consistently relieved: Continued maintenance of regular menstrual cycles.	Placebo for 30 days
April 17, 2022	Continued improvement: Ongoing regularity in menstrual cycles.	Placebo for 30 days

DISCUSSION

This case series includes four cases of ovarian cysts, comprising one case of left ovarian cyst, two cases of right ovary cyst and one case of bulky ovaries with multiple small cysts. All the cases in this series presented sometimes with pain in the lower abdomen with or without the presence of irregularity of menses. Here, pain in the abdomen may be due to some gynaecological conditions and some non-gynaecological conditions such as appendicitis, diverticulitis and nephrolithiasis as well. However, in this case series, the intensity of pain in the abdomen was not so severe or acute in nature, and the presence of menstrual irregularities led us to think about some gynaecological causes. Although there are many other gynaecological causes, such as functional cysts, chocolate cysts also known as endometrioma, uterine fibroid and PID, let us know the difference. Uterine fibroid is characterised by menorrhagia. Chocolate cysts manifest themselves through a peculiar character of pain aggravated before menses and ameliorated during the blood flow, and the association of fever is a prominent feature of PID. In our case, we did not get any such features. Moreover, the USG abdomen also revealed the presence of ovarian cysts.

In addition to those common symptoms, each case displayed individual symptoms that contributed to their unique totality. For each patient, individualised homoeopathic medicines were prescribed based on a comprehensive assessment of their symptoms and characteristics. Follow-up visits were scheduled at approximately 15-day or 30-day intervals until the symptoms subsided or improved. Pre-treatment and post-treatment investigation parameters were carefully evaluated, and the results demonstrated marked improvement in all four cases. The homoeopathic treatment showed significant effectiveness in addressing the symptoms associated with ovarian cysts and contributed to the overall improvement of the patients’ conditions. The doctrine of doses in homoeopathy involves the thorough assessment of the age, sex, habit, environment, constitution, nature and seat of the disease, etc. regarding this case series we had applied for medicines as per the characteristics totality; we had applied homoeopathic drugs which are deep acting anti-miasmatic in nature. In all four cases, we started with medium potency, keeping in view of master Kent’s 1^st observation to remain safe in avoiding unnecessary aggravation, if any.

By identifying the individuality of each case and tailoring the treatment accordingly, homoeopathy proved to be a valuable therapeutic approach to managing ovarian cysts. The positive outcomes observed in this case series through the subjective improvement and the findings of USG done excluding the bleeding phase of the menstrual cycle highlight the potential benefits of individualised homoeopathic treatment for ovarian cysts and related symptoms. As per a case report authored by Chakma and Sarangi^[15] a case of a 35-year-old patient suffering from hepatic haemangioma with an ovarian cyst was presented. The cyst on the right ovary measured (2.26 × 1.25) cm in size with pelvic congestion syndrome. In this case, the patient presented with dull aching pain in the lower abdomen and lower back which aggravated during the menses. Amongst important mental generals were prominent mildness, gentle attitude, liking for the company and feeling bad when alone; decreased thirst, chilly patient, intolerance to meat (pork), desire for spices, scanty and clotted menstrual flow, were important physical generals, and as particular symptoms, pain in the right hypochondrium and low back pain were considered for final selection of the medicine. After considering all this and conducting repertorisation the medicine Pulsatilla was chosen and was administered on a centesimal scale, that is Pulsatilla 30c. Pulsatilla was repeated in gradual ascending doses depending upon the reaction of the patient and finally, Pulsatilla 1M cured her. In another case report authored by Nath et al.,^[16] a case involving dysmenorrhoea and a right ovarian cyst measuring approximately 52 × 45 mm was presented. This case was successfully treated using constitutional homoeopathic medicine Lycopodium. In this case, the patient presented with pain in the right side of the lower abdomen for 1 year which aggravated before and during menstruation and was relieved by rest and warm application. She had profuse thirst, a desire for warm foods and sweets; thermally she was a hot patient, along with profuse sweat. Mentally she loved company and was an intellectual person. On repertorisation and consideration of those characteristics and totality of symptoms the medicine Lycopodium was prescribed in a centesimal scale, that is Lycopodium 200c and finally Lycopodium 1M cured her. In a study conducted by Ramanan and Radhakrishnan,^[17] a case series comprising three cases showed complete resolution of the ovarian masses. The positive outcomes were evidenced by ultrasonography, and individualised homeopathic medicines, including Thuja, were utilised for the treatment. Furthermore, another case report conducted by Lamba et al.^[18] also demonstrated beneficial results from individualised homoeopathic medicine. These studies collectively provide encouraging evidence of the effectiveness of homoeopathic treatment in managing ovarian cysts and related symptoms. In this current case series, a similar approach has been adopted, namely the classical homoeopathic treatment approach. The results obtained from this series are highly encouraging, suggesting the potential effectiveness of individualised homoeopathic treatment in managing ovarian cysts. This outcome underscores the significance of conducting a thorough case analysis and employing appropriate remedy selection based on repertorisation and the Materia Medica study.^[19,20] These findings demonstrate the remarkable potential of homoeopathy as a holistic and individualised therapeutic option for managing ovarian cysts. Numerous research studies have been published, each advocating various approaches for the selection of homoeopathic medicines in the treatment of patients with ovarian cysts. However, this particular case series serves to reaffirm the effectiveness of the constitutional approach for identifying the simillimum in the treatment of ovarian cyst cases. The constitutional approach, which involves a thorough and holistic evaluation of the patient’s individual symptoms, characteristics and overall constitution, is demonstrated to be a potent method in homoeopathy. In this study, noteworthy distinctions were noted in all laboratory parameters, accompanied by symptomatic improvements following individualised homoeopathic treatment. Upon the conclusion of the investigation, all collected data were found to fall within the normal range.

Nevertheless, as with any medical research, it is essential to acknowledge the limitations of this case series, including the relatively small sample size and potential confounding factors. To strengthen the body of evidence supporting the constitutional approach, further research with larger sample sizes and well-controlled study designs would be invaluable. The constitutional approach stands out as a valuable and effective method in the homoeopathic treatment of ovarian cysts. This case series reinforces the importance of individualised treatment strategies and the vital role of the patient’s unique symptoms and constitution in selecting the most appropriate homoeopathic remedy. It is important to acknowledge that further research, including larger studies with control groups, is warranted to solidify and expand upon these encouraging findings. Nonetheless, this study adds to the existing knowledge base on the potential benefits of individualised homoeopathic treatment, emphasising its role in promoting health and achieving positive clinical outcomes.

CONCLUSION

The study’s findings suggest that the individualised homoeopathic approach led to positive changes not only in the patients’ symptoms but also in the objective laboratory measurements. These observations indicate a favourable response to the homoeopathic treatment, further supporting its potential efficacy in managing the conditions under study. The constitutional approach, which involves a thorough and holistic evaluation of the patient’s individual symptoms, characteristics and overall constitution, is demonstrated to be a potent method in homoeopathy. By tailoring the treatment to each patient’s unique totality, this approach takes into account the entirety of the patient’s physical, emotional and mental aspects. While other approaches have their merits, this case series emphasises the enduring value of the constitutional approach in the homoeopathic management of ovarian cyst cases. The cumulative evidence from this study, along with previous research, contributes to a more comprehensive understanding of the diverse treatment approaches available in homoeopathy.