A holistic and individualised homoeopathic approach to adenomyosis – A case report

INTRODUCTION

Adenomyosis is a benign gynaecological disorder defined as the presence of ectopic endometrial glands and stroma within the uterine myometrium. The histopathologic abnormality was first named cystosarcoma adenoids uterinum.^[1] However, its epidemiology has drastically changed. Adenomyosis has long been thought of as a characteristic condition in multiparous women over 40 years old with pain and excessive menstrual bleeding. However, using imaging methods such as transvaginal ultrasound and magnetic resonance, adenomyosis has increasingly been discovered in young women who have pain, abnormal uterine bleeding, infertility, or no symptoms at all.^[2,3] Although the pathogenic mechanisms behind adenomyosis still need to be fully understood, an increasing number of studies over the past 10 years have demonstrated that sex steroid hormone receptors, inflammatory molecules, extracellular matrix enzymes, growth factors, and neuroangiogenic factors play a significant role.^[4,5] The most widely accepted explanation states that adenomyosis is caused by the invagination of basalis endometrium into the myometrium through a damaged or interrupted junctional zone, which is a highly specialised hormone-responsive structure found in the inner third of the myometrium^[4] or is created entirely from the metaplasia of residual embryonic Müllerian cells.^[4]Adenomyosis was formerly diagnosed primarily through histology examination.^[6] As a result, its incidence or prevalence has not been precisely determined. Therefore, estimates of adenomyosis prevalence range greatly from 5% to 70%, with the typical frequency of adenomyosis at hysterectomy between 20% and 30%.^[7,8] Adenomyosis remains an underdiagnosed condition due to a lack of pathognomonic symptoms.^[9] Up to 30% of patients are asymptomatic; menorrhagia, dysmenorrhea, chronic pelvic discomfort, dyspareunia, and subfertility are some of the presenting symptoms.^[10] Moreover, as endometriosis and fibroids frequently coexist and share similar clinical characteristics, diagnosing these conditions can be challenging.^[9] With the introduction and development of ultrasound and magnetic resonance imaging, various criteria have been used to determine the differential diagnosis, assess the depth of myometrial invasion, and track treatment response.^[11] Despite recent advancements in modern medicine in the treatment of adenomyosis, it still poses a significant challenge for clinicians. Gonadotropin-releasing hormone analogues, progestin, combined oral contraceptives, and non-steroidal anti-inflammatory drugs are conventionally used to treat adenomyosis. If conservative treatment fails, uterine artery embolisation or hysterectomy is performed; however, neither procedure ensures complete recovery.^[12,13]

As there are potential adverse effects of allopathic treatment, including menopausal symptoms, irregular bleeding, amenorrhoea, and thromboembolic phenomena, an alternative approach is required. Homoeopathy, as a holistic system of medicine, aims at eradicating the disease to its whole extent by restoring order to the dynamically deranged vital principle.^[14] It considers the psycho-physical aspect of each disease to individualise treatment for each patient. Thus, homoeopathy treats the patient and not the disease condition. Homoeopathy is based on the principle of minimum dose, so chances of adverse outcomes are minimal. As rightly written by Skinner, ‘Constitutional treatment alone was and is all that is necessary for successful treatment of all vaginal, uterine and ovarian diseases’.^[15] In the present case, the patient was treated gently following strict individualisation, which resulted in not only symptomatic relief but also the complete resolution of the condition at the organ level.

CASE REPORT

Diagnosis

The patient presented with progressive dysmenorrhoea and menorrhagia for a prolonged duration, which had not resolved following standard treatment. She had a history of repeated childbirth without a healthy gap between pregnancies. BPE revealed a tender and enlarged uterus. All these facts suggested a diagnosis of adenomyosis. An ultrasound dated 24 February 2021 revealed early adenomyotic changes in the uterus, chronic cervicitis, and pelvic inflammatory disease of the right adnexa [Figure 1].

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Figure 1:

Before treatment

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The case was diagnosed as adenomyosis. N80.03 is the International Classification of Diseases, Tenth Revision, and Clinical Modification code for Adenomyosis.

Results

At baseline, the patient was prescribed a single dose of Medorrhinum 200 on the basis of totality of symptoms. Some of the symptoms showed initial transient aggravation. The improvement of the case was steady and continuous following the first prescription. The medicine was repeated at different time points as suggested by the existing symptom complex. No other acute or intercurrent medicine was prescribed during the entire treatment-period. The total duration of treatment was 1 year and 3 months. This individualised homoeopathic treatment resulted in complete resolution of all presenting complaints [Table 1] which were also supported by post-treatment ultrasonography (USG)-findings [Figure 2]. The case was kept under observation for another 6 months, during which none of the symptoms recurred.

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Figure 2:

After treatment

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DISCUSSION

Adenomyosis is a uterine condition where the endometrial glands and stroma are pathologically demonstrated in the uterine myometrium layer which is a distinct entity of polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic and not yet classified – International Federation of Gynaecology and Obstetrics classification of aetiological factors of abnormal uterine bleeding.^[17] As there are significant limitations in conventional medicine which includes higher rate of recurrences, adverse effects of oral analgesics and inability to resolve the disorder without surgical intervention and hysterectomy is mostly advised treatment modality, an alternative approach is warranted to preserve the uterus.

After extensive searches in different databases, some cases were found to provide evidence of homoeopathy enabling successful treatment of adenomyosis. Ponnam et al. successfully treated a case of adenomyosis in a perimenopausal woman using conium maculatum following individualisation and constitutional approach.^[18] Another case study by the same author showed symptomatic relief and complete cure of adenomyosis in a 27-year-old woman, with Trillium pendulum 30, Natrum muriaticum 30 and Natrum muriaticum 200 prescribed at different time points as suggested by the existing symptom totality.^[19]

In the past decade, the incidence of adenomyosis in young fertile women has been found to be significantly high.^[3] The case was approached through meticulous homoeopathic case taking, identifying the uncommon peculiars and strict individualisation through totality of characteristic symptoms. The symptom totality and family background of sycotic miasm clearly indicated Medorrhinum, an antisycotic remedy which was prescribed in higher dilutions and minimum dose to avoid any unwanted aggravations. The medicine was repeated as required. The outcome was complete resolution of entire signs and symptoms which were supported by the post-treatment USG report.

In this case study, a young multiparous woman presented with profuse menstrual bleeding which is the most common presentation of adenomyosis as described in Stewart’s classification system^[20] and appeared to be a challenge to homoeopathy as she had undergone all available treatments which had yielded no results. In this particular case, we faced several difficulties regarding therapeutic approach and management. As the patient presented with heavy protracted bleeding with severe dysmenorrhoea, our medical team was also anxious about the clinical outcome of the case. We maintained a strong conviction regarding the homoeopathic single medication and its principles; the outcome became obvious in subsequent visits. Through homoeopathy, we could improve the patient’s quality of life in terms of subjective symptoms such as pain, bloated feeling, menorrhagia and preserve the uterus. Thus, homoeopathy may help women with this condition. The modified Naranjo criteria score after the treatment was 10 which exclusively showed positive causal attribution of the individualized Homoeopathic medicine in this case. [Table 2].^[21] Nevertheless, a single case report cannot proclaim the treatment efficacy of homoeopathy in adenomyosis. To produce strong evidence, a large-scale randomised controlled trial with sound methodology is suggested.

CONCLUSION

In the present day, the incidence of adenomyosis and its complicated forms (mostly with endometriosis) are gradually increasing. Due to limited treatment options in conventional medicine, an alternative approach is necessary. This case report highlights a successful instance of cure of adenomyosis through long-term homoeopathic therapy which was solely based on the totality of symptoms. The positive outcomes evident in this case underscore the potential of homoeopathy as an alternative for successfully treating adenomyosis.