Management of ovarian cyst through sepia given in LM potency – Case series

INTRODUCTION

Ovarian cysts are predominantly benign growths arising from the ovaries. These lesions may be diagnosed symptomatically or incidentally. The common ovarian lesions include physiological cysts, endometrium, benign cystic teratoma and cystadenoma. Malignant lesions are comparatively rare.^[1]

Ovarian cysts are more common in women of reproductive age. The incidence is slightly higher in girls at the age of menarche. While most ovarian cysts are benign, the risk of malignancy is higher in post-menopausal women.^[1,2]

Some ovarian cysts can be functional, such as follicular cysts. These occur when the follicle does not open and release the egg cell; the follicle occasionally fills up with fluid and a cyst develops. A corpus luteum cyst occurs when a corpus luteum fills with blood. Theca lutein cysts may develop in women who undergo infertility treatment with hormones. Chocolate cysts (endometriomas) are filled with dark, thick blood and develop as a result of endometriosis.

Dermoid cysts (which are not functional cysts) contain matter such as skin cells and sebaceous glands; these are less common and may develop from non-cancerous tumours.^[2]

The most common complications are rupture, bleeding and twisting of the cyst around its blood supply, known as torsion.

According to an extensive French study, the number of hospital stays for benign ovarian tumours or ovarian cysts was 45,000 in 1998 and 1999. Nearly 7000 women were hospitalised for follicular or yellow body cysts, that is, 15%, with an incidence of 29/100,000 women over the age of 15 years. Serous and mucinous cysts account for 20–30% of the operated cysts and dermoid cysts for 10–20%.^[3]

Homoeopathy is a system of medicine that focuses on individualisation to select the required remedy. Surgical cases like ovarian cysts have shown promising results with homoeopathy.^[4-10]

Literature states that the 50-millesimal potency has been shown to be the most effective in dealing with similar conditions.^[11-13]

According to a research published in 2022, titled ‘Noninvasive Resolution of Pathological Ovarian Masses with Homoeopathic Treatment – A Case Series’, complete resolution of the ovarian cysts occurred in all cases, evidenced by ultrasonography (USG). The patients improved within 4–15 months of treatment using individualised homoeopathic medicines.^[11] In another research published in 2011, titled ‘Evidence-based clinical study on the effect of homoeopathic medicines in cases of ovarian cysts’, a total of 73 patients suffering from ovarian cysts were enrolled, (48 completed the study) according to protocol. Medicines were selected on the basis of individualisation and changes in the size of ovarian cysts were assessed at the end of 1 year. After comparing pre- and post-treatment USG reports, the difference in mean values of the maximum dimension of the ovarian cyst was found to be statistically significant.^[5]

CASE SERIES

This article comprises of case reports (almost decade apart) of two females suffering from ovarian cyst, cured with Homoeopathic medicine Sepia based upon individualization of symptoms and using LM potency.^[13]

CASE 1

Presenting complaints

A 19-year-old unmarried woman reported on 20 April 2010 with complaints of delayed menses and pain in the left iliac region of the abdomen. She also reported occasional episodes of experiencing internal and external heat/flushes in the genitals. She had menorrhagia and dysmenorrhoea. She also reported acne with intense itching aggravated before menses. She also reported occasional whitish discharge per vagina. Her USG report was suggestive of a left-sided ovarian cyst [Figure 1].

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Figure 1:

USG report- Pre treatment.

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Baseline prescription

Based on repertorisation [Figure 2] and Materia Medica references, Sepia 0/1/OD was prescribed on the first visit on 20 April 2010 for 20 days. Materia Medica confirmed the symptoms and totality. The following Materia Medica books were studied: Hering Guiding Symptoms of our Materia Medica, The Clinical Materia Medica by JH Clarke and Lectures on Homoeopathic Materia Medica by Kent.^[14-18] Table 1 outlines the complete follow up of the case. USG advised after the treatment reported normal findings [Figure 3]. Her VAS score at initial visit was 9 [Figure 4].

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Figure 2:

Repertorial Sheet case 1.

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Table 1: Follow-ups.

Date	Symptoms	Medicine	Outcome
10 May 2010	Pain in the left iliac region of the abdomen – better Internal and external heat in genitals – slightly better Acne with itching – same	Sepia 0/2/OD/20 days	There was initial relief of symptoms, followed by status quo
30 May 2010	Menses (LMP – 27 May 2010) Dysmenorrhoea-same as before Pain in left iliac region of abdomen-better Internal and external heat in genitals-slightly better Acne with itching – slightly better	Sepia 0/3/OD/20 days	There was marked relief of symptoms, but dysmenorrhea present as before (LMP- May 27, 2010)
20 June 2010	Pain in the left iliac region of abdomen – better Internal and external heat in genitals – slightly better Acne with itching – slightly better	Sepia 0/4/OD/20 days	There was marked relief of symptoms, but they some repeated in between (abdominal pain and acne)
10 July 2010	Menses LMP – 26 June 2010, Dysmenorrhoea present Pain in the left iliac region of abdomen – episodes of increased pain in between Internal and external heat in genitals – still persistent Acne with itching – slightly better	Sepia 0/5/OD/20 days	LMP – 26 June 2010, Flow was normal. Dysmenorrhoea was still present with marked relief in other symptoms.
1 August 2010	Menses LMP – 27 July 2010, dysmenorrhea better Pain in the left iliac region of abdomen – better Internal and external heat in genitals – still persist Acne with itching – better	Sepia 0/6/OD/20 days	There was marked relief of symptoms, with occasional reoccurrence of a few of the symptoms
21 August 2010	Pain in the left iliac region of abdomen-better Internal and external heat in genitals – better Acne with itching – few new acne noted	Sepia 0/7/OD/20 days	Relief of symptoms
11 September 2010	LMP – 28 August 2010. No dysmenorrhea Pain in the left iliac region of abdomen – better Internal and external heat in genitals – better Acne with itching – better	Sepia 0/7/OD/20 days	Relief of symptoms. Same potency was repeated
31 September 2010	Pain in the left iliac region of abdomen – better Internal and external heat in genitals – better Acne with itching – some new pimples over forehead noted.	Sepia 0/8/OD/20 days	General condition of patient was much better. Itching in acne was reduced, but she noted some new pimples in between. Potency raised
21 October 2010	Pain in the left iliac region of abdomen – better Internal and external heat in genitals-better Acne with itching-better	Sepia 0/8/OD/20 days	Relief of symptoms. Same potency was repeated
1 November 2010	Pain in the left iliac region of abdomen – better Internal and external heat in genitals – better Acne with itching – better	Sac lac 0/9/OD/20 days	Relief of symptoms. USG advised
30 December 2010	Pain in the left iliac region of abdomen – better Internal and external heat in genitals – better Acne with itching – better	Sac lac 0/9/OD/20 days	USG report was normal [Figure 3]. There was no need of further intervention. Still for satisfaction of patient, placebo was given for next 20 days VAS score (for pain)-1

VAS: Visual analogue scale, USG: Ultrasonography

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Figure 3:

USG report- Post treatment.

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Figure 4:

Pre and post VAS score of patient 1.

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CASE 2

Presenting complaints

A 44-year-old patient presented with complaints of pain in the lower abdomen for 2 weeks, profuse menses for 2–3 months. Burning micturition on and off since 3 weeks. Discharge per vagina for 6 months. Pain in lower back for 2 months. Aggravation – especially during menses. Headache on and off at the time of menstruation. Chronic constipation for 2 years. She brought her USG reports [Table 2, Figures 5 and 6].

Table 2: Investigations case 2.

14 December 2020	Fatty Liver Grade I, Left adnexa shows well defined cystic lesion showing fine fibrous strands in cystic mass s/o haemorrhagic/complex cyst 4.28×4.26×4.92 cm Concretions in both kidneys
15 December 2020	Bilateral complex ovarian cyst
13 June 2021	Normal ultrasonography findings

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Figure 5:

Repertorial sheet case 2.

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Figure 6:

USG report- Pre treatment.

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Investigations

Investigations are mentioned in Table 2. USG reports before treatment [Figures 6 and 7] and after treatment [Figure 8].

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Figure 7:

USG report- Pre treatment.

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Figure 8:

USG report- Post treatment.

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Follow-ups

Follow up of the given case is mentioned in detail in Table 3 along with justification of the prescription. MONARCH Score at the end of treatment was 7/13 [Table 4].

Table 4: MONARCH score.

Items	Yes	No	Not sure
1. Was there an improvement in the main symptom or condition, for which the homoeopathic medicine was prescribed?	+2
2. Did the clinical improvement occur within a plausible time frame relative to the drug intake?	+1
3. Was there an initial aggravation of symptom? (need to define in glossary		0
4. Did the effect encompass more than the main symptom or condition that is, were other symptoms ultimately improved or changed?		0
5. Did overall well being improve?	+1
6. (a). Direction of cure: Did some symptoms improve in the opposite order of the development of symptoms of the disease?		0
(b). Direction of cure: Did at least two of the following aspects apply to the order of improvement of symptoms: • From organs of more importance to those of less importance • From deeper to more superficial aspects of the individual • From the top downwards		0
7. Did ‘old symptoms’ (defined as non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement?		0
8. Are there alternate causes (other than the medicine) that – with a high probability – could have caused the improvement? (Consider known course of disease, other forms of treatment and other clinically relevant interventions)		+1
9. Was the health improvement confirmed by any objective evidence? (e.g., laboratory test, clinical observation)	+2
10. Did repeat dosing, if conducted, create similar clinical improvement?		0

VAS Score pre-post [Figure 9].

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Figure 9:

Pre and post VAS score of patient 2.

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DISCUSSION

These cases have shown encouraging results with homoeopathic treatment. It is important to note that patients with ovarian cysts need to be assessed on mental and physical aspects for better prescription. In both the cases, individualisation was done on the basis of mental symptoms and dispositional characteristics of the patients were considered during prescription.

The first case report supports the findings of previous studies^[6,7,19] and a study by Gupta et al.^[5] where after comparing pre- and post-treatment USG reports, the difference in mean values of maximum dimension of ovarian cyst was found to be statistically significant. The useful homoeopathic medicines in this study^[5] were Natrum muriaticum, Pulsatilla, Sepia, Calcarea carb, Silicea, Arsenic alb and Phosphorus, which are almost similar to the constitutional medicines used in the previous studies. Sulphur and Carcinosin were the two medicines additionally prescribed in previous studies. A study conducted by Bukhsh et al. reported that large ovarian cysts in three patients were cured by the use of different potencies of the single remedy Thuja occidentalis; this study concluded that proper selection of the homoeopathic remedy considering the symptom totality can remove cysts from the ovary without any surgical intervention.^[8] A study by Das et al. indicates that proper selection of the homoeopathic remedy considering the symptom totality and in consultation with repertory can remove cysts from the ovary without any surgical intervention.^[9]

In the second case report, the modified Naranjo score of the patient after treatment was 7 [Table 4], which indicates there is a likelihood of causality between the result observed and the prescribed homoeopathic medicine in the case. This concurs with the study^[4] where The MONARCH score was calculated as +7/13, +9/13, and +9/13 for the three cases, respectively, indicating a positive causal attribution of homoeopathy in the resolution of these pathological ovarian masses. This report also supports previous studies where the patients improved within 4–15 months of treatment using individualised homoeopathic medicines.^[4,5] A case study by Nath et al. reports that the medicine was selected based on the totality of symptoms by referring to Repertorium Homoeopathicum Syntheticum and Materia Medica, yielding Lycopodium clavatum as the similimum. The patient’s general well-being improved; pre- and post-treatment USG reports proved the cure.^[10]

CONCLUSION

Individualisation is defined as a process of differentiating one person from others by some peculiar or unique features and a remedy is given accordingly. This article represents case reports of two such cases cured with an individualised homoeopathic approach, where medicines were given in LM potency. Homoeopathy not only showed promising results by improvement in patients’ symptoms but evidence in the form of USG reports justifies the cure. It can be concluded that homoeopathic therapy may reduce the burden of surgeries for ovarian cysts and may be considered as a viable treatment before considering surgery.