A case report on post menopausal complaints

Dr. Juhee Jain

PG Scholar, Dr. MPK Homoeopathic Medical College, Hospital & Research Centre (under Homoeopathy University), Jaipur, Rajasthan, India

INTRODUCTION:
Menopause is the permanent cessation of menstruation and is one of the most significant event in the life of a female. It brings up a lot of physiological changes in the body of female leading to development of variety of symptoms. The age of menopause is genetically determined and remains same in most of the females. Symptoms of post-menopausal syndrome may include: hot flushes, irritability, mood swings, insomnia, headache, depression, urge incontinence, stress incontinence, osteoporotic symptoms etc.[1]

CASE SUMMARY:
A 40 year old female reported to the outpatient department (OPD) on 20th August 2018, presented with hot flushes with palpitation of heart. She also complained of pain in both ankles and knee joints after the menopause. Pain was aggravated from first motion, sitting, rest and in morning, and ameliorated by continuous motion. Swelling was present in both the ankle joints. She also complaint of stiffness of lower limbs which aggravated in morning and cramps in calve muscles which aggravated at night. There was offensive odour from the mouth, more during empty stomach.

History of present complaints: Patient was apparently well before 3-4 years (before menopause) but after that, she started suffering from hot flushes, pain in both ankles and knee joints, with stiffness of joints at morning.She took allopathic medicines for pain joints but got temporary relief only.

Family history: Patient has five brothers and one sister. Sister is hypertensive and all other family members are healthy.

Physical generals: Patient has desire for sweets and aversion to sour and salty things. Spicy food causes urge for stool. Perspiration is profuse over the head. She is thermally chilly.

MentalsShe is dominating, and irritated and angered at trifles. She is ameliorated by consolation and feels suffocated in crowded places and closed rooms.

DIAGNOSIS: Patient was diagnosed as suffering from post-menopausal syndrome based on clinical presentation (N95.1 is a specific ICD-10-CM code for menopausal and female climacteric states).

REMEDY SELECTION
Repertorization was done by using ‘RADAR Homoeopathic Software’ (using Synthesis 9.1),taking into account the following symptoms: dominating nature, anger and irritability at trifles, amelioration from consolation, and suffocative feeling in crowded place and closed rooms, desire for sweets, aversion to sour and salty things, aggravation from spicy food, hot flushes, pain in both ankles aggravated from sitting and in morning and amelioration from continued motion, cramps in calf muscles of both the sides in night, offensive odour from mouth and palpitation of heart during menopause. After repertorization, Sepia was selected as it covered all important symptoms including causation, mental picture and physical generals of the patient. Sepia covered total 13 rubrics with score of 21, followed by Lycopodium, Phosphorus, Sulphur. etc.[Figure 1].

On the basis of repertorial analysis and in consultation with Materia Medica, first prescription was made on 20 August 2018 and two doses of Sepia200 was given followed by Placebo for 10 days.

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Figure 1 : Showing repertorization sheet

FOLLOW UPS:

     DATE      CHANGES IN SYMPTOMS PRESCRIPTION
04/09/2018 Slight amelioration in joint pain

>+ in hot flushes

Sepia officinalis 200/2D , Rubrum 30/TDS for 10 days
10/09/2018 >+ in joints pain

>+ in hot flushes

Burning urination < after urination

Sepia officinalis 200/2D 

Cantharis 30/B.D (SOS) for 14 days

24/09/2018 >++ in pain in b/l joint pain

>++ in cramps in calves

Flatulance > by eructation 

< after eating

>+ in burning urination

>++ in hot flushes

Lycopodium 200/2D

Rubrum 30/TDS for 14 days

(As per repertorization)

08/10/2018 >++ in pain in b/l joints pain, cramps in calves, in flatulance 

>+ in burning urination

Hot flushes reappear again

Lycopodium 200/2D

Rubrum 30/TDS for 10 days

22/10/2018 Marked >++ in all the complaints Placebo 30/ TDS for 15 days
5/11/2018 >++ in all the complaints Placebo 30/TDS for 15 days
21/11/2018 >++ in all the complaints Placebo 30/TDS for 15 days

 pastedGraphic_1.png

Figure 1. Pre- treatment Menopausal rating scale assessment

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Figure 2. Post- treatment menopausal rating scale assessment

OBSERVATIONS & RESULTS:
As there is no physical criteria for assessment of the patient, hence, menopausal rating scale (MRS) was used for the assessment of the case. Pre- treatment assessment using MRS was done on 20/08/2018, with score value 10 as shown in figure 1. Reassessment was done on 24/9/2018 using MRS with score decreasing to 7 after treatment of 1 month as shown in figure 2. Although patient was symptomatically much relieved after the treatment.

CONCLUSION:
Homoeopathic medicines are efficacious in cases of post menopausal syndrome, when given symptomatically to the patient. Further studies are suggested using different parametersand on large study sample.

REFERENCES:

  1. Dalal P, Agarwal M. Postmenopausal syndrome. Indian Journal of Psychiatry [Internet]. 2015 [cited 18 March 2019];57(6):222. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539866/

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