Adenomyosis
And the importance of posologic theory.
This case report outlines adenomyosis in a 36-year-old nulliparous Australian woman who was treated with individualized classical homeopathy for one year alongside the standard medical protocols of endometrial ablation and implanon rod insertion. Retrospectively, an initial posological misstep encouraged the author to publish this case report in order to highlight the importance of working within the Levels of Health theorem.
Keywords
Adenomyosis. Levels of Health theory. Posology. Remedy reactions.
First published by Hpathy (online) 20 March 2023 as part of a presentation by the International Academy of Classical Homeopathy, Greece.
Introduction
Adenomyosis is characterized by the presence of endometrial glands in myometrium, typically manifesting pelvic pain, abnormal uterine bleeding and infertility. Although adenomyosis and endometriosis share a number of features, they are considered to be two different medical conditions.1
Adenomyosis often coexists with other gynaecological conditions, such as endometriosis and uterine fibroids, and has a negative impact on quality of life. Its pathogenesis remains elusive, and no one theory can explain its different phenotypes. Current treatment is a lifelong symptom management plan. Once considered the classic condition of multiparous women over 40 years old with pain and heavy menstrual bleeding and diagnosed at hysterectomy, the present epidemiological scenario has completely changed, adenomyosis is now increasingly identified in young women.2
Case report
36-year-old nulliparous woman presenting with a recent diagnosis of adenomyosis, and associated iron deficiency anaemia.
Initial consultation
2021-07-12. Australia.
Main complaint
'I am literally bleeding to death' from painless uterine haemorrhage, 50ml daily loss of ‘bright red blood which pours out of me, gushes out.’
Heavy, protracted and inconsistent menses developed during marital discord two years’ prior. Uterine fibroids (left sided) diagnosed in Oct 2019. Irregularity of menses worsened after replacement of contraceptive pill (taken for sixteen years’) with an Intra Uterine Device (IUD) in July 2020.
Abnormal heavy uterine bleeding without dysmenorrhea, and intermittent passing of very large, painful clots, described as 'the size of my shoe' began in Nov 2020. During this period, she was under extreme work stress, and was prescribed Ciprofloxacin for unexplained high fever a few days prior, and underwent exploratory uterine procedure, removal of the IUD and biopsy after IUD had dislodged, resulting in diagnosis of adenomyosis , and was scheduled for uterine ablation in one weeks’ time, with planned insertion of the Implanon rod. Tranexamic acid and Estrogen had been prescribed but was not currently taking either. An iron infusion had no effect, and supplemental iron Maltofer was taken twice daily.
Table 1: Past Medical History
Table 2: Family Medical History
Analysis
Progression of the original disturbance from the respiratory system to the urinary system to the reproductive system is indicative of significant chronic health burden. The continuum of a unified theory of diseases3 postulates that continued and incorrect treatment of acute inflammatory diseases i.e., with multiple antibiotic prescriptions leads, via suppression, to sub-acute inflammatory process aka chronic, degenerative disease. Here this theory is confirmed - immune system dysfunction / chronic disease progresses in a non-healthful direction.
Looking at the hierarchical structure within the three levels of the human being energy complex, we note with concern that both maternal and paternal lines have dementia - the deepest pathology. Burdened predisposition, peripheral disturbance i.e., physical pathology which has steadily descended layers, and dissatisfaction (marital) – an identified contributing factor to the current condition - involving the emotional sphere4 gives weight to descending and deteriorating health.
Figure 1: Repertorization of presenting symptoms.5
Figure 2: Repertorization results.6
Remedy differentiation
SABINA - Metrorrhagia with active, gushing flow of bright red blood, or mixed with clots. The great guiding symptom is 'pain in the back radiating to the pubis', excruciating pelvic pains, severe dysmenorrhea, or more generalized back and pelvic pain7 is not seen in this case.
IPECACUHUANA - Uterine haemorrhage with starts suddenly with bright red uncoagulated blood, coming in gushes, often with nausea, vomiting & faintness8 is not seen in this case.
PHOSPHOROUS - Haemorrhagic tendency, debility & collapse states, left sided symptoms, fibrocystic growths, uterine fibroids, Metrorrhagia with bright, red blood - almost never clotted, prices are paid for poor boundaries.9 As if there are no barriers which on the physical manifests in haemorrhage from any injury or stress. Painless haemorrhage. While physical symptoms predominate there are few mental / emotional symptoms. Puts concerns of others above themselves, vulnerable to all types of influence, emotions go freely to others, little ability to contain and protect oneself from emotional vulnerability, - can be seen here as 'trying to please everyone else – over giving my time &energy. 'Causation of strong emotions, anger.’ Daydreaming – fantasizing. Typical craving for fish, and characteristic thirst for ice cold drinks.10
USTILIGO - Uterine haemorrhage, fibroids with haemorrhage, metrorrhagia.11
Posology
Levels of Health theory makes posology logical and comprehendible. Factors determining the Level of Health of an individual are: Hereditary disposition; Individual actions concerning the management of health; Vaccination, and unnecessary drugs, taken by the individual, and their ancestors.12
This complex presenting complaint combined with a convoluted personal medical history, additional weight of severe pathologies in both her parents, and coupled with the fact that her last known fever was recent but unexplained and not associated with two head colds, indicates a Level of Health classification 7 where systemic, chronic disease will manifest in full strength symptomatology after stress.13
Prescription PHOSPHOROUS
Potency 1M
Regimen One dose daily for two days.
Table 3: Reaction to the remedy – four & eight weeks’ post remedy
Symptoms that have been ameliorated
MIND - PLEASING - desire to please others (Fig;1) 'I'm putting boundaries up, now I'm not very concerned any more about who wants what from me, or that huge fear of letting people down.'
Table 4: Reaction to the remedy – four & seven months’ post remedy
Table 5: Reaction to the remedy – one year post remedy
Discussion
An organism overloaded with various hereditary predispositions created not only by the primary miasms of psora, sycosis, and syphilitic but also by poorly treated infectious diseases,1415 will descend down through the Levels of Health. Advancements in homeopathic theory161718state Hahnemann’s miasms are but a glimpse into understanding genetic predisposition, and it is descent through the Levels of Health which enables the miasms to start exerting effect, which is usually further convoluted by medical interventions. According to Vithoulkas19 (p.108),
“Since allopathic drugs are never selected according to the Law of Similars, they inevitably superimpose upon the organism a new drug disease which then must be counteracted by the organism.”
I have submitted this case not as an example of a good outcome or prescribing but rather to highlight the importance of adherence to sound theoretical basis for every prescription we make. If I had followed my own advice here and initially matched the potency to the level of health – who knows, the ablation and rod may have not been taken, with a much clearer case before you now.
Conclusion
My advice? Know homeopathic theory and apply it to every, single case before you. Master homeopaths of superlative mind have figured this all out for us humble prescribers, we just need to be aware of, mimic, and always apply, their methods.
Lacheta, 2019. Uterine adenomyosis: pathogenesis, diagnostics, symptomatology and treatment. Ceska Gynekol. Spring;84(3):240-246. English. Available from https://pubmed.ncbi.nlm.nih.gov/31324117/
Vannuccini & Petraglia, 2019. Recent advances in understanding and managing adenomyosis. F1000Res. Mar 13;8:F1000 Faculty Rev-283. Available from https://pubmed.ncbi.nlm.nih.gov/30918629/
Vithoulkas G, Carlino S. 2010. The "continuum" of a unified theory of diseases. Medical Science Monitor [online]. Feb;16(2):SR7-15. Available from https://pubmed.ncbi.nlm.nih.gov/20110932/
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