Article published online: 2024-02-01

Case Report 45

Polycystic Ovarian Syndrome Treated by

1 Regional Research Institute of Homoeopathy, Agartala, under Address for correspondence Laijun Nahar, MD, Regional Research
Central Council for Research in Homoeopathy, Ministry of AYUSH, Institute of Homoeopathy, JK Kobra Para Road, Khumulwng, Agartala,
Government of India, Tripura, India Tripura 799045, India (e-mail: [email protected]).

Homœopathic Links 2024;37(1):45–49.

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Abstract Background Polycystic ovarian syndrome (PCOS) is one of the most common
endocrinopathies among reproductive women. Cardinal manifestations of PCOS
include hyperandrogenism, oligo/anovulation and/or polycystic ovarian morphology.
Affected women often display notable metabolic co-morbidities. Plenty of evidence on
PCOS favouring homoeopathy is available in the literature. In this case, also individual-
ised medicine portrayed a favourable response within a short span of time.
Case Summary A case of PCOS with the complaint of irregular, delayed menses, acne
on the face and dark pigmentation on the neck for the last 3 years is presented here.
The outcome was assessed by using two validated measurement scales. After 4 months
of follow-up, the case was markedly improved on the Outcome Related to Impact on
Daily Living (ORIDL) scale (þ4) as per the patient’s perspective. Clinical improvement
Keywords was correlated with objective evidence from the ultrasonography report. Modified
► polycystic ovarian Naranjo criteria for Homeopathy (MONARCH) score recorded at the final visit (þ8 on
syndrome the ‘6 to 13’ scale) is suggestive of a high likelihood of improvement by homoeo-
► individualised homo- pathic intervention.
eopathic Conclusion The case report presented here has produced significant evidence of the
► MONARCH effect of individualised homoeopathic medicine in the treatment of PCOS within a short
► case report time.

Introduction
for cardiovascular disease and symptoms of anxiety and de-
Polycystic ovarian syndrome (PCOS) is a heterogeneous pression.3 PCOS is often exacerbated by obesity.8 Loss of body
syndrome, considered the most common endocrinopathy in weight (BW) and lifestyle modifications are highly recom-
women of reproductive age.1 As per Rotterdam criteria, diag- mended as the first line of management in PCOS, especially
nosis of PCOS commonly requires at least two of three features: for obese women.9,10 A 5 to 10% loss in BW over 6 months,
polycystic ovaries on ultrasonography (USG), biochemical/ regardless of body mass index (BMI), may be associated with
clinical hyperandrogenism and oligo/amenorrhea.2 PCOS improvements in central obesity, hyperandrogenism and ovu-
affects 9 to 18% of women of reproductive age,3 with an overall lation rate.10 However, PCOS is associated with many compli-
prevalence of 9.13% in Indian adolescents.4 cations and it is quite difficult to cure by contemporary
Despite the high prevalence, PCOS is an under-recognised systems.11 In the conventional medical system, various med-
condition and many women remain undiagnosed.5 It affects icines are being used for symptomatic management which is
health and well-being over the lifespan.6,7 It is the most very expensive and also has side effects.12 Homeopathy as an
common cause of anovulatory infertility and women with alternative system of treatment may be tried for reducing the
PCOS have a greater prevalence of type 2 diabetes, risk factors excessive side effects and minimise treatment costs.

article published online © 2024. Thieme. All rights reserved. DOI https://doi.org/
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46 Polycystic Ovarian Syndrome Treated by Homoeopathy Nahar, Shil

Homoeopathy is strictly based on individualisation. For normal. She reported loose stool daily two to three times for
the selection of medicine, more emphasis is to be given to the last 6 months which aggravated after breakfast and had
striking, uncommon and peculiar (characteristic) signs and a history of frequent urination at late night for the last 1
symptoms of the case of disease (§153).13 Ample studies on month. She also had profuse sweat on covered parts of her
PCOS favouring homoeopathy11,12,14 are available in the body. She had disturbed sleep (þ) and dreams of falling from
literature. Homoeopathic medicines cure patients when the height.
criteria of similarity are completely matched. In this case, Mentally she was irritable, forgetful, weak in memory.
improvement was documented through a standard and On examination, she was mesomorphic, with a BMI of
validated scale. The diagnostic report in the form of USG 23.8 kg/m2 and blood pressure 110/76 mm Hg. She had no
correlated with clinical improvement. Case reporting was anaemia, jaundice, cyanosis, oedema and lymph node was
done in compliance with the HOM-CASE guidelines15 not palpable.
[a supplement of CARE guidelines16]. Her last menstrual period was on 4 April 2018; the
previous period was on the 21 February 2018. USG done
on 3 July 2018 revealed the existence of polycystic ovarian
Patient Information

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disease (PCOD), with a bulky uterus.
Present Complaints
A 27-year-old unmarried female reported with complaints of Diagnostic Assessment
the absence of menses for the last 3 months and acne on the The patient presented with amenorrhoea for the last 3
face (grade of acne severity was mild in Global Acne Grading months and acne on the face, dark pigmentation on the
System) and dark pigmentation on neck for the last 3 years. She neck for 3 years. She was also having complaints of thin,
was also having complaints of thin; watery leucorrhoea for the watery leucorrhoea for the past 1 year. On the basis of USG
past 1 year. She had a history of a delayed menstrual cycle with report she was diagnosed as PCOD with a bulky uterus.
a 45 to 55 days interval for 3 years. The patient was taking
hormonal pills on and off to regularise periods but without Therapeutic Intervention
improvement. For erecting totality, complete repertory was selected
and repertorisation was done with the help of HOMPATH
Past History software17 using the rubrics mentioned in the repertorisa-
The patient had a history of lipoma on the back, which was tion chart (►Fig. 1). After repertorisation, from the
operated on, 1 year ago and had a history of chickenpox in list of drugs (►Fig. 1) Thuja occidentalis scores highest
childhood. (21) covering 9 symptoms out of 9. Based on repertorisation
and further consultation with materia medica Thuja
Family History occidentalis was prescribed18 on the basis of homoeopathic
From the family history. it was found that her mother and principles of totality. Medicine was procured from
sister had type 2 diabetes mellitus. Good Manufacturing Practice (GMP) compliant pharmaceu-
tical company and prepared by strictly following the
Personal History instructions given in Homoeopathic Pharmacopeia of India
She was an unmarried girl living in a joint family belonging (HPI).
to a middle socio-economic group and having a good
relationship with other family members. She was unem- First Prescription (first visit)
ployed, had no addiction and her dietary habit was regular. Thuja occidentalis 200, once daily  4 days with placebo for
There was no history of any regular drug intake. 14 days and advice for moderate exercise, and to take a
balanced diet.
Generalities
Her appetite was satisfactory. She had a desire for fish (þ) and Follow-Up and Outcomes
salty food (þ), and an intolerance for fatty food (þþ). Thirst was The detailed follow-up is mentioned in ►Table 1.

Fig. 1 Repertorisation chart.

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 Polycystic Ovarian Syndrome Treated by Homoeopathy Nahar, Shil 47

Table 1 Timeline including follow-up of the case

Relevant past medical history (symptoms, diagnosis, interventions) ORIDL score Modified
Naranjo
Dates 2001 Chickenpox
criteria for
2017 Lipoma; operated Homeopathy
(MONARCH)
Current symptoms Dates Interventions Pt. A. Phy. A.
Baseline: First visit 1. Thuja occidentalis 200/4D – – –
• Absence of menses, LMP-04/04/ To be taken in the morning on
2018 an empty stomach for 4 days
• Irregular and delayed menses 2. Placebo 200/
• Acne on face To be taken once daily for
• Dark pigmentation on the neck 3 months
• Thin watery leucorrhoea
• Frequent urination
• Loose stool

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• Sleep disturbed(þ)
Follow-up visits: Second visit 1. Thuja occidentalis 1M/4D 0 0 Not done
No change of any symptoms, i.e. To be taken in the morning on
same as before empty stomach for 4 days
2. Placebo 200/28D
To be taken once daily
LMP- 20/08/2018 Bright red, no Third visit Placebo 30 / BD  1 month þ2 þ2 Not done
clots, Leucorrhoea decreased, acne
on face reduced dark pigmentation
on neck slightly lightened
Frequent urination slightly reduced
Sleeplessness persisted
Stool complaint remains the same
LMP- 23/09/2018, Bright red, no Fourth visit Placebo 30 / BD  1 month þ3 þ3 Not done
clots, Leucorrhoea same, acne on
face reduced, dark pigmentation on
neck same
Sleep disturbed
Frequent urination standstill
Stool complaint slightly improved
LMP- 22/10/2018 bright red, no Fifth visit 1. Thuja occidentalis 1M/4D þ3 þ3 Not done
clots, leucorrhoea same, acne on To be taken in the morning on
face same, dark pigmentation on empty stomach for 4 days
neck same 2. Placebo 200/28 doses
Frequency of urination same To be taken once daily
Stool complaint standstill
Sleep disturbed
Advised for USG pelvis
USG Last follow-up (24/11/2018) þ4 þ4 þ8
Suggests normal study, acne on face disappeared, dark pigmentation on neck lightened,
leucorrhoea disappeared, sleep was markedly improved, urine complaint disappeared,
stool regular once daily

Abbreviations: BD, twice daily; LMP, last menstrual period; ORIDL, Outcome Related to Impact on Daily Living; USG, ultrasonography. Pt. A. Patient
Assessment, Phy. A.- Physician’s Assessment.

Response to the Course of Treatment repeated when the case came to standstill. At the end of
The patient was followed up for 4 months. After taking treatment, the cysts in both ovaries completely disap-
Thuja 200C, menses have not appeared, and all the other peared as shown on pelvic sonography, acne on the face
symptoms were the same as before. After reconsidering the disappeared, dark pigmentation on the neck lightened, ab-
symptomatology, only the potency of the medicine was normal vaginal discharge also disappeared, sleep was marked-
increased (Thuja 1M/4 doses) as per the demand of the ly improved, urine complaint disappeared, stool became
case. On changing the potency menses appeared, leucor- regular once daily.
rhoea decreased, acne on the face reduced, dark pigmenta-
tion on the neck slightly lightened and frequent urination Clinician and Patient Assessed Outcomes
slightly reduced. Sleeplessness persisted and stool com- The clinical improvement and outcome of signs and symp-
plaints remained the same. In the subsequent follow-up, toms were assessed by Outcome in Relation to Impact on
she was put on placebo and the same medicine was Daily Living (ORIDL)20 score of the case at every follow-up

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48 Polycystic Ovarian Syndrome Treated by Homoeopathy Nahar, Shil

visit. Objective evidence of the case was documented by USG The case was observed for further 3 years without recurrence
report at baseline and after 4 months of treatment. of symptoms.11
ORIDL score of the case is given in ►Table 1. The above case showing the classical features of PCOS
was treated with the help of individualised homoeopathic
Intervention Adherence and Tolerability medicine Thuja Occidentalis in increasing potencies (200,
The patient was advised to report at every 14 days interval to 1M) and no adverse event was encountered during the
check the intervention tolerability. She was found to be period of treatment. In this case, a validated scale (ORIDL)
adherent to the instructions given to her about the dosage was used to assess the improvement (i.e. chief complaint as
and timing of taking the medicines and to take adequate rest, well as general well-being; ►Table 1). Scores obtained from
exercise and proper diet. this scale revealed clinically significant results after treat-
ment. Objective evidence in the form of pelvic sonography
Adverse or Unanticipated Events was also documented. MONARCH was applied to assess the
No unanticipated event in the form of aggravation or wors- causal attribution between prescribed medicine and im-
ening of symptoms was reported by the patient throughout provement. The high total score of MONARCH (►Table 1) at

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treatment.21,22 the final follow-up (þ8, on a ‘6 to 13’ scale) implies that
the improvement was by homoeopathic intervention.
Objective Evidence In this case, homoeopathic medicine Thuja occidentalis
The improvement of the case was documented by the pelvic has been found effective to relieve the symptoms as well
USG report ( ►Table 1). as resolution of cysts in the ovary within 4 months of
treatment.

Discussion
Conclusion
PCOS is a common complex condition in women associated
with psychological, reproductive and metabolic features. It is This case report shows the usefulness of individualised
a frustrating experience for women, often difficult for clini- homoeopathic medicine in the management of PCOS. Al-
cians to manage, and is a scientific challenge for researchers. though a single case report cannot draw any certain conclu-
It is a chronic disease with manifestations across the lifespan sion, more documented cases and scientific research could
and represents a major health and economic burden. Both help to establish the favourable effects of homoeopathy in
hyperandrogenism and insulin resistance contribute to the scientific field. Nevertheless, randomised controlled trial is
pathophysiology of PCOS. Management should focus on suggested for further advancement in this regard.
support, education, addressing psychological factors and
strongly emphasising healthy lifestyle in addition to the Patients’ Consent
targeted medical therapy. Lifestyle changes are the first Informed consent has been obtained from the patient.
line of treatment in the management of the majority of
PCOS women who are overweight.7 Funding
The conventional medical management of PCOS includes None.
symptomatic treatment and lifestyle modification with
weight reduction. Metformin, oral contraceptives, anti- Conflict of Interest
androgens, clomiphene citrate and thiazolidinediones are None declared.
being used for the management of different presentations of
PCOS. But these drugs are very costly and have many side
effects.12 With the increasing prevalence of PCOS and its References
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