A Tricky Case of Dysfunctional Uterine Bleeding

‘Shruti’* a 32 year old lady came with complaints of irregular menses since past two years, protracted with heavy flooding. The flow would continue for 10-12 days and was more on certain occasions.

A couple of months back she had developed horrible low abdominal pain during menses with heavy bleeding with clots which doubled her up and led her to consult her gynaecologist who suggested her hysterectomy for which she & her husband were not ready. Complete bed rest was advised as there was excessive flooding.

Along with all these the problem which she presented with was one of troublesome urinary frequency and urgency. There was soreness all over, in vagina, in abdomen & even in urethra.

As regards her other systems, she had a lifelong tendency to constipation which had worsened in the last two years. She had a history of uterine prolapse 4-5 years back but was well managed by the external use of pessaries as suggested by local gynaecologist.

In general she was not especially sweaty, tended to be chilly in cold weather and enervated by the sun. Thunderstorms did not worry her; in fact she rather enjoyed them. Food preferences were for spicy, salty food and she loved pickles. She was averse to fat and moderately thirsty. Her favourite pastimes were walking, swimming and most of all, dancing!

As a person, Shruti came over as a sweet, gentle person, very neat and polite but warm and caring. She admitted to a tendency to excitability especially in the context of her work, when she would rush around in a flap being somewhat less than productive at times.

She was saddened by the effect of her problem on her sex life with her husband, although she admitted that she had never been highly-sexed. She was not especially keen on comforting and consolation when upset and saw herself as fairly self-sufficient emotionally.

The psychological profile presented me with a little difficulty in terms of choosing a medicine for Shruti. She had been through the standard diagnostic and therapeutic procedures for her problem and, indeed, homoeopathy seemed to offer her hope where all else had failed. Many of her features were those of the medicine Sepia, which is cuttlefish ink prepared homoeopathically. In particular, the history of prolapse, the pain on passing water and on intercourse, the craving of salt and pickles, the love of dancing and the tendency to constipation, fitted well. Against Sepia was her lack of obvious emotional reaction to hormonal changes.

Sepia women are generally very susceptible to severe premenstrual syndrome. The archetype is described by M.L. Tyler in her Drug Pictures as an exhausted mother, worn out, hating everyone, especially her children and husband and just wanting to run away and escape. These drug pictures, although a useful aide-memoire can be a little dangerous if taken too literally.

I overcame my doubts and prescribed Sepia 1M for three doses separated by twelve hours. On review a month later, Shruti had made remarkable progress. The soreness had gone from the vagina and abdomen and was now localised to the urethra itself. The urgency had improved and she now slept all night. She could also resist the urge to pass water on occasion and in general felt less as if her life was being ruled by her bladder. However, she was feeling emotionally generally depressed and weary.

I felt that the Sepia had definitely had an action. Undeterred by the low mood, I repeated the dose and arranged to see Shruti again after three months. Good news again! She’d had a minor headache this time after the dose but no other ill effects. The low mood had lifted and she said that she felt generally calmer and better able to cope in her job. The bladder symptoms, though not completely resolved, were better again and she was slightly less constipated. Her menstrual cycle seems to be regular with normal flow & without any discomfort. She’d had no menstrual problem at all since starting the treatment and, amazingly, had managed to make love with her husband on two occasions, for the first time in eighteen months.

We were both delighted and encouraged by this process and agreed that the best thing to do at this stage would be nothing. The Sepia was probably still acting in Shruti’s system and it was best not to give any more until the action of the last dose had ended. I feel confident that she will continue to improve steadily It is, of course, possible that she may require further doses or a different potency in the future, but we will cross that bridge when we come to it. What is important at this stage is that the subtle cuttlefish had once again acted, and in a person who would not have struck one instantly as a “Sepia type”.

* Name Changed