Mrs. R. D., a 21 years old female, married since 1-½ years, came with a history of polymenorrhea since the past 6-7 months. This followed a D&C (Dilatation & Curettage) after an abortion during the fourth month of her pregnancy. The menses were irregular, usually appearing every 15 days, lasting one day with a scanty flow. The bleeding was like the washings of meat but was not clotted. She also had a thin, watery, profuse, non-offensive, non-irritating leucorrhea about 6-7 days before the menses. The leucorrhea was always preceded by a body ache. Since the past 6 months she also could not retain the semen after an intercourse.
Her appetite had reduced since the past 6 months and she craved pungent food. She drank 4-5 glasses every day, mostly with her meals. She did not sweat much and her bowel and bladder functions were normal. She sleeps for 8-10 hours at night and 3-4 hours in the afternoon. She wakes up unrefreshed from her sleep and does not feel like getting out of bed in the morning. She does not remember her dreams.
The patient came to Mumbai three months ago with her husband who works as a driver. She has studied till the sixth grade. She cannot tolerate dishonesty. She will get angry and feels like beating the other person. She will always express herself and will never keep things in her mind.
Treatment
On November 18, 2002 she was prescribed a dose of Natrum carb 200.
Follow up:
She was seen again on November 25 (LMP was Nov. 11) and December 2 when she was given SL. Meanwhile, she had been advised an ultrasound examination of the pelvis. This showed minimal free fluid in the pelvis, suggesting a pelvic inflammatory disease (PID). Other investigations like blood glucose, urine, VDRL, HIV, HbsAg were normal. The haemoglobin was 10.1 gm/dl.
December 23, 2002: The LMP was Dec. 12. Bleeding was for 3 days, bright red. Leucorrhea was better. She had a mild back ache and pain in the abdomen. 2 doses of Natrum carb 200 were repeated. January 1, 2003: Feels better. Backache with a pain in the abdomen- as if about to menstruate. 2 doses of Natrum carb 200 were repeated.
January 20, 2003: LMP was Jan 7. Menstrual complaints and backache were better. She had also put on some weight. It was decided that we would give her coital advice at the next visit. 3 doses of Natrum carb 1M were prescribed.
February 14, 2003: Nausea at the sight of food since 1 week. Distension of abdomen and constipation (no urge for stools). Thirst had increased a lot. There was some headache and dizziness. The tongue had a thin, white coating. Per vaginum examination showed a firm cervix and external os. A Urine Pregnancy Test (UPT) was done, which was positive. Diagnosis- Pregnancy. Arsenicum album 200 t.i.d. was prescribed for the next 7 days for the nausea and the abdominal discomfort.
March 21, 2003: No distension of abdomen. Nausea persisted and was worse from the smell of food, on eating, on lying down. She could tolerate water, and had an aversion to vegetables and pulses. Colchicum 200, q.i.d. was prescribed for the next 7 days.
Doses of Natrum carb 1M were repeated infrequently during her pregnancy and she had an uneventful pregnancy.
Discussion:
In this patient, the menses first became regular and then she was able to conceive with the help of Natrum carb.
The drugs that are commonly indicated in sterility are Borax, Natrum mur, Agnus, Natrum carb, Sepia, Phos, etc. When sterility is from non-retention of semen, the drug is Natrum carb; acrid, pungent secretions cause sterility in Natrum phos; Iodium has sterility with atrophy of the breasts and the ovaries; Agnus has sterility from suppressed menses and with loss of sexual desire; Phos has sterility with too early or too late menses.