CLINICAL Homeopathy for the treatment of menstrual irregularities: a case series P Cardigno* Homeopathic Clinical Research, Scientific Department FIAMO-Homeosynesis Medical Association, Colorno, Italy Objective: A preliminary study to evaluate the usefulness of homeopathic treatment in the care of menstrual irregularities. Method: Patients were diagnosed at the first appointment according to menstrual cycle over the past year: Amenorrhea (AM), Oligo-amenorrhea (OL-AM), OL, Taking hormone replacement therapy (HRT). All patients were prescribed an individualised, global homeo- pathic treatment. The main outcomes were: time to resumption of periods, change of clinical diagnosis at the end of follow-up or after 2 years. The secondary outcomes were: menstrual regularity at the end of follow-up, compared to pre-treatment frequency flow characteristics clinical course of acute and chronic concomitant symptoms. Results: 18 consecutive cases of secondary amenorrhea (SA) and oligomenorrhea (OL) met the entry criteria. 8 women had SA, 2 were on HRT, 6 had OL-AM and 2 had OL. The average duration of considered follow-up was 21 months. The average time before the reappearance of menstruation was 58 days (s.d. 20) in the 8 women with SA at the time of the first appointment, for all cases 46 days (s.d. 42). Change of clinical diagnosis: 50% of women, who were diagnosed AM, recovered their ovulatory cycle (OV), whereas 12.5% remained amenorrheic 33.3% of patients, who were initially OL-AM, showed an OV 100% of oligomenorrheic and HRT patients recovered an OV. The average frequency of spontaneous cycles per year changes from 4.32 (s.d. 1.97) pre-treatment to 9.6 cycles per year at the end (s.d. 2.92). Four detailed case histories are reported. Homeopathy (2009) 98, 97���106. Keywords: secondary amenorrhea oligomenorrhea classical homeopathy menstrual res time menstrual frequency Introduction Menstrual irregularities have become very frequent. 58% of adolescent girls requesting a gynaecological consultation have secondary amenorrhea (SA) and 42% have oligome- norrhea (OL).1 The annual prevalence of SA in the general 15���44 year-old population is 4.6%.2 The most common forms of SA are Hypogonadotrophic disorders caused by hypothalamic suppression, particularly Functional Hypo- thalamic Amenorrhea (FHA), and an ovulatory disorders of- ten associated with Polycystic Ovary Syndrome (PCOS). Less frequently, they are related to Hyperprolactinaemia (HYPER), Hypergonadotrophic conditions caused by Pre- mature Ovarian Failure (POF) and concomitant hormonal disorders (hyper- or hypothyroidism, Cushing���s Syndrome). The frequency of the various forms varies with the subject���s age.3,4 Discontinuation of oral contraception can cause Post- pill Amenorrhea (PPA) in 2% of women or significantly in- crease the length of the cycle for the first 9months5 Hormone Replacement or Progesterone Therapy (HRT/PROG) does not appear to restore normal Hypothalamus-Hypophysis- Ovarian axis function and physiological cyclicity and sex hormone pulsatility. On suspending HRT/PROG, after 1 year, only 5 out of 100 women regain a normal OV, 4 be- come oligomenorrheic, the others remain amenorrheic.3 SA is the interruption of menstrual flow for more than 3 months in women with a history of spontaneous periods.3���6 Identifying the cause of SA allows often-successful aetio- logical treatment. The most frequent specific causes are *Correspondence: Paolo Cardigno, FIAMO, Scientific Depart- ment, Homeopathic Clinical Research, Viale Mentana 1, Colorno 43052, PR, Italy. E-mail: ricerca.clinica@homeosynesis.com, ricerca@fiamo.it Received 4 December 2007 revised 1 April 2008 accepted 7 January 2009 Homeopathy (2009) 98, 97���106 �� 2009 The Faculty of Homeopathy doi:10.1016/j.homp.2009.01.004, available online at http://www.sciencedirect.com

tumours, chronic illnesses, medicines, concomitant endo- crinopathies, excessive exercise or drastic weight loss.6 However, in many cases, either it is difficult to define a spe- cific cause that can be eliminated3 or the outcome of therapy is an irregular, oligomenorrheic menstrual cycle. Cytoge- netic studies on women with SA have shown karyotype chromosome anomalies in 16.33%7 and of sexual chromo- somes alone in 9.9%,8 suggesting that SA sometimes has a genetic aetiology. It has also been observed that situations of severe stress that activate the hypothalamus-hypophysis- adrenal gland axis or suppress the hypothalamus-hypophy- sis-thyroid axis, can interrupt the HPO axis with consequent FHA.9 Classic homeopathy indicates a single homeopoathic medicine is given, taking into account the patient���s overall symptomatology.10 Some individual cases of amenorrhea (AM), treated with classical homeopathy have been re- ported in the literature.11,12 No systematic studies on the ef- ficacy of homeopathic treatment in the SA have been published, but the possible efficacy of complex13 and uni- tary14 homeopathic medicines has been observed in restor- ing the oestrus cycle in dairy cattle. I report the results of classical homeopathic treatment in 18 patients with menstrual irregularities and describe 4 successful case histories. Materialsandmethods Patients My patients��� records are filed using Radar and Winchip software. Of the 8022 records available, I selected those with primary diagnosis: SA and OL. 27 patients were iden- tified. Only 18 of these satisfied the following inclusion criteria: 1. Age 16���45, diagnosed by a gynaecologist as having SA. 2. At least 12 months��� follow-up with regular check-ups at least once every 3 months. 3. Regular recording of all menstrual cycles. 4. No administration, during homeopathic treatment, of sex hormones or medicines that stimulate or regularise pro- duction of the same. 5. No more than 7 menstrual cycles per year, equal to an average cycle length of 52 days or with AM at the time of the first appointment. 6. Absence of a clear aetiological cause, whose elimination might restore a normal menstrual cycle. Nine patients were excluded for the following reasons: 2 for inadequate follow-up, 3 for imprecise recording of the length of periods, 4 because of hormonal therapy adminis- tration. The 18 included patients were divided into 4 groups, according to the clinical diagnosis at the first appointment: 1. AM: absence of menstrual cycle for more than 3 months at the time of the first homeopathic appointment. 2. OL-AM: less than 5 cycles in the last year or at the most 7 cycles per year but with a period of AM exceeding 3 months. 3. OL: 5���7 cycles in the past year. 4. Taking HRT. Almost all patients have had severe menstrual irregular- ities in their gynaecological history (Table 1). Table 2 shows the gonadotrophic diagnosis made by gy- naecologist, their hormonal therapy and the reason that led the patients to choose the homeopathic treatment. The rea- sons were often connected to the fact that hormonal treat- ment is unable to regulate the menstrual cycle and has undesired and/or non-tolerated effects. Five patients refused hormonal therapy. Table 1 Gynaecological history Case no. Age Initial clinical diagnosis Duration of SA (months) Onset of menstrual irregularity Hormone treatment duration Period free of hormonal drugs before homeopathic treatment Spontaneous cycles in last year 1 19 AM Menarche 3 years 7 months 0 2 32 AM 6 Menarche 7 years 6 months 0 3 31 AM 5 10 months 1 month 7 months 1 4 20 AM 8 Menarche 5 months 5 months 0 5 26 AM 5 3 years 2 years 6 months 0 6 38 AM 6 Menarche 8 years 10 years 3 8 7 40 AM 9 months 2 months 3 months 2 8 45 AM 2 years no yes 6 9 27 OL-AM 3 5 years 1 year 2 years 2 13 10 32 OL-AM Primary Primary AM 13 years 3 years 5 11 22 OL-AM 12 Menarche no yes 2 12 28 OL-AM 13 Menarche 2 years 2 years 4 13 41 OL-AM 4 11 months no yes 7 14 43 OL-AM 4 3 years no yes 7 3 15 43 ON-HRT 6 Menarche 18 years no 0 16 18 ON-HRT 6 Menarche 8 months no 0 17 24 OL 8 5 years 4 years 1 year 6 18 16 OL 3 Menarche no yes 7 Menstrual irregularity P Cardigno 98 Homeopathy