Clinical Cases

A Case of Pre Menstrual Syndrome

Last modified on February 17th, 2016

Homeopath Cynthia Kingsbury presents a case of PMS in a woman of 22.

A mother ed me with concerns about her 22 year old daughter. At our initial meeting, the client sits slightly hunched over. She is slim, fair-skinned, with straight blonde hair; her dress is conservative; her language polite, almost formal. She touches her face a lot during the intake, in gestures that register insecurity. On the intake form, she lists her overall energy (1-10; 1 being low) at a 6. Several years ago she was treated successfully with the homeopathic remedy Natrum Muriaticum; tried it again last year but it was no longer helpful.

Initial Intake

“When my mom called you to make the appointment I had PMS and depression related to that. Usually it dies down, but I’m still feeling nausea, depression, which is kind of unusual. I’m disappointed I can’t find a job. I want to be independent from my parents. I keep a lot to myself. That’s kind of restricting me from things I could be doing.”

When I ask her to describe her PMS symptoms, she said they start 10 days before, and she has feelings of low self-esteem, worthlessness, a lot of nausea, and low energy. Given a 1-10 self esteem scale, she says it gets down to 2; today it’s a 4.

CK: When you say low self esteem, how bad does it get?

Client: Pretty bad. Like, feelings of hopelessness.

CK: Any suicidal thoughts or feelings?

Client: A little bit. At its worst, there’s the feeling of not having any purpose, that everything is terrible, wanting to end it all. That was at the peak of the PMS, for one day, then it got a little better.

CK: When you say, “Wanting to end it all” do you get specific?

Client: No.

CK: On a depression scale 1-10 where the worst is 1, where would you put yourself?

Client: During PMS, a 1. Today, 4.

CK: What are your other PMS symptoms?

Client: Backache. Bloating. Abdominal pain. That’s the first 2 days, then the pain switches off. That and the nausea. They last about 6 days; the last one was heavy, with a lot of clotting. It was dark red.

CK: Describe what your shyness looks like:

Client: Ever since I was little I remember I wouldn’t do the talking. Other people would say, “She’s so shy.” I fulfilled that. I’ve made attempts to change this. I think it stems from anxiety. Especially in large groups, I don’t do well. What are they going to think about me if I say the wrong thing?

CK: What were you like as a kid?

A: Pretty obedient. Wanting to please.

Generals:

“I really like fresh air; in the house I like the window open unless I’m cold. I was wearing a jacket and was cold when others were wearing short skirts. But in hot temperature I get hot fast.”

CK: How is your sleep?

Client: Usually takes me awhile to go to sleep; usually thinking about things; toss and turn for 20 minutes. But I sleep well when I sleep. Can be a long sleeper: 10-11 hours.

CK: How’s your perspiration, compared to others?

Client: I tend to be the one that sweats the least, except my hands.

CK: How’s your digestion?

Client: I have had a lot of diarrhea lately. When I have my period I have to run to the bathroom all day with diarrhea. It’s kind of greenish lately.

Asked about sensitivities: “I’m definitely too sensitive in general. Like someone makes a comment about me. It could be a classmate that said something about me, a judgment. I’m also sensitive to lights, and noise, especially loud music. I’m fairly sensitive to smells too, like if someone doesn’t brush their teeth!

Head-to-Toe, anything not covered yet: “I slouch. Occasionally have dry skin under armpits; scaly; no oozing. And dandruff. When I was 11yo I had a whole outbreak of warts on my hands. Used salic acid on them. Right now I have a small one on my right thumb.”

Asked what she likes to do in her free time: “I have too much free time lately. Read books, watch movies. Used to play the violin. Cultural activities.”

CK: If you could do anything with no constraints, what would that be?

Client: I guess I’m really into the idea of altruism. I’d do something altruistic; don’t know exactly what context… That’s not a very concrete answer.

Observations: No teary moments. Nails are very short; may chew them. Not cheerful but not very glum. Lots of tentativeness, sentences which trail off.

Initial Analysis

The most intolerable symptoms in the client’s case at this point center around her menses. While she has had depression and nausea with it in the past, they had subsided before. The depression has become so severe that she wanted “to end it all.” This is an extreme disturbance in the life force–when it turns on itself–and thus must be taken very seriously.

Although it is not at the top of her concerns presently, when timidity (repertory language for shyness) is severe enough that it is causing the client to not be able to fulfill her potential. It should be weighted heavier. A related characteristic to this is her sensitiveness: she is sensitive/over-sensitive in a number of areas: emotionally, to others’ opinions of her; to noise (esp. loud music), light and smell.

Rubrics used for the Repertorization:

Mind. Suicidal disposition PLUS Mind. Suicidal thoughts:

Mind. Sadness. Menses before PLUS during:

Mind. Sensitive, music to:

General. Air. Open, desire for:

Sleep. Prolonged:

Stomach. Nausea, menses before PLUS during:

Skin. Warts:

The four remedies that came through the strongest using these rubrics were: Calcarea Carbonicum, various Natrums, Phosphorus, and Sepia. I decided to look at the Natrums as a group, because the client had already had an initial positive experience with Natrum muriaticum

Calcarea: The client does have the solid, responsible aspect of Calcarea However, there is not much else in the mental/emotional realm that resonates: fear and anxiety are not much present. She is neither particularly obstinate nor precocious. Also, except for chilliness, many of the generals and particulars are opposite.

The Natrums: Of the Natrum family, beside Nat-M which had stopped working, Nat-C came through very well. Although it was not under the “Suicidal” rubric, Nat-M and Nat-S were; and Nat-C was under the “Sadness before and during menses” rubric. R. Morrison’s description of Nat-C patients being “gentle, self-less and refined” is very fitting. The client is hoping to center her life around altruism. Nat-C also has the sensitivity to music, timidity, and great sadness. The SRP of diarrhea during menses is also covered under this remedy. Nat-C’s also tend to be sensitive to heat and cold, and have warts. It even mentions stoop shoulders. This looks like an excellent match overall.

Phosphorus: Certain aspects of Phosphorus mentals match well: being sympathetic, and sensitive on many levels. Phos also covered a number of the physicals well, such as diarrhea during menses, warts on the hand, dry skin. However there is much more reserve in the client than I would expect in a Phosphorus Key words from Morrison’s description of Phos–bubbly, flighty, open, suggestible–none of these ring true for this client.

Sepia: Sepia’s strong affinity to PMS issues makes it one to be considered seriously in this case. Although the client was not indifferent (Sepia’s often are), she did appear shutdown emotionally. On the other hand, the client is not showing the harsher side of Sepia: no evidence of sarcasm, irritability or anger. However, sometimes these things are not discovered at first. Chilliness and dry skin are present in both. But since there’s such excellent coverage of the client’s mental/emotional state with Nat-C, I will begin there. But Sepia is certainly a viable option.

I chose to give one dry dose of Nat-C 30C. Because some of her recent physical symptoms had been fairly strong, I wanted to stay away from the possible strong aggravation that sometimes comes with the 200C.

1st follow-up (2.5 weeks after first dose, a bit sooner than usual, but necessary in this case):

The client reports “It’s been up and down. The week after I took it was really positive, which feels really strange because I’m not used to it. Afterwards it went down again. Two days ago felt really sad, crying for hours. Yesterday had another really positive day. Suicidal thoughts? Briefly crossed my mind the day before yesterday; was feeling terrible again. I feel like I’m changing every day. But even on bad days when I was crying it was different. Before the remedy I would cry till I vomited; that hasn’t happened.”

She hasn’t had a period since taking the remedy. Had nausea the week after taking the remedy and the day of the interview, but not since then. Diarrhea [which had been continuous]: hasn’t had it the last few days; has been on and off overall.

Energy: the first few days it was really hard to get out of bed. Now it’s an 8 out of 10. Sleep has been good; 7-9 hours. “Feels like enough.” When asked about her self confidence, she said “Yesterday was really good.” Asked if she was doing anything differently, she answered, “On good days, I can make jokes, be funny.” The loud music hasn’t seemed to affect her quite as much. She was sweatier than usual when she ran yesterday.

Assessment: The remedy is clearly acting: her having “oddly” positive days; energy has increased to 8 (was a 6). The nausea immediately after the dose was likely an aggravation, and has subsided. A number of things are changing: the diarrhea, her self confidence, her perspiration, her sensitivity to music. There is no reason to do anything at this point. Because her menses is central and she has not yet had a period, and because many things are shifting up and down–as can happen during the early days after dosing–it is too early to determine how well the remedy is going to cover her case. But it is looking to be at least a good partial, since the energy is better.

2nd Follow-up (a few weeks later):

Her period went quite smoothly. Pain was very mild; she did not experience any depression following our meeting or at any time during her period. The nausea was not problematic either. Blood flow lighter. The last few days has been having high energy but “not so high confidence.” Feeling “very positive most of the time.” Only 2 very brief moments of feeling negative, one 3 days ago, and one today. She’s beginning to feel slightly anxious. “My energy is still pretty high, but I think my confidence level is still not where it should be.”

Assessment: This is a very different picture: these are radical improvements in her menses. But I am concerned that the effects are waning: she had negative moments 3 days ago, and today; she is beginning to feel more anxious; and thinks her confidence level is “not where it should be”–and since she is prone to understatement, this is not good. Now is the time to give a dose of the next higher potency of this remedy that has acted very well on every level, especially because I want to be sure she is supported during her next period. Client took one dry dose of Nat-C 200C.

3rd Follow-up (a few weeks later):

Client reports: “Since I took the second dose things have been really good. My period was great; no comparison to before; only had one day of mild cramping.” No nausea, no backache, no depression, no weepiness. Not only are most of the menstrual issues negligible now, but her self confidence is much better (9 out of 10, feeling like she CAN accomplish things), and she’s able to speak in groups. Her body language reinforces this shift in confidence as well: she touches her face less, meets my gaze more. Sleeps 8 hours and wakes refreshed. Energy is 9 out of 10. Some interesting wording comes up; she’s not “dwelling” on things as much: Natrums do have that tendency to dwell, but she had not mentioned this previously. This is a very nice response on every level, and there is no reason to do anything at this time.

4th Follow-up (several weeks later):

A lot of improvements are still holding: her self confidence and energy, both key indicators of how she is doing on the deepest level, are still very good. Still no depression or suicidal thoughts. However, some of the physical symptoms are slightly worse: the diarrhea and the nausea have returned, though mild; and one day of menses was “fairly painful.” She was also notably bothered by direct sun, a common Natrum symptom. Because I want to be sure she is supported during her menses in a couple of weeks, I will have her take the next higher potency. Client took one dry dose of Nat-C 1M.

5th Follow-up (2 months later):

Many things that had improved a month ago have declined. Sometimes when there are extra stressors in a person’s life, the response to the remedy is shortened. One month ago, she experienced a major life change, moving to a new country and starting a new educational program, so it would not be surprising that she might need a boost. Although her energy is still good (8), her confidence is down: speaking in class is very uncomfortable. Her PMS symptoms have increased again in the last month, and the sadness has returned with lots of crying. Because all of these things had improved, we will go ahead with another dose at this time. Took one dry dose of Nat-C 10M.

Concluding/5th Follow-up (about one month later):

The client reports: “My period started a couple of days ago and it has been very low-key — almost no pain, no depression or sadness, no nausea, and no diarrhea. Another thing I noticed was a wart on my hand which may or may not have been there before but it seems to be increasing in size. I used to have a problem with warts, so I am guessing this might be one of those recurring symptoms that you asked about. Last couple of weeks have been very positive for me and I am also experiencing less anxiety in groups. I’m very happy about this!”

BIBLIOGRAPHY

–Dr. Horst Barthel’s Synthetic Repertory in 3 volumes; 3rd improved edition, 1987. B. Jain Publishers, India

–Dr. James Tyler Kent’s Repertory of the Homoeopathic Materia Medica, 1897; Reprint edition 1992; B. Jain Publishers, India

–Roger Morrison’s Desktop Guide to Keynotes and Confirmatory Symptoms [1993. Hahnemann Clinic Publishing, California]

–Notes from my 4 years’ study at The Institute for Classical Homoeopathy in San Francisco, CA, 2005-2008

–William Boericke’s Materia Medica with Repertory, 9th Edition [1927]

About the author

Cynthia Kingsbury

Cynthia Kingsbury

Cynthia Kingsbury is a Certified Classical Homeopath trained at the rigorous 4-year program at the Institute of Classical Homoeopathy, located in San Francisco. She has been treating clients since 2006, and practices in Santa Cruz, CA, and via Skype. To her, call 831.431.0855 or see her website: www.simplyhomeopathy.com

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