Synopsis

Of

“ Utility of Homoeopathic Medical Repertory by Robin Murphy

in PolyCystic Ovarian Syndrome”

A Dissertation to Be Submitted In Partial Fulfillment of the Requirement

For The Award of the Degree of

DOCTOR OF MEDICINE IN HOMOEOPATHY

(REPERTORY)

OF

DR. BHIM RAO AMBEDKAR UNIVERSITY, AGRA (U.P.)

At

BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL

KNOWLEDGE PARK– I, GREATER NOIDA (U. P.)

By

ISHA ARORA

Session : 2013-2016

Under the guidance & Supervision of

DR. HARCHARANJEET KAUR

Prof & HOD of Repertory Dept in Bakson Homoeopathic
Medical College & hospital
 SYNOPSIS PROFORMA OF THE PROPOSED DISSERTATION WORK FOR
ACCEPTANCE OF UNIVERSITY

NAME OF THE CANDIDATE : ISHA ARORA

Permanent Address : MIG FLAT NO. 13-A POCKET A DILSHAD GARDEN DELHI
1. -110095
NAME & ADDRESS OF THE INSTITUTION:
BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,
2. 36 B KNOWLEDGE PARK, PHASE I, GREATER NOIDA -201306
COURSE OF STUDY AND SUBJECT:
3 DOCTOR OF MEDICINE IN HOMOEOPATHY, REPERTORY.
DATE OF ADMISSION TO THE COURSE & BATCH
4 OCTOBER 2013
TITLE OF THE TOPIC
5 Utility of Homoeopathic Medical Repertory by Robin Murphy in PolyCystic Ovarian
Syndrome
6 BRIEF REVIEW OF THE INTENDED WORK
6.1 Research Question:
Is Homoeopathic Medical Repertory by Robin Murphy useful in managing the
cases of polycystic ovarian disease ?
Research Hypothesis:
Homoeopathic Medical Repertory by Robin Murphy is useful in managing the
cases polycystic ovarian diseases
6.2 Need of study : Polycystic ovarian syndrome is one of the most common endocrine
dysfunctions in women of reproductive age with a prevalence of approximately 5-10%
worldwide , characterized by irregular menstruation , obesity, hyperandrogenism and
polycystic ovary.1
In India PCOS is reported in 9% of adolescents.2 Among Indian women 15-35 years of age
evaluated at rural gynecology clinic, 13% presented with menstrual irregularies, half of which were
found to have PCOS, estimating the prevalence to be around 6.5%.3 Although cases of PCOS
may exist in rural areas of India, the focus of current research is based on urban areas of
India, such as Delhi, where impacts of Westernization and globalization have heavily
influenced urban Indians undergoing a rapid nutrition transition toward an obesogenic diet
and lifestyle.4 In Kashmir (India), the prevalence is much higher at 10.5%.5
PCOS may include hyperandrogenism, chronic anovulation and sonographic polycystic
ovarian morphology. Hyperandrogenism, either clinical or biochemical, is required for
diagnosis of PCOS by the 1990 National Institute of Health Criteria and the 2006 Androgen
Excess PCOS Criteria, in contrast to the 2003 Rotterdam Criteria, which allows for any 2 0f
3.6-8
The pathophysiology of PCOS is still not clear, and medical care of these patients has been
limited to symptomatic control and infertility. To our knowledge, no study has assessed the
different clinical, biochemical and metabolic characteristics of PCOS subtypes and healthy
controls among Asian women, using the AES-2006 criteria, until now.9
Allopathy treats the PCOS with Metformin, Clomiphene, Oral Contraceptives. Metformin's
 most common side effect is stomach upset, usually diarrhea & serious side effects
associated with metformin is liver dysfunction, Clomiphene should not be used for more
than six months as it is associated with an 11% risk of multiple pregnancies.10
Contraceptives on long term use they may cause some of the side effects like Breakthrough
bleeding, weight gain, amenorrhoea, increased risk of myocardial infarction, increased risk
of venous thromboembolism, decreased high-density lipoprotein, increased low-density
lipoprotein, increased risk of myocardial infarction and increased risk of stroke in smokers
and in those with high blood pressure.11-13
Homoeopathic constitutional treatment helps balancing hyperactivity of glands, regulate
hormonal levels, dissolve the cysts in the ovaries and bring back them to resume normal
functioning. Hence, Homeopathic medicines can restore hormonal balance, normal
ovulation, menstrual cycles, and also eliminate the need for hormone therapies and surgery.
This can significantly increase the chances of conception. Homoeopathy is permanent, cost
effective & with no adverse effects.The different expressions of this disease can be
managed effectively, safely and gently with Homeopathic remedies.
 A prospective study was conducted in PCOS patients using homoeopathic
medicine (pulsatilla), which shows that there is significant difference between
the scores representing the symptoms of PCOS before & after treatment. The
difference can be clearly attributed to homoeopathic medicines & can be said
that the treatment is effective.14
Therefore, this work is aimed at better understanding of Homoeopathic Medical Repertory
by Robin Murphyin cases of polycystic ovarian syndrome.

7. AIM
To evaluate the utility of Homoeopathic Medical Repertory by Robin Murphy in managing
of Polycystic ovarian Syndrome.
OBJECTIVE
To manage the cases of Polycystic ovarian Syndrome.
To evaluate group of Homoeopathic medicines effective in treating Polycystic ovarian
Syndrome
8. REVIEW OF LITERATURE
PCOS is a hormonal condition, not a problem with the ovaries. Ultrasound is NOT enough
to diagnose PCOS. 25% of perfectly normal women display polycystic ovaries at one time
or other .15 A subsequent ultrasound will show it to be normal again. True PCOS involves
hormone irregularities that must be picked up with blood test.
Many cases of PCOS are temporary. More specifically, many cases of so-called PCOS that
we see in our clinic can more accurately be described as post-Pill syndrome. It is a
medically recognized fact that it can take up to 2 years for normal ovulation to resume after
stopping the Pill. (16-18) .It is important to understand a normal ovary produces fluid-filled
follicles that contain the eggs. Ovarian 'cysts' form and are reabsorbed every month, in
every woman. Follicles of different number and different size will be visible in every
ovary. When the follicles do not form properly cyst is actually being formed. Follicles can
be too large (a type of 'ovarian cyst' that can cause pain or rupture), or too small (as seen is
polycystic ovaries). The 'cysts' seen in PCOS are actually small, underdeveloped
follicles. They look like that because ovulation is not occurring properly, and this can be
due to a number of causes, but in true PCOS, it is due to a problem with insulin.
The polycystic appearance may be normal. Or the ovaries may look that way because
something is preventing ovulation from progressing normally.
Type 1 PCOS: Insulin-resistant
The real underlying issue is insulin resistance and leptin resistance. Improper signaling
from these metabolic hormones inhibits ovulation and causes the ovaries to produce
testosterone. It is a problem with the metabolic hormones that causes weight gain.
Type 2 PCOS: Non-insulin-resistant
The ultrasound may show multiple, undeveloped follicles. LH may be elevated, and periods
do not occur regularly. Testosterone may be high or normal. If testosterone is normal, the
acne and facial hair exist because oestrogen is too low (compared to testosteorne). Body
weight can be normal.
In insulin-resistant Type 1 PCOS, the ovaries were prevented from ovulating because of
insulin. In type 2 PCOS; the ovaries are prevented from ovulating because of something
else.
A recent German study has found that PCOS sufferers have an increased risk for
autoimmune thyroid disease.(19)
The researchers believe that the progesterone deficiency associated with PCOS makes
women more susceptible to the autoimmune condition. It may also be that women with
thyroid conditions are more like to develop PCOS. Healthy thyroid function is necessary
for healthy ovulation.
"As [PCOS patients] get older, their chance of getting pregnant may actually be higher,"
according to Swedish researcher Miriam Hudecova. Her research shows that by the age of
35, women with PCOS have had as many successful pregnancies as women without PCOS,
even without the assistance of fertility treatment. (20)
Symptoms
Women with polycystic ovary syndrome may display a wide range of clinical
symptoms but they usually present for three primary reasons: menstrual irregularities,
infertility and symptoms associated with androgen excess (e.g., hirsutism and acne). In one
study, 70 percent of affected women reported menstrual dysfunction. A smaller percentage
of women with polycystic ovary syndrome actually have normal cycles..
Clinical signs include those associated with a hyperandrogenic anovulatory state. Hirsutism
and acne are common. Approximately 70 percent of affected women manifest growth of
coarse hair in androgen-dependent body regions (e.g. chin, upper lip, periareolar area,
chest, lower abdominal midline and thigh), as well as upper-body obesity with a waist-to-
hip ratio of greater than 0.85. Obesity is present in up to 70 percent of patients. Ovarian
enlargement may be unilateral or absent .
Diagnosis
To diagnose PCOS, a combination of clinical symptoms and lab tests. The blood tests to
consider are:
 Free testosterone - elevated in PCOS.
 DHEA -S- elevated in PCOS.
 Sex hormone binding globulin (SHBG) - usually low in PCOS.
 Fasting insulin - elevated in PCOS. Results greater than 9 or 10 can indicate insulin
 resistance. Insulin resistance is usually the underlying cause of PCOS. Also 2-hour
post-prandial insulin test, along with a 2-hour post-prandial glucose test.
 Fasting glucose or 2-hour post-prandial glucose - elevated in PCOS. Using this
information in combination with the insulin tests helps to diagnose insulin
resistance. Also, women with PCOS have a higher risk of diabetes so it is important
to screen for this early and often.
 LH: FSH- ratio between these two hormones. In PCOS, we would expect LH
(Lutenizing Hormone) to be elevated in comparison to FSH (Follicle Stimulating
Hormone).
 Ultrasound to check for the presence of ovarian cysts. Even if the ovaries do appear
normal, the absence of ovarian cysts does not mean that a woman doesn't have
PCOS. Not every woman with PCOS has ovarian cysts, and not every woman with
ovarian cysts has PCOS.
 Cholesterol levels and liver function tests, as these can also be abnormal in PCOS.
Complications
Untreated polycystic ovary syndrome may be regarded as a disorder that progresses until
the time of menopause. Ongoing studies lend support to the hypothesis that women with the
syndrome are at increased risk for the development of cardiovascular disease . Because the
syndrome is also associated with lipid abnormalities..
Other long-term effects of polycystic ovary syndrome are related to the clinical
consequences of persistent anovulation. These effects include infertility, menstrual
irregularities ranging from amenorrhea to dysfunctional uterine bleeding, hirsutism and
acne.
More important, the long-term effects of unopposed estrogen place women with the
syndrome at considerable risk for endometrial cancer, endometrial hyperplasia and,
perhaps, breast cancer..
HOMOEOPATHIC APPROACH
Homeopathy is the dominant option to treat Polycystic Ovarian Syndrome. Homeopathic
approach towards management of PCOS is constitutional taking into account the patient’s
physical symptoms along with their mental and genetic makeup that individualizes the
person. Early intervention with Homeopathy can assist in preventing further progress and
hence deterioration caused by PCOS. Homeopathic constitutional treatment will help
balance hyperactivity of the glands, regulate hormonal balance, dissolve the cysts in the
ovaries and force them to resume normal functioning. Hence, Homeopathic medicines can
restore hormonal balance, normal ovulation, menstrual cycles, and also eliminate the need
for hormone therapies and surgery. This can significantly increase the chances of
conception.
Several researchers in Polycystic Ovarian Syndrome has been done , one of the research
published in Boletin Mexicano de Homeopatica14 in which 36 women suffering from
Polycystic Ovary Syndrome (PCOS), and fitting the mental picture of the homoeopathic
remedy Pulsatilla, were given Pulsatilla 6C, 4 hourly throughout the day for 2 weeks after the
end of menstruation, and this was repeated for 4 consecutive cycles.
Many stalwarts’ of Homeopathy and authors have suggested certain medicines for
providing permanent relive to the patients and also to control the acute episodes.
The Homoeopathic Medical Repertory by Robin Murphy is based on the principles of
 clinical as well as classical homoeopathic practice. The author’s aim to make it modern
practical and easy reference book . He has enriched this repertory with many clinical as
well as pathological rubrics & which helps the practitioner to find out simillinum on the
basis of clinical and classical symptoms There are 3 typographies used in this Repertory to
indicate the gradation of remedies CAPITAL BOLD :3, Italics : 2, Roman:1
RUBRICS FOR Polycystic ovarian syndrome –
1. Female Cyst, genitalia-cysts,ovarian
Left
Right
2.Amenorrhea, menses absent(see suppressed)
Girls in young
3.Constitution, distribution masculine in women
4. Obesity uterine complaints with

9. MATERIALS AND METHODS:

9.1) Study setting & Study duration

The study will be conducted at the I.P.D, O.P.D and P.O.P.Ds of Bakson
Homoeopathic Medical College & Hospital, 36-B, Knowledge Park-1, Greater
Noida (U.P.)-201306. The study duration will be of 18 months.

9.2) Selection of samples

Sample selection will be done at the study setting on the basis of inclusion and
exclusion criteria as stated below.
9.3) Inclusion / Exclusion criteria

Inclusion Criteria -
1) Diagnosed cases of PCOS.
2) Females of age groups of 1 5 – 30 years.
3) Patients complying with regular follow up.

Exclusion Criteria –

1) Patients with complications of PCOS like endometrial cancer, heart disease,

diabetes and metabolic syndrome.
2) Patients with other systemic disorder.
3) Pregnant women.
4) Patients unable to comply regular follow up.

9.4) Study design

Prospective Observational Single Blind Clinical Study.

9.5) Intervention
Homoeopathic Medicines as per the totality of each case.

9.6) Selection of tools

 The following tools would be used during study:
 Standard homoeopathic case taking Performa
 Questionnaires,
 Investigations supporting the diagnosis,
 Screening procedures to fulfill the inclusion/exclusion criteria,
 Homoeopathic Medical Repertory by Robin Murphy

9.7) Outcome Assessment

Outcome assessment will be done with the help of measuring Quality of Life Scale
(QoL) in patients with PCOS by comparing the result after treatment with previous
status.
A positive outcome as to the improvement in Quality of life (QoL) of the patient is
dependent primarily on a reduction in number and frequency of symptoms, days of
work missed, doctor visits, through avoidance of the aforementioned
circumstances.

9.8) Statistical analysis

The data obtained from the observations after treatment will be statistically
analyzed by using statistically appropriate techniques

9.9) Does the study require any investigation or intervention to be conducted on

patients or other humans or animals? If so, please describe briefly.
Investigation like USG will be done as per the requirement. Study will conducted
on patients (humans) .
9.10) Has Ethical Clearance been obtained from your Institution in case of 9.11?
The ethical clearance will be obtained prior to the initiation of the study.

10. EXPECTED OUTCOME AND THEIR USEFULNESS:

1. It is expected that Homoeopathic Medical Repertory by Robin Murphy is
useful in treating Polycystic ovarian syndrome
2. After documenting the result of the study –
- It will help in identifying group of remedies useful in Polycystic ovarian
syndrome.
- The proposed study will enrich the existing literature & enhance the knowledge
of homoeopathic fraternity ;there by the patient suffering from Polycystic
ovarian syndrome will be benefitted.
- It will also encourage the researchers to take up other studies on other area of
problem adopting different parameters.

11 REFERENCES:
1. Anthropometric and Biochemical Characteristics of Polycystic Ovarian Syndrome in
South Indian Women Using AES-2006 Criteria) ,Thathapudi S, Kodati V, Erukkambattu
J, Katragadda A, Addepally U, Hasan Q 2014 Jan 5 12(1): e12470
2.Niddi R, Padmalatha V, Nagarathna R , Amritanshu R . Prevalence of polycystic Ovarian
syndrome in Indian Adolesc Gynecol. 2011; 24; 223-7
3.Chhabra S, Venkatraman S . Menstrual dysfunction in rural young women & the presence
 of Polycystic ovarian syndrome. J obstet gynaecol . 2010 Jan, 30(1) ; 41-5
4 Ovary syndrome (pcos) in urban india, Heidi Ann Manlove ,2011,University of Nevada,
Las Vegas
5. Zargar AH, Wani AI, Masoodi SR, Laway BA, Bashir MI, Salahuddin M. Epidemiologic
& etiologic aspects of hirusitism in Kashmiri Women in the Indian Subcontinent . Fertil
Steril. 2002; 77(4): 674-8
6 Rotterdam ESHRE/ ASRM – Sponsored PCOS consensus workshop group, Revised 2003
consensus on diagnostic Criteria and long term health risks related to polycystic ovary
syndrome . Fertil Steril 2004; 19-25
7. Azziz R, Carmina E, Dewailly D , Diamanti – kandarakes E , Escobar- Morreale HF,
Futterweitw, etal. Positions statements : Criteria for defining polycystic ovary syndrome as
a predominantly hyperandrogenic syndrome: an Andogen Excess Society guideline, Jelin
Endocrinal Metabolic 2006; 91(11) : 4237-45
8. Dunaif A, Givens J Haseltine F, Merriam G , editors Polycystic ovary syndrome Boston ,
MA : Blackwell Scientific Publications ,1992
9 Anthropometric and Biochemical Characteristics of Polycystic Ovarian Syndrome in
South Indian Women Using AES-2006 Criteria) Thathapudi S, Kodati V, Erukkambattu
J, Katragadda A, Addepally U, Hasan Q 2014 Jan 2014 Jan 5; 12(1): e12470
10.A Detailed Study on Poly Cystic Ovarian Syndrome and It’s Treatment With Natural
Products ,Nagarathna P.K.M, Preethy Rachel Rajan, Raju Koneri, 2013; 5(4): 109-120
11.Speroff L, DeCherney A. Evaluation of a new generation of oral contraceptives.
ObstetGynecol.1993;81:1034–47
12.Petiti D, Sidney S, Bernstein A, Wolf S, Quesenberry C, Ziel H. Stroke in users of low-
dose oral contraceptives. N Engl J Med. 1996; 335:8–15.
13.Alternative Treatment of Ovarian Cysts with Tribulus terrestris Extract: A Rat Model,
onlinelibrary.wiley.com/doi/10.1111/j.1439
14 Sanchez-Resendiz J., Guzman-Gomez F., Polycystic Ovary Syndrome. Boletin
Mexicano de Homeopatica, 30, 1997, 11-15.
15 Polson DW et al. Lancet. Polycystic ovaries--a common finding in normal women.1988
Apr 16;1(8590):870-2.
16 Gnoth, C et al. Cycle characteristics after discontinuation of oral contraceptives.
Gynecol Endocrinol 2002:16(4): 307-17.
17Vessey, M et al. Return of Fertility after discontinuation of oral contraceptives: influence
of age and parity. The British Journal of Family Planning. 1986: 11: 120-124.
18Nader, S et al. The effect of desogestrel-containing oral contraceptives on the glucose
tolerance and leptin concentration in hyperandrogenic women' J Clin Endocrinol Metab
1997 82: 3074-7
19 Janssen OE. High prevalence of autoimmune thyroiditis in patients with polycystic
ovary syndrome. Eur J Endocrin 150(3): 363-369
20 . Long-term follow-up of patients with polycystic ovary syndrome: reproductive
outcome and ovarian reserve. M. Hudecova1, J. Holte, M. Olovsson, and I. Sundstro¨m Poromaa,
Human Reproduction, Vol.1, No.1 pp. 1–8, 2009 doi:10.1093/humrep/den482

12 SIGNATURE OF THE CANDIDATE:

13 REMARKS OF GUIDE:

14 PARTICULARS OF GUIDE

14.1) Name & Designation :PROF. DR. HARCHARANJEET KAUR

(in BLOCK letters) HOD HOMOEOPATHIC REPERTORY

14.2)Address:BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL

14.3)Signature:

15 PARTICULARS OF CO-GUIDE(if any)

15.1) Name & Designation:

15.2) Address:

15.3) Signature:

16 16.1 NAME OF THE DEPARTMENT: HOMOEOPATHIC REPERTORY

16.2 Name of the H.O.D: PROF. DR. HARCHARANJEET KAUR

16.3 Signature
17 17.1 REMARKS OF THE PRINCIPAL / HEAD OF THE INSTITUTION:

17.2 Signature:

Seal: