title: Semi-standardised homeopathic treatment of premenstrual syndrome with a limited number of medicines: feasibility study.
abstract: BACKGROUND
  Individualised homeopathy involves a large number of possible medicines. For clinical research purposes it is desirable to limit this number, create more consistency between prescribers and optimising the accuracy of prescription. Using a semi-standardised treatment protocol, we aimed to improve homeopathic management of targeted subgroups of women with premenstrual syndrome/symptoms (PMS/S).
  
  
  OBJECTIVE
  To design a semi-standardised protocol for individualised prescribing in PMS/S with a limited number of homeopathic medicines, and to explore the feasibility of working with it in daily homeopathic practice.
  
  
  METHODS
  With help of an expert panel, homeopathic medicines were selected, as well as predictive symptoms and characteristics (keynotes) for each medicine. With those, we designed a patient questionnaire and a diagnostic algorithm. The patient questionnaire contained 123 questions, representing potential predictive symptoms for 11 homeopathic medicines for PMS/S. The medicines selected (in rank order) were Sep, Nat-m, Lach, Cimic, Lac-c, Puls, Calc, Lil-t, Mag-p, Mag-c, Phos. In a feasibility study 20 homeopathic doctors used the protocol in daily practice. The diagnosis was confirmed by daily rating of pre-defined symptoms during two consecutive menstrual cycles. The acceptability and feasibility of the protocol were evaluated after 3 months follow-up, at which time we also measured changes in premenstrual symptom scores and patient-reported changes in symptoms and general health.
  
  
  RESULTS
  The doctors mostly complied with the protocol and valued the computerised diagnostic algorithm as a useful tool for homeopathic medicine selection. 33 patients completed 3 months follow-up. By then, 19 patients still taking the first medicine on the basis of the algorithm. We received valid symptom records of 30 patients. Premenstrual symptom scores dropped by 50% or more in 12 patients and by 30-50% in 6 patients; scores dropped by less than 30% or increased in 12 patients. Recruitment of patients (n=38 in 9 months) proved difficult. Adherence to the diaries and the questionnaire was satisfactory.
  
  
  CONCLUSIONS
  It is feasible to use a semi-standardised protocol for individualised homeopathic prescribing in PMS, in daily practice. Its predictive value and the percentage of women with PMS/S helped by the selected medicines remain to be evaluated in further research. In future research, active promotion will be needed to recruit patients.
authors.affiliation: Dutch Association of Homeopathic Physicians (Artsenvereniging voor Homeopathic VHAN), Wageningen, The Netherlands. ctlaansma@planet.nl
authors.forename: C T
authors.initials: CT
authors.lastname: Klein-Laansma
authors.forename: J C H
authors.initials: JC
authors.lastname: Jansen
authors.forename: A J W
authors.initials: AJ
authors.lastname: van Tilborgh
authors.forename: D A W M
authors.initials: DA
authors.lastname: Van der Windt
authors.forename: R T
authors.initials: RT
authors.lastname: Mathie
authors.forename: A L B
authors.initials: AL
authors.lastname: Rutten
mesh_terms: D000328:Adult; D000465:Algorithms; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006705:Homeopathy / Q000379:methods*; D006801:Humans; D008419:Materia Medica / Q000627:therapeutic use*; D008875:Middle Aged; D018579:Patient Selection; D008517:Phytotherapy / Q000379:methods; D010936:Plant Extracts / Q000627:therapeutic use*; D011293:Premenstrual Syndrome / Q000188:drug therapy*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D008419:Materia Medica; D010936:Plant Extracts