DEAR DR. DONOHUE: I am only 26, but I feel like 126. I have horribly painful menstrual periods ­­- so much so, I cannot work. Sometimes sexual relations are painful. My doctor thinks I have endometriosis and is planning more tests. I would be grateful if you could tell me something about this and how it’s treated. – R.V.

The endometrium is the lining of the uterus. During every menstrual cycle, the endometrium undergoes a transformation that prepares it to be a suitable environment for nourishing a fertilized egg. If no fertilization takes place, the endometrium is shed during the menstrual period.

Endometriosis is the state of affairs where the endometrium is found in places outside the uterus. It can lie on the ovaries, the fallopian tubes or other pelvic structures and tissues. It can migrate to sites as distant as the rectum. In these places, the transplanted endometrium responds to a woman’s monthly surge of hormones just as the uterine endometrium does.

Painful menstrual periods are one of its cardinal symptoms. Intercourse is frequently painful. Endometriosis can also cause infertility.

A peek into the pelvis with a laparoscope provides incontrovertible evidence of endometriosis.

Treatment depends on the severity of symptoms, the woman’s age and the woman’s desire to have children. For mild cases, ibuprofen, indomethacin and naproxen – anti-inflammatory/painkilling drugs -might be the only medicines needed.

For more incapacitating symptoms, birth control pills can create an environment similar to pregnancy. Such an environment shrinks displaced endometrial tissues. Hormones such as Synarel and Lupron produce similar results. Surgical removal of the transplanted endometrium is another approach, and often that can be accomplished with a laparoscope.

The endometriosis pamphlet supplies details of its treatment and symptoms. Readers can obtain a copy by writing: Dr. Donohue – No. 1105, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: About 30 or 40 years ago, I had a successful stapes replacement. I went back to see the doctor after one year to have the other ear operated on. The doctor had died. I ignored the problem. Do they still do these operations? – P.R.

Yes – ear, nose and throat doctors still do stapedectomies (STAY-puh-DECK-toe-mees), and the operation has been refined since you had yours.

Sound waves strike the eardrum. The vibrating drum activates a chain of three bones that span the middle ear to amplify and conduct sound to the hearing nerve in the inner ear. The hearing nerve activates the auditory section of the brain, and we can hear.

Otosclerosis is an ear condition where one of the three tiny ear bones — the stapes — has become immobile and can no longer transfer sound waves. There are many ways to correct the situation, including replacement of the stapes with an artificial substitute.

Most people who have the operation are amazed and grateful for a return of sound to the deaf ear. Why have you waited so long to see about this operation?

DEAR DR. DONOHUE: I live in a small town, and I am 80 years old. I bowl at least twice a week. I don’t like to slap hands with five or six people every time someone makes a strike or a spare. I think it transfers germs and that’s how I got the flu. I had one woman get quite nasty because I wouldn’t slap hands with her. She maintains that, as long as you wash your hands when done, it’s OK. I think not. Who is correct? – A.M.

You are right. The hands and fingers are a chief source for the spread of germs such as the ones that cause colds. They might not be responsible for flu transfer, but they do transmit many other germs. Stick to your guns. You have every right not to participate in high-fiving it. Hand-washing is protective, but constant hand-washing isn’t practical.

Introduce gentle head-butting as a sign of athletic accomplishment. If the high-fiver refuses to participate, act offended.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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