DEAR DR. DONOHUE: Please say something about endometriosis. I take Aleve for it, but I need something stronger. What can I do? My pain is unbearable at times. – F.J.

ANSWER: The endometrium is the lining of the uterus. Monthly, the endometrium is shed in the menstrual flow when no egg is fertilized.

Pieces of the endometrium can find themselves in places where they should not be, like the ovaries or the structures in the pelvis. Those pieces respond to monthly hormonal stimulation just as the uterine lining does. The transplanted tissue cannot be shed. It produces great pain.

How the bits of endometrium find their way to distant sites is a matter of debate. Some feel that small segments of the uterine lining make their way through the fallopian tubes to distant body sites. Others agree with that but add that there must be another element involved, for many women have a backflow of endometrial tissue through their fallopian tubes. Only a small number, however, develop endometriosis. The reason why a few women develop it could lie in their immune systems. They don’t clean up these bits of endometrium like other women’s immune systems do.

Anti-inflammatory drugs, like your Aleve, work for mild endometriosis. You do not have the mild variety. You need stronger medicine or alternative treatment. The newly marketed extended-cycle birth control pill might control endometriosis pain for you. The pill stops menstruation for three months, and that allows transplanted endometrium to shrivel. Leuprolide, another medicine, shuts off estrogen production and is worth considering. Then there are surgical procedures that remove this tissue. Laser bombardment of the out-of-place endometrium is another way to get rid of it.

You have a friendly and invaluable resource in the Endometriosis Association. You can reach the association at 1-800-992-3636 or via www.endometriosisassn.org.

The pamphlet on endometriosis presents the details of this not-uncommon disorder. Readers can order a copy by writing to: Dr. Donohue – No. 1105, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I just had a uric acid kidney stone. My doctor says this kind of stone happens to people with gout. I do not have gout. How could I have gotten this kind of stone? – W.S.

ANSWER: I wish I had a pat answer for you. I don’t, and I don’t know anyone who does.

Uric acid comes from the daily recycling of body cells. When a person produces too much uric acid or gets rid of too little, it infiltrates joints, where it causes the swelling and pain of gout.

People with high blood levels of uric acid are also at risk for forming uric acid kidney stones. These people can take medicine that lowers the blood uric acid level.

Where does this leave you? Your blood level of uric acid is normal. You are a puzzle. You are not the only human in whom this happens, but there are not a whole lot of you.

The best way to protect yourself from a recurrence of a stone is to drink water, lots and lots of it. Stones don’t form in dilute urine. You know you are drinking enough if your urine is colorless.

It wouldn’t hurt you to eliminate foods high in uric acid from your diet: anchovies, brain, kidneys, liver, sweetbreads, sardines and gravies.

DEAR DR. DONOHUE: I take Prozac for depression. I don’t want to be depressed, but I also don’t want to take a mind-control drug. I feel as though I am not in control of myself when I take a drug like this. Am I being unreasonable? – E.T.

ANSWER: Prozac is not a mind-control drug. It is a mood-control drug. It does not make you lose control of your body or your thoughts.

Depression is the result of an imbalance of messenger brain chemicals. Prozac restores the brain’s supply of serotonin, a brain chemical that is essential for mood stability.

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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