DEAR DR. DONOHUE: My daughter, 21, is in her last semester of college. She has had painful periods since her late teens. Now they have gotten so bad that she has had a tough time keeping up with her schoolwork. At the college health service, they told her she has endometriosis and have put her on birth control pills. Please explain this to me. – N.D.

The endometrium is the lining of the uterus. It grows every month in preparation for nourishing a fertilized egg. When fertilization doesn’t take place, the lining is shed during the menstrual period. Pieces of the endometrial lining can migrate to places other than the uterus. They pass through the ovarian tubes and implant in many places in the pelvis – on the ovary, the bladder or rectum, and on the lining tissue of the pelvis. Those implants constitute endometriosis. They respond to the monthly cycle of hormones just as the uterine lining does. About 5 percent of women between the ages of 15 and 45 have it. Most often, the problem goes away at menopause, when hormone production wanes.

The transplanted tissue causes pelvic pain, menstrual discomfort and painful intercourse, and it can produce infertility.

Symptoms strongly suggest the diagnosis. Ultrasound provides more evidence. Definite proof comes with laparoscopic visualization of the endometrial tissue.

Often, birth control pills control pain. An anti-inflammatory drug — Aleve, Advil — can be added if needed. Today’s birth control pills have a large dose of the hormone progesterone, which causes endometrial tissue to shrink. If the birth control remedy fails to stop the pain, medicines that suppress production of estrogen can be quite effective. They include drugs like Lupron, Zoladex and Synarel. Other medicines are also available.

If drug treatment fails, then doctors can remove the transplanted tissue surgically. Most often, they use a laparoscope – a viewing tube inserted into the pelvic cavity through a small incision and instruments similarly inserted.

READERS: The many readers who have asked for information on back problems can obtain the booklet on that topic by writing: Dr. Donohue – No. 303, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have had laryngitis for six weeks. My throat doesn’t hurt, but it’s sort of uncomfortable, and I’m aware of it. My voice is very rough and raspy. I am not a smoker. I have been whispering, but I’m not getting any better. Can you suggest anything to hurry this along? – D.M.

You must see a doctor. Hoarseness that last longer than two weeks requires an examination of the vocal cords and the voice box (larynx – LAIR-inks). Cancer of the voice box, while not the most common cause of prolonged hoarseness, is the most important cause, and has to be excluded as a possibility. Vocal-cord polyps are another cause. They’re wartlike growths on the vocal cords. Ordinary laryngitis is a viral infection that goes away in about two weeks. Whispering isn’t helping your voice. It’s harder on the vocal cords than talking is. Keep talking to an absolute minimum. Don’t clear your throat. Drink plenty of water to maintain moisture in the cords. And make the doctor’s appointment quickly.

DEAR DR. DONOHUE: I visited a friend in the hospital, and the person in the bed next to her had yellow skin. I have never seen anything quite like it. What causes it? Is it catching? – R.R.

That’s jaundice. “Jaune” is the French word for yellow. Every day, around 1 percent of all our red blood cells are dismantled, and their parts are recycled to make new red blood cells. One byproduct of this process is bilirubin, a pigment. The liver processes it. If the liver isn’t working properly, blood levels of bilirubin build, and the skin and whites of the eyes turn yellow. If that patient had a contagious illness, he or she would be in a private room.

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. Readers may also order health newsletters from

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