Endometriosis is transplantation of uterine lining
DEAR DR. DONOHUE: I am 36 and have been married for four years. My menstrual periods are very painful, and have been so for at least seven years. My husband and I have been trying to have a family. We haven’t been successful. Could these two things be related? I plan to see a gynecologist. — H.C.
ANSWER: Yes, they could be related. Endometriosis can be the cause of both. The endometrium is the lining of the uterus. Every month, due to the surge in hormone production, it grows in preparation to receive a fertilized egg. If no egg has been fertilized, the endometrium is shed during the menstrual period.
Bits of the shed endometrium can pass through the ovarian (fallopian) tubes and reach the pelvis and the structures in the pelvis, like the ovaries. Those transplanted pieces of endometrium respond to the monthly hormone surges just as they would if they were in the uterus. That, in turn, causes inflammation and pelvic pain. Often, the pain is worse at the time of menstrual periods. Women with endometriosis also can experience painful intercourse, painful urination and infertility.
I am glad you’re going to see a gynecologist. That’s the only way to get to the bottom of your problem. And it’s the only way you’re going to get endometriosis treated, if that is what you have. If the pain of endometriosis isn’t severe, then anti-inflammatory drugs like Aleve and Advil might be able to ease it. With more-severe pain, other medicines have to be prescribed. Birth-control pills create an environment that dries up the transplanted tissue. Drugs like Lupron (leuprolide), Zoladex (goserelin) and Synarel (nafarelin) suppress ovarian release of estrogen and cause the endometrial transplants to regress.
For a woman who wishes to become pregnant, surgical removal of the tissue permits ovulation to occur. The surgery sometimes can be accomplished with a scope passed through small incisions.
READERS: Thyroid disorders are an often-asked-about subject, and they are explained in the pamphlet of that name. Readers can obtain a copy by writing: Dr. Donohue — No. 401, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) 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 just been diagnosed with autoimmune hepatitis. Could you share some information with me on the topic? — M.D.
ANSWER: Our immune system is supposed to protect us. Sometimes it gets mixed up and attacks our organs and tissues. Autoimmune hepatitis is a case in point: The immune system targets the liver as being a troublemaker and attacks it. The attack is proven by finding unusual antibodies in the blood. Antibodies are the product of the immune system. As a result of the attack, the liver becomes inflamed. “Hepatitis” means “liver inflammation,” and the inflammation doesn’t always come from viruses. There are two varieties of autoimmune hepatitis that are distinguished by the antibodies in a person’s blood. Some people are so mildly affected that they need no treatment. Others become quite ill. Those people most often are treated with prednisone, one of the cortisone drugs. Up to 40 percent of patients obtain a full remission. The rest have to put up with ongoing treatment or the resumption of treatment when liver inflammation flares up.
DEAR DR. DONOHUE: Why don’t doctors strongly advise against smoking when pregnant, like they do for drinking and drug abuse? It seems to me that a poison like nicotine could be deadly to the embryo. I believe attention-deficit hyperactivity disorder, ADHD, is now so prevalent because women are smoking during pregnancy. What do you think? — J.S.
ANSWER: Every doctor is squarely behind you in warning pregnant women not to smoke. Smoking can cause low birth weight, which puts the infant at risk for many infections. It increases the risk of premature birth, another danger for the baby’s health. And it seems to be linked to sudden infant death syndrome.
I don’t know of the ADHD link. Fewer people — and that includes pregnant women — are smoking these days, but ADHD appears to be on the rise.
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 www.rbmamall.com.

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