Dr. Ozgul Muneyyirci uses sonography to check the health status of an expectant mother and her baby.

Q: Lately I've been having painful periods. Sometimes I feel twinges of pain during intercourse or when I move my bowels. Could this be caused by endometriosis? I'm worried because I've heard that it can lead to infertility and I want to have children some day.

The endometrium is the lining of the uterus. Sometimes bits of endometrial tissue grow outside the uterus, usually within the abdominal cavity. It can appear on the ovaries, fallopian tubes, and the outside of the uterus, and less commonly in the rectum, vagina, intestines, and bladder.

Since the tissue continues to respond to reproductive hormones, bleeding occurs during the menstrual cycle, causing the symptoms you describe. Other symptoms include spotting between periods, abdominal swelling, diarrhea, or blood in the urine or stool.

Endometriosis is a leading cause of infertility. However, there may be reasons other than endometriosis for why you are feeling pain. The best course of action is to go for a physical and pelvic exam so that your health provider can make a diagnosis and prescribe treatment.

Ozgul Muneyyirci-Delale, M.D.
Department of Obstetrics and Gynecology

Q: When is the flu not the flu? My son seemed to have it last month and missed a lot of school, but now he's sick again. There are so many cold remedies on the market, including new drugs that fight influenza, but I'm not sure if they're safe.

According to a recent Gallup poll, only 28 percent of Americans saw their doctor the last time they had the flu. Your pediatrician or family practitioner is the best person to determine whether your son has the flu, because many viruses can cause fever and cough. Each year, roughly 10 percent of all children are diagnosed with the flu, and infants, who are at greatest risk for developing lung complications, sometimes require hospitalization.

You might want to consider having your son vaccinated next year, before the flu season begins. The flu vaccine is not approved for children under six months of age, but immunization for older children and adults can prevent extra doctor visits, antibiotic treatments, and lost time from school or work. Researchers are now working on a flu vaccine that could be delivered as a nasal spray, which would certainly be more attractive to children than getting an injection.

As to medications that provide relief for flu symptoms, there are many cold remedies designed for children that are safe to use. However, two new prescription drugs, which shorten the illness, are causing some skepticism and concern.

Both Relenza and Tamiflu have been promoted heavily by their manufacturers as being effective against the flu, but they only shorten the duration of symptoms by a day and a half and must be taken within the first 48 hours to be effective. These drugs do not kill the viruses that cause influenza but merely prevent their spread to new cells.

The FDA has issued a warning for people with asthma to stay away from Relenza inhalants because they can trigger an attack. Before taking these or any other drugs, it is important to always read the labels and counterindication instructions carefully.

Margaret Clark-Golden, M.D.
Department of Pediatrics

Q: I may need to have a mastectomy, but I'm not sure that I want breast reconstruction. Do I have to decide right away?

If you're not ready to decide, why not give yourself more time to explore the options. Advances in reconstructive techniques allow surgeons to create breasts that look and feel extremely natural by using skin and muscle tissue from other parts of the body, or artificial implants. You may decide that you would rather wear a breast form beneath your undergarments, or not bother with anything at all. But if you're leaning toward having breast reconstruction, there are some advantages to immediate versus delayed reconstruction.

Many surgeons feel that the best-looking results are achieved when they can work together with a plastic surgeon to perform the mastectomy and reconstructive surgery during the same operation. That way the patient does not need to undergo a second procedure and can wake up knowing that she still has the breast.

On the minus side, reconstruction lengthens the time that the patient must remain under anesthesia. Implants usually add an hour, but if a woman's own tissue is used to form the breast, the operation can take much longer.

Not every woman is a good candidate for reconstruction. Those who have advanced cancer and need further treatment may need to postpone the procedure. Radiation therapy may rule it out altogether. In addition, saline implants can make it difficult to use mammography to detect recurring cancer. For these reasons, some women prefer to wait until they have reasonable assurances that they are out of danger.

David L. Abramson, M.D.
Department of Surgery