Dr. Steven R. Goldstein - Obgyn in Manhattan warns on precancerous lesions

 

Doctor Steven R. Goldstein MD is a leading Obgyn in Manhattan warns on diagnoses from gynecologists about precancerous lesions in the cervix.

 The typical scenario is one where a mother brings her young daughter to Dr Goldstein’s office because she has had a markedly abnormal pap smear done elsewhere and has been told that she needs a LEEP procedure, which is somewhat destructive in that it removes a portion of the cervix. This LEEP procedure would triple her risk of preterm birth and incompetent cervix (a cervical insufficiency) when she does decide to have children.

 While it is appropriate to do such a procedure for high-grade abnormal Pap smears, Dr Goldstein likes to have the pathology specimens re-reviewed by a very skilled pathologist, like the ones at GYN Pathology here at NYU and look at them with him over a two-headed microscope. About 80% of the time the NYU pathologist will end up showing Dr Goldstein the area that this other pathologist thought was highly abnormal. The NYU pathologist is able to downgrade this to mildly abnormal or just atypical, thus allowing the young patient who hasn’t had her children yet to avoid any surgical intervention.

 Most physicians do not have pathology specimens re-reviewed, especially when these are sent to large commercial labs like Quest or National Health Laboratories. This is especially important if one is going to undertake a serious surgical procedure (like a total mastectomy or a LEEP of the cervix) for a “precancerous” lesion.

 Dr Steven R. Goldstein is a top Obgyn in NYC and ovarian cancer screening specialist who screens his patients twice annually for ovarian and cervical cancer. If you have been told you have a precancerous lesion and need a LEEP procedure, see Dr Goldstein for a second opinion and evaluation.

Dr Steven R. Goldstein MD - Menopause and Depression

 

Dr Steven R. Goldstein MD is the leading Menopause Specialist in NYC who has helped thousands of women cope with the symptoms of menopause. Dr Goldstein is a past President of the International Menopause Society, past President of the North American Menopause Society and is a Certified Menopause Practitioner. For over two decades Dr Goldstein has seen patients in menopause and perimenopause and tailored treatments to meet their needs.

 Many women suffer through the symptoms of menopause, which comes about when a woman’s ovaries stop making enough estrogen for her body. These symptoms include but are not limited to night sweats, foggy memory, hot flashes, vaginal dryness, mood changes, irregular periods and more.

 However, a lack of enough estrogen in a woman’s body can also cause even more serious conditions than those symptoms. High cholesterol levels, bone loss, elevated risk of heart disease, are just a few. Estrogen has been linked to reducing mild symptoms of Alzheimer’s disease by helping to support the production of acetylcholine, a chemical that helps transmit nerve signals across synapses in the brain. Less estrogen, accordingly, means a harder time remembering and learning new things.

 As a Menopause Specialist in NYC, Dr Goldstein has seen some menopausal women experience depression. Estrogen creates a sense of well-being in women by boosting serotonin levels, thus women who already have low levels of serotonin will have even lower levels during menopause due to the absence of estrogen.

 This is why when Dr Goldstein, a hormone specialist in NYC, prescribes HRT it is after a long discussion in which he listens to the patient regarding her gynecological health and symptoms of menopause, explains everything and helps the patient weigh her risks and benefits. HRT must be tailored to meet the needs and symptoms of each woman with her family history in mind as well. Dr Goldstein believes it is important that a woman leaves his office not just with a prescription, but with the answers to her questions and a treatment designed specifically for her.

 Dr Goldstein is the co-author of 2 books on menopause and HRT

 Women interested in finding our more about the use of female hormone replacement therapy can arrange for a consultation with Dr Goldstein by contacting his office in New York City.

Dr. Steven R. Goldstein MD - Polycystic Ovarian Syndrome (PCOS)

 

Doctor Steven R. Goldstein MD is a leading Gynecologist in NYC that has seen very young patients come in with their mothers and present with a diagnosis of Polycystic Ovarian Syndrome (PCOS). They are requesting a second opinion. If you have been told you have PCOS, then there is some information you should now.

 If patients are extremely young, they may have what Dr Goldstein refers to as “multicystic ovaries” instead of polycystic ovaries. In 2003 there was The Rotterdam Criteria for the Diagnosis of PCOS, at that time the consensus was if a women had two of the following three characteristics she could be labeled as having PCOS. They were 1) irregular menses, 2) increased androgens (either in their blood or clinical manifestations), and 3) more than twelve follicles in their ovary on ultrasound.

 Today, as the resolution of transvaginal ultrasound has increased, as many as 50% of women will have more than twelve follicles in their ovary! And many young women will be having slight irregularity to their menses as their cycle “matures.” Their menstrual cycle is still slightly irregular because of the fact that the hypothalamic-pituitary-ovarian axis has not yet matured.

 Typically, the women who were thought to have PCOS would be obese, have male pattern hair growth (especially on the chin), and bloodwork showed increased androgens (testosterone and an entity know as DHEA-S). These recent patients seen by Dr Goldstein who were diagnosed by other physicians to have PCOS were 1) not obese, 2) had no evidence of increased androgens, either clinically or in their blood, and 3) were extremely healthy.

 It has been Dr Goldstein’s experience that the overwhelming majority of such patients, as they get into their mid- and later twenties, ultimately have very normal menstrual cycles, normal fertility, and no increased risk of insulin resistance or diabetes. 

 Upon examination, none of these recent cases truly had PCOS itself. What they had was not unusual for late adolescence (women in their teens and even early twenties).  The problem is someone performed an ultrasound and they had multiple small follicles in their ovary, and thus, were told they had polycystic ovarian syndrome. In the opinion of Dr Goldstein, top Gynecologist in Manhattan, it is important as to how the follicles are arranged in the ovary. In the original description of polycystic ovarian syndrome, the follicles were all very peripheral and often were referred to as a “string of pearls,” as opposed to just an increased randomly distributed number of follicles. 

 If you have been told that you have Polycystic Ovarian Syndrome (PCOS) and would like a second opinion, schedule a consultation with Dr Steven R. Goldstein MD, a top Gynecologist in NYC