Dr Steven R. Goldstein is a Menopause Specialist in NYC and one of the nation’s leading gynecologists. In private practice for over 25 years, Dr Goldstein has treated many patients with early menopause, and is a specialist for Premature Ovarian Failure and Premature Ovarian Insufficiency. A co- author of the book “The Estrogen Alternative”, he is the first hormone specialist in NYC to write about Selective Estrogen Receptor Modulators (SERMs) for the relief of menopausal symptoms which are also associated with POF and POI.
Experienced in both Menopause and Hormone Replacement Therapy (HRT), Dr Goldstein is uniquely qualified to help women suffering with Premature Ovarian Failure (POF) and Primary Ovarian Insufficiency (POI)
What is Menopause?
Menopause is defined as having no more ovarian function due to a depletion of eggs. The average age of natural menopause in the United States is 51.4. However, there is a great deal of range around that number for different people. In my own practice, the oldest patient I have had who was still making her own ovarian estrogen was three weeks before her fifty-ninth birthday. When a patient has a full hysterectomy, she becomes surgically menopausal at the time of the removal of her ovaries.
What is Early Menopause?
If natural menopause takes place prior to age forty-five, it is considered “early menopause”.
Obviously, early menopause, especially if it is before a woman has finished her desired childbearing, can be emotionally and psychologically devastating. Dealing with those aspects as well as educating a patient about what her childbearing options may still be going forward is an important part of healthcare for such individuals.
What is Premature Ovarian Failure (POF) / Premature Ovarian Insufficiency (POI)?
If natural menopause occurs prior to age forty, this is what defines premature ovarian failure (POF) or more recently labeled premature ovarian insufficiency (POI).
What can you do about Premature Ovarian Failure (POF) / Premature Ovarian Insufficiency (POI)?
As a Hormone Specialist in NYC, Dr. Goldstein says that Hormone replacement therapy (HRT) in such individuals, unless absolutely contraindicated by a personal history of breast cancer or a previous history of a blood clot (for instance in the legs or the lungs), is almost mandatory. Anything one has heard about the pros and cons of hormone replacement therapy was information gathered from women who went through typical menopause in their early fifties.
When someone goes through premature ovarian insufficiency (or early menopause prior to age 40), giving them hormonal support until they reach the average age (roughly fifty-one) is essential for their overall health. Furthermore, the doses of hormone that such patients require is often considerably greater than that required by a typical fifty-one-year-old who may be experiencing hot flashes, night sweats, and vaginal dryness resulting in painful sexual intimacy.
It is often also necessary to do a further workup for patients who do suffer premature ovarian insufficiency (early menopause prior to age 40). Often, these patients have antithyroid antibodies and sometimes an autoimmune process. In addition, they may have an abnormal number of DNA “copies” in one of their X chromosomes which may be relevant, especially if they have had children.
Women of a similar age who are still having regular cyclic menses are making a large amount of estrogen and progesterone naturally of their own, and so replacing similar amounts of estrogen and progesterone in patients with premature ovarian insufficiency is merely bringing them up to the level that their peer group is still making and what they would have made if they had not gone into premature menopause.
Early Menopause prior to age 40 requires individualized therapy
Thus, one can see that Premature Ovarian Insufficiency (POI) or early menopause prior to age 40 is a relatively unique subset of general menopause. It requires special testing, and individualized and unique therapy as well. Unfortunately, many healthcare providers are not aware of the unique nature of POI and simply treat such patients the same way they would treat an average fifty-one-year-old going through natural menopause.
Dr Steven R. Goldstein is Menopause Specialist in NYC. He is a past President of the International Menopause Society, a past President of the North American Menopause Society and a Certified Menopause Practitioner. As part of his expertise in this and menopause in general, Dr. Goldstein routinely consults and treats patients with POI or early menopause. He is specialist for Premature Ovarian Failure and Primary Ovarian Insufficiency (POI). If you feel this is a possibility in your case, consultation would be more than appropriate.
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