MENOPAUSE AND WEIGHT GAIN

 

Dr Steven R. Goldstein is a Menopause Specialist in NYC He is a Certified Menopause Practitioner and immediate past President of the International Menopause Society.

 

Many women reach menopause and battle with weight gain. It’s a well-researched fact that a woman’s metabolism slows down 2 percent a year in middle age. One patient remarked “These days I look at food and gain weight”. She’s not far off. Do the math, and it’s clear why women who don’t eat any more or exercise any less thatn they did at forty-five may be ten pounds heavier at fifty-five.

 

Another patient remarks that she’s been walking half hour a day for the last five years, but sadly it no longer does much for her weight. She didn’t like hearing this, but she had to be told the truth  that at her age she may have to do an hour a day, and that’s just for her to keep what she has.

 

Added to this easy gain, hard loss reality is the fact that a woman’s weight is going to shift to different places as she grows older, and the shift is more obvious in thinner women. One menopausal woman remarked “I spent my twenties and thirties complaining about the cellulite in my thighs. It dawned on me the other day that my thighs haven’t looked this good in years. But I have this little growing pot belly. And it feels like my breasts are getting fat”. It isn’t her imagination. Nature distributed your fat where it determined it was most needed for procreation. When estrogen production stops and menopause enters the picture, the pear-shaped woman often turns into the apple shaped woman, much to her chagrin.

 

In the August 8^th 2017 New York Times Science section, there was an extremely interesting article entitled, “Researchers Track an Unlikely Culprit in Weight Gain.” talks about the fact that it may be FSH by itself that results in the deposition of fat to the midriff as well as a loss of bone.

 

Dr Goldstein, a leading menopause specialist in NYC goes on to state:    

Those women who do choose to go on estrogen in the form of hormone replacement therapy at the time of menopause will, in fact, drive down FSH levels. Thus, regardless of whether it is actually the elevation in FSH or the actual use of estrogen that helps maintain bone mass and prevent accumulation of central fat in the belly, the end result will be the same in menopausal women who use Hormone Replacement Therapy.

 

To cope with the symptoms of Menopause, and for health maintenance in post menopausal women, Dr Goldstein, a a Hormone Specialist in NYC, and co author of the book “The Estrogen Alternative” uses hormone replacement therapy (HRT), particularly Selective Estrogen Receptor Modulators (SERMs). Hormone Replacement Therapy is not for everyone. A decision to use it requires a comprehensive medical and gynecological exam and a discussion with a specialist like Dr Goldstein to understand the symptoms of menopause the patient is experiencing.

 

If you are a woman experiencing the symptoms of menopause or interested in the use of hormone replacement therapy (HRT) for health maintenance such as bone health, heart health and more, a consultation with Dr Steven R. Goldstein,  a Menopause Doctor in NYC, may be in order.  

 

WHAT IS A DILATION AND CURETTAGE?

 Abnormal bleeding is one of the chief complaints that bring women into the gynecologist’s office. Until recently, if these women were past thirty-five, most of them were headed to the operating room. Every day in this country hundreds of women undergo Dilation and Curettage (D&C) for diagnosis, when they could have a simple, painless procedure in their doctors’ offices instead.

 

Dr Steven R. Goldstein, an obgyn in Manhattan, uses this simple, painless procedure to diagnose patients who come in with abnormal bleeding. This state-of-the-art technique, Sonohysterography, is used by Dr Goldstein to eliminate the need for diagnostic surgery in potentially 75 percent of the cases of abnormal bleeding. Armed with this knowledge, any woman can avoid an unnecessary trip to the Operating Room.

 

Let’s call this patient Cindy. This forty-six-year-old woman is a good example. She was told by her doctor that she needed Dilation and Curettage (D&C) to find out the cause of her abnormal bleeding. She said “when my period came, there was no question something was wrong. I was through a pad every hour. I ruined two pairs of pants”.

 

But did she need surgery to find out the cause? She goes on to say “my mother had two D&C’s so I thought it was no big deal. Then the nurse came in and started grilling me about insurance. All of a sudden it hit me that a D&C is surgery. It means anesthesia. A trip to the operating room. A hospital stay. Days off from work. Someone to watch my kids. Insurance nightmares. I was sorry I even mentioned the bleeding. It didn’t seem that bad all of a sudden. We had enough financial problems. Did I really need all of this?”

 

What exactly is a D&C? It stands for Dilation and Curettage, a procedure in which doctors dilate the cervix and then scrape the endometrial linin of the uterus. The procedure has been around since 1843. It’s done both for diagnosis – to find out why a woman is bleeding abnormally – and therapeutically, and to remove certain growths in the uterus.

 

Dr Goldstein, a leading Manhattan Obgyn says it is the most common surgical procedure women undergo in America. They are told it is a routine procedure. But it is still surgery, requiring anesthesia and the risks that go with it. Worse, 75 percent of these invasive and costly operations are unnecessary. They turn up nothing.

 

For instance, a large percentage of perimenopausal patients with abnormal bleeding have no anatomic abnormalities. They simply had a hormonal imbalance (lack of ovulation, or “dysfunctional uterine bleeding”, in medical jargon)

 

If you are experiencing abnormal bleeding and have been told you need a Dilation and Curettage (D&C), then an appointment with Dr Goldstein, an obgyn in Manhattan, may be in order. Using painless Sonohysterography, Dr Goldstein is able to diagnose the cause of your abnormal bleeding.

 

TESTS FOR PERIMENOPAUSE

 

 

How exactly does a doctor determine that a woman’s symptoms are due to unopposed estrogen instead of something else? Dr Steven R. Goldstein,  a Perimenopause Specialist in NYC, and past President of the International Menopause Society and a Certified Menopause Practitioner says that the first place to begin is with menstrual history, which is why it is very important for women to keep a good calendar.

 

In addition, the doctor inquires about subtle symptoms such as mood changes (depression), free-floating anxiety, sleep disturbances, forgetfulness, changes in libido, difficulty concentrating etc.

 

Doctors can also do blood tests to verify this transition. One test measures the level of estradiol in the blood. Estrogen isn’t really one hormone, but three – estrone, estradiol, and estriol. Estradiol is the predominant estrogen in terms of potency. Estradiol comes mainly from the ovaries, which is why this is the type of estrogen your gynecologist is most interested in.

 

The second test is for FSH (follicle stimulating hormone) level. FSH is the hormone that tells the ovary to release an egg. It will also appear in your blood.

 

Sometimes, however, these blood tests can give confusing results. Many patients have estrogen levels that are not in the menopausal range (in other words they are still making estrogen), but their FSH levels have started to rise (greater than 30, which is typical for post menopausal women), and their interpretation when given the laboratory’s norms will be in the menopausal status. It appears paradoxical, because the patient’s estrogen level is premenopausal, but the patient’s FSH level is post menopausal.

 

How does this happen? In Perimenopause sometimes an ovary responds and sometimes it doesn’t. Sometimes it responds only given a high level of FSH. The ovaries do not turn themselves off like a light switch. They often “sputter”. What this means to you is that a single measurement of FSH or estradiol may be insufficient in telling you whether you are perimenopausal or menopausal. It also means that you’d be wise to request these tests more than once if your fertility is an issue or if you’ve been told that you’re in menopause.

 

If a doctor measures only estradiol, he or she may conclude that you are not menopausal if you still make some estrogen. If FSH is the only thing tested, and the reading is high, a doctor might conclude that you are menopausal and recommend hormone replacement therapy (HRT), when in fact it isn’t necessary yet.

 

Dr Steven R. Goldstein, a  Perimenopause Specialist in NYC , says that any diagnosis he makes is aided greatly by the use of transvaginal ultrasound as part of the overall pelvic exam. Transvaginal ultrasounds show if a patient is indeed having episodes of anovulation (not ovulating or releasing an egg), and unopposed estrogen, the gynecologist will expect to see a nonsecretory endometrium and not to find a corpus luteum in either ovary on ultrasound. He or she expects to see multiple follicles present and a relatively homogenous uterine lining suggestive of unopposed estrogen.

 

Dr Steven R. Goldstein is a Perimenopause Doctor in NYC and co-author of the book “Could it be….Perimenopause?”