ESTROGEN DEFICIENCY AND SLEEP

 

 

Doctor Steven R. Goldstein MD is a Certified Menopause Practitioner and a Menopause Specialist in NYC in private practice. He has helped thousands of women cope with menopausal symptoms over his 25 plus years in private practice.

When women reach menopause, they often don’t sleep as well as they once did because of the estrogen deficiency. Two very common problems are having trouble falling asleep and waking up in the middle of the night and being unable to fall back to sleep sometimes for an hour or two.

It's true that women who take estrogen often report that they sleep better. Here are three things women can do to improve their chances of getting a good night’s rest. There will be a second part to this article with more points.

1. Wake up at the same time every day. If that doesn’t help, wake up half an hour earlier. This is easier said than done. You’ve tossed and turned, perhaps because of night sweats or tension and ended up watching the 4 am movie. Just as the alarm goes off, you finally feel sleepy. Forget thinking that you need those eight hours of sleep and deciding to crawl back into bed. You will do more damage to your body clock and eventual body well being by over sleeping. For many women, the key to not being able to fall asleep is getting up even earlier. Force yourself to keep a regular schedule, and you’ll reap the benefits of deeper sleep.

2. Beware of hidden caffeine. Chocolate is one source of caffeine that can keep you awake. Excedrin before bedtime keeps some women up for hours. And read the ingredients of cold medicines. The over the counter lose-weight-quick pills of too many names and varieties to list are also full of caffeine.

3. Make your largest meal lunch. Why add major digestion to your night time list of things your body needs to do to finally settle down and relax enough to sleep. The full stomach that makes you nod off in front of the TV at seven at night has a habit of waking you up just when you gather yourself up off the couch and head for bed.

If you are menopausal and need help coping with its symptoms, an appointment with Dr Steven R. Goldstein MD, a doctor for Menopause in NYC. He is a past President of the North American Menopause Society and a past President of the International Menopause Society. He has also coauthored several books on hormone replacement therapy such as “The Estrogen Alternative”.

Dr Goldstein also specializes in hormone replacement therapy (HRT) to help women with the symptoms of menopause. His practice offers individualized patient care and Dr Goldstein will personally see you from the beginning to the end of your visit.

 

IS IT POLYCYSTIC OVARIAN SYNDROME?

 

Dr Steven R. Goldstein is an Obgyn in Manhattan 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 know.

 

PCOS affects roughly five to fifteen percent of women of reproductive age but many of the cases go undiagnosed. Many of those diagnosed are in their twenties or thirties. Here’s a bit of history on PCOS.

 

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. And if patients are extremely young, they may have what Dr Goldstein refers to as “multicystic ovaries” instead of polycystic ovaries.

 

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, a 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,” the appearance of small follicles around the edge of an ovary.  This is what points to Polycystic Ovarian Syndrome (PCOS).

 

Women cannot be diagnosed as having PCOS with just an increased randomly distributed number of follicles. There must be the string of pearls pattern.

 

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 leading Manhattan Obgyn

 

OVARIAN MASSES AND CANCER

 

 Doctor Steven R. Goldstein MD  is a Gynecologist in NYC who advocates for regular ovarian and cervical cancer screening, particularly for those with a personal or family history of these diseases. In his writings Dr Goldstein elaborates on the statistics that show the high survivability rate if ovarian cancer is detected early.

 

There is confusion among women about ovarian cysts and cancer. Many are told they have an ovarian cyst, become very fearful and insist that they want it out before it “becomes cancer”. While a normal reaction, let’s examine the relationship between ovarian cysts and ovarian cancer. 

 

Ovarian cysts never become ovarian cancer. These “functional cysts” consist of those that are formed prior to ovulation and called “follicular cysts” and those that are formed after ovulation from a small amount of bleeding into the area of ovulation. These are called “haemorrhagic cysts”. Neither of these are tumors and will not become cancerous. Now let’s look at Ovarian Tumors.

 

OVARIAN TUMORS AND CANCER

 

Cystic changes in ovaries that are not functional or dysfunctional would be considered a “new growth” (not an ovarian cyst) and represents a tumor, however, most of these tumors are benign while some may be malignant. It is important to note that with ovarian tumors they are benign or malignant from the start.

 

Therefore, if we can reliably diagnose an ovarian mass as being benign the chances of it transforming into malignancy are virtually zero. How is this diagnosis done?

 

It is done Sonographically by using painless Transvaginal ultrasound using the color flow doppler feature to assess blood flow within the pelvic organs. This helps to distinguish if it is truly suspicious, and perhaps needs surgical removal, or if it shuld be left alone. Dr Goldstein, a NYC Gyn, is one of the most highly regarded individuals in the field of gynecologic ultrasound. Here is what he looks for:

 

1)    the lack of any solid area coming off the cyst wall, and

2)    the lack of any vascularity as measured by color flow Doppler ultrasound.

 

Tumors need blood to grow, to divide, to invade, and the lack of any vascularity on color flow doppler means a lack of blood flow. This is an extremely reassuring sign. When people have what appear to be benign growths of ovaries, rather than remove them, we continue to watch them and be sure that they maintain those sonographic features that are reassuring of their benign (non-cancerous) nature.

 

If you have been told you have an ovarian cyst or an ovarian mass (tumor) and need to be screened for ovarian cancer, perhaps a consultation with Dr Steven R. Goldstein MD, a leading Gynecologist in NYC may be in order. Dr Goldstein uses transvaginal ultrasounds with color flow doppler and state of the art radiology to provide painless,  screening for ovarian cancer, the examination of ovarian masses and to look at ovarian cysts. A former Director of Gynecologic Ultrasound at NYU Langone Medical Center, Dr Goldstein personally performs all transvaginal ultrasounds. He does not rely on a technician or use reports to diagnose patients.