THERE SHOULD BE NO BLEEDING AFTER MENOPAUSE

 

Dr Steven R. Goldstein MD, a leading gynecologist in NYC, is a Certified Menopause Practitioner, a past President of the North American Menopause Society (NAMS), and past President of the International Menopause Society. He is also a former Director of Gynecologic ultrasound at NYU Langone Medical Center, and a past President of the American Institute of Ultrasound in Medicine.

 

Dr Goldstein’s skill and knowledge of gynecologic ultrasound combined with his knowledge of menopause makes him unique in the field menopause practitioners

 

As a menopause specialist in NYC Dr Goldstein regularly has patient encounters with menopausal women who are bleeding. This should never be the case since their ovaries are no longer functioning and therefore not making any estrogen or progesterone. Any post menopause bleeding must be evaluated at once, and be considered “uterine cancer until proven otherwise”.

 

Dr Goldstein uses painless Transvaginal Ultrasounds and Sonohysterograms to rule out uterine cancer, hyperplasia and polyps. These simple, inexpensive transvaginal ultrasounds produce very clear, high resolution images and allows Dr Goldstein to see detail on the endometrial lining and make an accurate diagnosis as to whether it is the cause of the post menopausal bleeding. You do not need to have needless, painful diagnostic surgery in order to determine your condition.

 

Regular sonograms employ a transducer rubbed on the abdomen. With a transvaginal ultrasound, very high frequency probes are placed in the vagina and image pelvic structures such as the and ovaries with greater magnification. These transvaginal ultrasounds (also called vaginal sonograms) do not only tell about the anatomy of the uterus, ovaries and fallopian tubes, but also their physiology, that is, their function and whether hormonal function is normal.

 

Dr Goldstein, a menopause specialist in NYC points out that the original observational studies in postmenopausal women with bleeding consistently found that an endometrial echo on transvaginal ultrasound <5 mm was associated with lack of significant tissue. Multiple large, prospective trials, mainly out of Western Europe, caused the American College of Obstetrician and Gynecologists in 2009 to opine that “when present, a thin, distinct endometrial echo on transvaginal ultrasonography 4 mm or less has a risk of malignancy of 1 in 917 and, therefore, endometrial sampling is not required.”

 

With uterine cancer ruled out, the post menopausal bleeding can be caused by what is known as Endometrial atrophy, where the endometrial lining degenerates and becomes very thin in a post menopausal woman. This is because of a lack of estrogen.

 

If you are in menopause and experiencing bleeding, please schedule a consultation with Dr Steven R. Goldstein, a menopause specialist in NYC  immediately to determine whether your condition is because of a thin endometrial lining or something more serious. Bleeding in post menopausal women must be examined immediately and considered uterine cancer until determined otherwise.  

 

 

CONSIDER THIS BEFORE ANY INVASIVE GYNECOLOGICAL SURGERY

 

 Women with complaints of abnormal uterine bleeding, heavy menstrual bleeding, menorrhagia, ovarian cysts, thick endometrial lining, fibroids and so on who have been recommended for painful biopsies, exploratory surgeries or Dilation and Curettage (D&C) should opt for painless Transvaginal Ultrasounds or Sonohysterography says  Dr Steven R. Goldstein MD, an expert Gynecologist in NYC for a second opinion before any gynecologic surgery.

 

These procedures are painful, expensive, require anesthesia and recovery time and not guaranteed to properly diagnose the cause of bleeding or other conditions. Surgery should not be the first method of diagnosis.

 

Dr Goldstein prefers using non-invasive methods for diagnosis and treatment instead of blind endometrial biopsies or unnecessary and painful surgeries. In 1989 Dr Goldstein was the first to suggest that simple cysts in postmenopausal ovaries were benign and did not require surgery. This became the standard of care in 2009.

 

Since 1995 Dr Goldstein has argued against blind endometrial biopsies, instead recommending saline infusion hysterograms. This was finally endorsed by the American College of Obstetrics and Gynecology (ACOG) in 2012.

 

In 2004 Dr Goldstein was the first to warn against unnecessary biopsies in nonbleeding postmenopausal patients with an incidental finding of thick endometrial lining. This was affirmed by ACOG in its practice bulletin in 2009, and reaffirmed in 2015.

 

Instead of painful exploratory surgeries, Dr Goldstein, a top gynecologist in NYC uses non-invasive methods such as Transvaginal ultrasounds (water sonograms) and Sonohysterography to obtain clear images of the ovaries, fallopian tubes, uterus and endometrial lining. Dr Goldstein performs each of these procedures himself and does not delegate it to a technician.

 

For instance, with abnormal uterine bleeding, it may be caused by hormonal factors, which Dr Goldstein can easily detect using the 2 non-invasive methods.

 

Upon conclusion and review of the images from Transvaginal Ultrasounds or Sonohysterography, Dr Goldstein sits personally with each patient to discuss the findings for their condition and discuss possible treatment options.

 

Doctor Steven R. Goldstein MD is one of the nation’s top Obstetricians and Gynecologists and is well known internationally for ground breaking work in gynaecological ultrasound and imaging. He is regarded as one of the nation’s top doctors in Gynecology. He is a Professor of Obstetrics and Gynecology at New York School of Medicine, served as former Director of Gynecologic Ultrasound at New York University Medical Center and is a past President of the American Institute of Ultrasound in Medicine.

 

If you are suffering from abnormal bleeding, heavy periods, post menopausal bleeding etc. do not opt for painful exploratory procedures or surgeries. Instead you may contact Dr Goldstein, an expert NYC Gyn  at his New York office to schedule a consultation

 

IS THERE ANYTHING WOMEN CAN DO TO AVOID PERIMENOPAUSE?

 

Dr Steven R. Goldstein is a Perimenopause Specialist in NYC who has helped thousands of women navigate the difficult stage of life called Perimenopause (the decade or so before menopause). Some patients ask whether there is anything a woman can do to delay the onset of Perimenopause, perhaps because their mothers and old sisters went through menopause in their forties.

 

It is impossible to say how much of perimenopause / menopause is genetic. Certainly, when a woman says that her mother and both of her older sisters went through their “changes” in their early forties, it is understandable why she thinks she will as well.

 

Dr Goldstein usually tells his patients that genes are incredibly powerful. Although menopause is not like blue eyes (if your mother and father both have blue eyes, you will definitely have blue eyes), one should never underestimate its hereditary component. However, there is no question that most things have a genetic predisposition and then need environmental influences to cause their expression.

 Some of the other factors that seem to be good predictors that a woman will reach menopause slightly younger than her peers include:

  

 Smoking cigarettes, especially more than half a pack a day

·        Being more than ten pounds underweight
·        Having had surgery to remove all or part of an ovary
·        Having been treated for cancer with chemotherapy or abdominal-radiation therapy.

 

The median age of the onset of perimenopause is 47.5, though it can start earlier or later. As many as 70 percent of women in their forties experience a change in their menstrual cycles. About 35 percent of women experience their first episodes of depression during perimenopause. Twenty to forty percent complain of sleep problems. Up to fifty percent ultimately experience hot flashes as they get close to actual menopause. And yes, there are women who experience nothing at all. There are also women who do not attribute these symptoms to their changing patterns of ovulation and never seek medical intervention or even tell their medical doctors about what they’re experiencing psychologically.

 

All in all, there are many women who avoid the roller coaster of transition or whose symptoms are very mild.

 

Dr Steven R. Goldstein,  a Perimenopause Specialist in NYC, and past President of the International Menopause Society, past President of the North American Menopause Society, is a Certified Menopause Practitioner and co-author of the book “Could it be….Perimenopause?” If you are a woman in her late thirties or forties and going through this phase of subtle symptoms such as period irregularities, then a consultation with Dr Goldstein may be in order.

 

HAVE YOU BEEN TOLD THAT YOU HAVE AN ABNORMAL PAP SMEAR?

 

 

Dr Steven R. Goldstein MD, a leading obgyn in Manhattan strongly recommends women have a Pap Smear exam done annually to help detect the presence of any cervical cancer cells early and prevent the need for aggressive treatment. He feels strongly that the benefits of a pap smear – catching and preventing cervical cancer’s continued growth – deserves an annual test.

 

This routine, painless examination performed by Dr Goldstein checks the changes in the cells of the cervix and is the best test for identifying abnormal, cancerous and pre-cancerous cells. The number of cases of invasive cervical cancer in this country has fallen dramatically over the last sixty years mainly because of the pap smear. This painless test is completed during the patient’s routine pelvic exam.

 

If the pap smear results are abnormal, that doesn’t mean the patient should jump to conclusions and conclude that they have cancer. An abnormal pap smear doesn’t mean it will necessarily lead to cancer. It simply means there has been a change in the cervical cells. The reason for the change in cervical cells can be infection, inflammation, changes in the menstrual cycle, or in some cases pre-cancerous or cancerous cells.

 

To check for cancerous or pre-cancerous cells, there are a number of available tests to identify the abnormality after your case has been examined thoroughly.

 

Dr Goldstein, a gynecologist in Manhattan points to some of the tests that can be performed:

 

Colposcopy: A colposcope is used to see the vaginal and cervical cells in detail and any precancerous changes of, or cancerous tissue in the cervix. A colposcope is a special lighted microscope that magnifies the tissue lining the cervix and vagina. Any abnormalities that appear can be biopsied and sent to the lab to be studied under a microscope and tested for cancerous or pre-cancerous cells.

 

Endocervical curettage: A small spoon-shaped tool (curette) collects a sample of cells from the endocervical canal. This procedure is done in an outpatient setting or a hospital. The patient is given medicine not to feel pain, and the medical provider gently scrapes a layer of tissue from the cervical canal and sent to the lab to test for any problems such as cancerous or precancerous cells in the cervix.

 

If this additional testing determines that treatment of the abnormal cells is needed, Dr Goldstein may recommend one of the following options:

 

Cryotherapy: Destroys abnormal tissue through freezing. A cold chemical is applied to the area with abnormal cells in the cervix to freeze them and then remove them.

Laser therapy: Destroys or removes abnormal cells with the use of a narrow beam of intense light

Conization: A cone-shaped piece of tissue is removed with a knife, laser or LEEP technique.

If you have been told you have an abnormal pap smear, don’t jump to conclusions. As stated earlier, an abnormal pap smear doesn’t automatically mean you have cancer or pre cancer of the cervix. All it means is that there is a change in cervical cells. This  can be due to inflammation, changes in the menstrual cycle, or infection as well.

 

If you are in the New York City area, a consultation with Dr Steven R. Goldstein, an  obgyn in Manhattan may be in order.