TISSUE SELECTIVE ESTROGEN COMPLEX – TSEC. WHAT IS IT?

 

 

Dr Steven R. Goldstein is a leading Menopause Specialist in NYC. He is a Certified Menopause Practitioner with the North American Menopause Society and a past President of the International Menopause Society as well as a past President of the North American Menopause society. In private practice for over 25 years in New York City, Dr Goldstein has successfully helped thousands of women cope with the symptoms of menopause.

 Dr Goldstein, a Menopause Specialist in NYC says one of the novel “new” hormone therapies for coping with menopause is the Tissue Selective Estrogen Complex” (TSEC). The concept grew out of the women’s health initiative. There were 2 arms, the Premarin and Provera arm which news broke in 2002 that the use resulted in an increase in breast cancer and cardiovascular disease. Little mention was given to the fact that women who had hysterectomy and took Premarin by itself had a 25% reduction in breast cancer when followed up over 11.3 years and no increase in heart disease over the long haul. So clearly the culprit was the Provera, the progestogen.

 

This progestogen was given to protect the endometrium for those who had a uterus. Question is, can you protect the uterus without giving the progestogen? The answer is Estrogen plus a SERM (Selective Estrogen Receptor Modulator). Examples of these SERMs are Raloxifene, Tamoxifen, Bazedoxifene etc. SERMS are unique compounds that can be estrogenic in some tissues and estrogen antagonistic in other tissues. For instance:

 All of them are Estrogen-like in bone and estrogen blockers in the breast

 In the endometrium (the innermost lining layer of the uterus), they are variable. For instance, Basodoxifene has been shown to reduce endometrial thickness under transvaginal ultrasound. So, the Premarin was paired with the SERM Basodoxifene instead of with the progestogen. This combination became approved after clinical trials for treating vasomotor symptoms in menopausal women such as hot flashes and night sweats. The occurrence of these vasomotor symptoms was reduced from around ten to two per day in menopausal women.  

 Where would this one pill combination be best used instead of traditional hormone replacement therapy like estradiol and estrogen? Dr Steven R. Goldstein, a leading hormone specialist in NYC, says it is best used to reduce breast cancer risk because each component in it is an anti estrogen in breast.

 The type of patient this would be best for is any woman who would be considered for combination oral therapy. She should be considered for this Tissue Selective Estrogen Complex (TSEC) first. Dr Goldstein remains in practices as a Menopause Specialist in NYC and continues to help menopausal women find relief from the troublesome symptoms by using hormone replacement therapy (HRT) involving SERMs and TSEC.

 

SALINE INFUSED SONOHYSTEROGRAMS FOR INFERTILITY

 

 A source of decreased fertility in women is submucosal myomas. These submucosal myomas are also indicative of an increased risk for pregnancy loss. Another indication of infertility problems in women are Endometrial polyps.

 

Dr. Steven R Goldstein MD, a top Gynecologist in NYC is one of the most highly recognized and regarded individuals in the field of vaginal probe ultrasounds. He is an expert in Saline Infused Sonohysterograms (SIS), which can be used in patients experiencing infertility problems or are at an increased risk for pregnancy loss.

 

By using fluid enhanced Sonohysterograms, Dr Goldstein can tell if any of these conditions are present in women and differentiate between them. It can also consistently diagnose intra and pericavitary lesions in infertile women. In addition, this saline infused sonoysterography is widely used to diagnose the shape of the uterine cavity in cases of suspected uterine malformation.

 

Dr Goldstein has championed the use of these Saline Infused Sonohysterograms (SIS). During a saline infusion sonohysterogram (SIS), a tiny catheter, the size of a swizzle stick, goes into the cervix a couple of inches tops, and about a tablespoon of sterile saline is injected. Dr Goldstein, a Gynecologist in NYC, developed a tiny catheter for these purposes.

The injection of a tablespoon of water into the uterus via catheter pushes the front and back walls of the uterus apart and enables us to see the uterine lining with microscopic precision. Any submucosal myomas or conditions that can cause infertility become visible. Sonohysterograms are a non-invasive, painless, less expensive way of diagnosing conditions in women and take only a few minutes in the office of Dr Goldstein.

 

Dr Goldstein has been in practice for over 25 years and is a Professor of Obstetrics and Gynecology at New York University School Of Medicine. He is also a Past Chairman of the American College of Obstetrics and Gynecology, New York section, Past President American Institute of Ultrasound in Medicine and is a former Director of Gynecologic Ultrasound at NYU Langone Medical Center.

 

If you are a woman suffering from infertility problems then schedule a consultation with Dr Steven R Goldstein MD, a top Gynecologist in NYC for a non-invasive Sonohysterogram.

 

GYNECOLOGIST IN MANHATTAN CAUTIONS AGAINST BLIND ENDOMETRIAL BIOPSIES

 

 

 

Many women have been told they need a uterine or endometrial biopsy for diagnosis purposes. Do not do so. Blind endometrial biopsies became very popular in the early 1990’s and became the standard of care after a report said they were 97.5% accurate. Before that women had Dilation and Curettage (D&C) or a scraping that was done under anaesthesia. Both of these are painful, invasive, procedures that cause women a lot of discomfort and needless pain.

In 1995 a well-known study showed that for women with cancer who had a biopsy in the operating room, the biopsy missed 11 out of 65 of those cancers, (16.9%). However, when they cut open those uteri they found that the cancer occupied less than half of the surface area of those uteri.

Dr Goldstein, an expert gynecologist in Manhattan, lectured on this since 1995, but in 2012 the ACOG finally put in their practice bulletins that when these biopsies are negative, it is not a stopping point. Unfortunately, the majority of practicing gynecologists do not know this and continue to do a biopsy as their first choice. Studies have shown these gynecologists are very likely to miss the abnormality with a blind biopsy.

Instead, a saline infusion sonogram, where some fluid is put into the uterus allows the operator to see better and produce clear, high-resolution images of the entire uterus. If you’ve been told that you need a uterine biopsy for diagnosis, ask first for a saline infusion sonogram, a painless, non-invasive procedure which is performed right in the office in a few minutes.

Dr Steven R. Goldstein is one of the best gynecologists in Manhattan and is well known internationally for ground breaking work in gynaecological ultrasound and imaging. He is a Professor of Obstetrics and Gynecology at New York School of Medicine, served as Director of Gynecologic Ultrasound at New York University Medical Center and is a former President of the American Institute of Ultrasound in Medicine.

 

USING TRANSVAGINAL ULTRASOUNDS TO HELP DIAGNOSE ENDOMETRIOSIS

 

 

 Endometriosis is a painful condition which occurs in women. It is a very unusual gynecologic disease, whereby the glands that normally lie inside the uterine cavity and are the ones that are shed with a normal period, somehow come to lie outside the uterine cavity almost always in other places in the pelvis. Thus, when bleeding from a period occurs, these glands will have a tiny amount of bleeding internally. This can cause some scarring (adhesions) as well as inflammatory changes that are a well-known source of pelvic pain and sometimes infertility.

 

Usually, the pain is worse with the menses, although it can often occur between periods as well. Implants of endometriosis can occur anywhere; however, the more common areas of involvement include the bladder wall, ureter, and anterior abdominal wall in patients who have had abdominal surgery such as a prior C section or laparoscopy.

 

Endometriosis of the bladder wall appears as a fusiform solid thickening of the wall itself. A non-functioning kidney may be the result of chronic ureteral obstruction that is silent and present as a result of endometrial implants impinge on the ureter. In patients who have had prior abdominal surgery, endometriosis may present as a hard, solid mass in the anterior abdominal wall in the region of the scar.

 

Dr Steven R. Goldstein, a leading NYC Gyn, uses painless, non-invasive Transvaginal Ultrasounds to diagnose whether women experiencing pelvic pain, painful periods and heavy bleeding during periods have endometriosis.

 

Transvaginal ultrasound, something that Dr. Goldstein has pioneered, can help to make a strong enough presumptive diagnosis of endometriosis so that patients can be treated without the surgical procedure of laprascopy. Laprascopy was the gold standard for making a differentiation for pain that might be from endometriosis versus “dysmenorrhea,” which is Latin for painful periods. Thus, not all patients with severe period pain have endometriosis. Dr. Goldstein does not recommend laparoscopies, but uses painless, non-invasive Transvaginal Ultrasounds to diagnose your condition.

These transvaginal ultrasounds are performed in the comfort of Dr Goldstein’s office in a few minutes without anesthesia or the painful effects of surgery. In addition to what Dr Goldstein sees on the screen, these transvaginal ultrasounds lead to the production of clear, high-resolution images of the uterus, endometrial lining, fallopian tubes, ovaries and so on to allow Dr Goldstein to make a precise diagnosis and preserve the images for any other specialist who may need to see them.

 

Dr Steven R. Goldstein MD is a top NYC Gyn.  He has been in private practice for over 25 years and is a Professor of Obstetrics and Gynecology at New York University School of medicine, a former Director of Gynecologic Ultrasound at NYU Langone Medical Center and a Past President of the American Institute of Ultrasound in Medicine.

 

Women experiencing painful periods or heavy bleeding during periods may schedule a consultation with Dr Steven R. Goldstein MD, a top ranked NYC Gyn.

 

 

WHAT ARE CHEMICAL PREGNANCIES?

 The advent of the home pregnancy test has revolutionized early pregnancy and our understanding of its failure. Patients can now diagnose a pregnancy event by the time they have their missed menstrual period with very sensitive home, over-the-counter pregnancy tests. Research indicates that as many as 22% of conceptual events (in other words, when an egg meets a sperm) will develop minimally and then bleed at or around the time of the expected menses. These have been dubbed “chemical” pregnancies and may be as high as 22% of all conceptions.

 

Dr Steven R. Goldstein, a top Gynecologist in NYC, says many patients feel they have suffered a miscarriage. Data, however, shows that the occurrence of such an event, although clearly sad, and parents can and should “mourn” the loss of their pregnancy—still need to realize that the prognosis for a healthy pregnancy is 35% in the next month and has high as 83% in the next six months! In other words, such a chemical pregnancy failure is a very good prognostic sign.

 

It means that the woman is ovulating, her partner produces sperm, at least one tube is open, and she is capable of capacitating her partner’s sperm. The prognosis for a couple who have such a chemical pregnancy is infinitely better than her sister, friend or coworker who would like to be pregnant but simply gets her period month after month after month.

 

Dr Goldstein’s practice in NYC offers early pregnancy monitoring services for women who are expecting. This is an important service to protect against arriving in the emergency room due to a miscarriage. Especially important for patients who have a history of recurrent miscarriages. Dr Goldstein uses painless transvaginal ultrasounds to monitor the pregnancy, making sure that the milestones of a healthy pregnancy are being met.

 

Dr Steven R Goldstein MD is a leading Gynecologist in NYC in practice for over twenty five years and a Professor of Obstetrics and Gynecology at New York University School of Medicine. He is regarded as one of the best Gynecologists in the United States. His clinical research has had a significant influence on the way gynecology is practiced, with much of his research adapted by the American College of Obstetricians and Gynecologists (ACOG) as the standard of care.

 

MENOPAUSE AND YOUR MEMORY

 

The Menopause stage of life in women is brought on by the lack of estrogen produced by the ovaries. Dr Steven R. Goldstein, a top Menopause Specialist in NYC points out that there are over three hundred tissues from brain to bone to skin in a woman’s body that contain receptors for Estrogen. All of a woman’s most important body tissues contain Estrogen receptors. When the secretion of Estrogen changes, a woman’s health and well-being reflect those changes.

 

There are also sites in the brain where Estrogen receptors are found. Therefore, when a woman enters menopause and the body produces less estrogen, there is a significant impact on a woman’s overall health above and beyond the symptoms like hot flashes.

 

One of the areas affected is the brain, which is why many menopausal women complain about “foggy memory”. Studies have shown that women are three times more likely to develop memory loss and Alzheimer’s disease as they get older. From forgetfulness to Alzheimer’s where does Estrogen matter?

 

Dr Goldstein, a Menopause Specialist in NYC points out that studies have shown 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. Acetylcholine is abnormally low in Alzheimer’s sufferers and may explain their impaired abilities to learn and remember.

 

Estrogen creates more connections among nerve cells, and it helps information travel more easily along those connections. Less estrogen, accordingly, means a harder time remembering and learning new things.

 

Women come into Dr Goldstein’s office who are clearly menopausal, clearly making no estrogen. They are eating healthy, exercising and doing all the right things and feel great. However well they are doing, hormone replacement therapy (HRT) will benefit their overall health, and one of the areas it will benefit is the brain. 

 

Dr Steven R. Goldstein is a Certified Menopause Practitioner, North American Menopause Society and a past President of the International Menopause Society. As a Menopause Specialist in NYC, Dr Goldstein has helped thousands of women over more than two decades of private practice to improve their overall health during the menopause and cope with the symptoms of it by using Hormone Replacement Therapy (HRT).