A Paradigm for delivering Hormone Replacement Therapy

 

 Dr Steven R. Goldstein is a leading menopause specialist in NYC in private practice for over 25 years in NYC. He is a past President of the International Menopause Society, past President of the North American Menopause Society and a Certified Menopause Practitioner. He is considered one of the nation’s top gynecologists, his research having changed the way gynecology is practiced and recognized by the ACOG. In the field of hormone replacement therapy (HRT), Dr Goldstein, a hormone specialist in NYC, is the co author of The Estrogen Alternative.

 

Dr Goldstein speaks of a new paradigm for delivering hormone replacement therapy in a much safer fashion than previously thought. The product, Duavee, is estrogen with a SERM rather than an estrogen with progesterone.

What are SERMs? SERM stands for Selective Estrogen Receptor Modulator, which are pharmaceutical drugs that act like estrogen on some tissues but blocks the effect of estrogen on other tissues. They can be used to treat the symptoms of menopause / perimenopause, osteoporosis and more. For delivering hormone replacement therapy, both the estrogen in Duavee (Premarin) and SERMs, in general, have been shown to reduce breast cancer.

Thus, this new combination is a much better form of delivering the benefits of the estrogen (relief of any night sweats and hot flashes, prevention of bone loss, and promoting lean body mass, not to mention prevention of vaginal atrophy) than traditional estrogen plus progesterone. So many of Dr Goldstein’s patients who are on Duavee for hormone replacement therapy come to him and say that their friends all tell them, “you are crazy to be on HRT.” His comment to these patients is to tell their friends that, “this is not your mother’s HRT.”

Pfizer released this on June 5^th 2023 - Pfizer Inc. today announced that DUAVEE® (conjugated estrogens/bazedoxifene), an estrogen-based menopause hormone therapy, is now back in stock in the United States, with improved packaging, following a voluntary recall. The recall was due to an issue with the packaging and was not based on any efficacy or safety concerns with the product itself.

 

If you are a menopausal woman struggling with the effects of menopause and the loss of estrogen, then contact the office of Dr Steven R Goldstein MD, a hormone specialist in NYC for a consultation to see if Hormone Replacement Therapy is suitable for you.

 

Dr Steven R. Goldstein - The Benefits of Early Pregnancy Monitoring

 

 

Dr Steven R. Goldstein, an obgyn in NYC, works closely with pregnant patients or those considering a family in early pregnancy monitoring to make sure that all aspects of the pregnancy are covered and meeting established milestones.

One of the ways this is done is by analyzing the Human Chorionic Gonadotropin (HCG) levels. A developing pregnancy will produce detectable hormone of pregnancy by eight days post conception. That means it is there and present prior to being late for one’s menses. Home pregnancy tests turn positive at around the time of the expected menses (approximately fourteen days after conception). The rate of rise of hCG in normal healthy pregnancies is extremely well established.

Thus, if there is any concern for the health of a pregnancy, measuring the hCG rate of rise at 48 hour intervals will tell us a great deal about the health of the pregnancy (although, it does not tell us anything about the pregnancy’s location). Usually the hCG level doubles at 48 hours. However, there is a minimum rate of rise of approximately 35-45% in early pregnancy depending on the starting value of testing. Early pregnancy monitoring is particularly helpful for those patients who have had a previous miscarriage or those prone to recurrent miscarriages.

As a leading obgyn in NYC, Dr Goldstein uses non-invasive transvaginal ultrasounds to monitor pregnancies. Serial observation with transvaginal ultrasound allows gynecologists following such pregnancies to be sure that they maintain the milestones that are very predictable and that are the best sign of embryonic well being. If a pregnancy were to fail, Dr. Goldstein is able to make such a diagnosis prior to spontaneous passage (miscarriage) and allow for an elective D&C (dilatation and curettage) so that miscarriage in the middle of the night, and emergency D&C is unnecessary.

Dr. Goldstein has published and lectures extensively on early pregnancy, both its detection by transvaginal ultrasound and how to diagnose pregnancy failure before miscarriage, as well as, diagnosing ectopic pregnancy early enough to be treated non-surgically with medication.

Dr Steven R. Goldstein, an  obgyn in NYC, Dis a Professor of Obstetrics and Gynecology at New York University School of Medicine, a former Director of Gynecologic Ultrasound at NYU Langone Medical Center, a pioneer in the field of gynecologic ultrasound and considered one of the nation's top doctors in gynecology.