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.