THE HORMONE OF PREGNANCY - HCG

 

 

Dr Steven R. Goldstein is an obgyn in Manhattan and considered one of the nation’s top doctors in Gynecology. Dr Goldstein performs early pregnancy monitoring with Transvaginal Ultrasound to make sure a pregnancy is meeting its milestones and there is no miscarriage.

 There is a hormone present during pregnancy - HCG (human chorionic gonadotropin). 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). An Ectopic pregnancy can occasionally result in a relatively normal early development, which may follow normal doubling times of hCG.

 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. Dr. Goldstein has published and lectures extensively on early pregnancy, both its detection by 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 Goldstein, an obgyn in Manhattan , is an expert in Transvaginal Ultrasounds and a former Director of Gynecologic Ultrasound at NYU Langone Medical Center. Dr Goldstein is one of the most highly recognized and regarded individuals in the field of vaginal probe ultrasounds. He has championed painless, non-invasive means of diagnosis such as Transvaginal Ultrasounds and Sonohysterograms over painful, invasive, exploratory surgeries as a first means of diagnosis. He is a Professor of Obstetrics and Gynecology, New York University Grossman School of Medicine.

 If you have been told you are pregnant, then a consultation with Dr Goldstein, a leading obgyn in Manhattan would be appropriate for early pregnancy monitoring by Transvaginal Ultrasound to ensure the position of the pregnancy and that it is meeting its milestones. Dr Goldstein works by appointment only and does not overbook his practice. Please allot at least one hour for your visit.

 

ESTROGEN AND YOUR BONES PART 2

 

 

Dr Steven R. Goldstein is a leading Menopause Specialist in NYC who has helped his patients cope with the symptoms of menopause. This is a second part to the original article regarding “Estrogen and your Bones”. To recap – Menopause is a stage of life in women where the body stops producing estrogen (a female hormone). The tissues in a woman’s body, over 300 of them, rely on estrogen. Cholesterol levels, the brain, the heart, the bones and so on are all affected by estrogen. We also touched on bone health, that bone is living tissue, constantly having cells broken down and replaced. Calcium is vital to the body and bone, and estrogen plays a key part in the absorption of calcium and in keeping calcium levels normal. Thus, any deficiency in estrogen negatively impacts bone health.

 Which is why many women who are menopausal struggle with bone health, osteoporosis and osteopenia (wasting away of muscle). The bone disease of osteoporosis (weak or thin bones), or its precursor of low bone mass known as osteopenia, can lead to spine, wrist, and hip fracture in later years resulting from bones continually losing density and strength.

 Consider the following. The National Institutes of Health says roughly 4 in 10 white women age 50 or older in the United States will experience a hip, spine, or wrist fracture sometime during the remainder of their lives.

 More than 1.5 million bone fractures currently occur each year in US women.

 In terms of hip fractures, the rate for women is two to three times higher than that for men.

 One out of every six women will suffer a hip fracture in her lifetime, a risk equal to the combined risks of developing breast, uterine and ovarian cancer.

 Twenty percent of postmenopausal women who experience hip fractures die within one year of the injury, and fifty percent of those who survive will never walk independently again.

 Two hundred thousand women will experience a wrist fracture each year.

 Dr Steven R. Goldstein, a Menopause Specialist in NYC , 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, osteoporosis and osteopenia.

 He also serves as the Co-Directory of Bone Densitometry and Body Composition at NYU Langone Medical Center and is an Osteoporosis Specialist in NYC where he combines his knowledge of menopause and bone density to help patients.

 If you are a woman in menopause or post-menopausal and have been told that you have osteoporosis, osteopenia or just concerned about menopause and bone health, then a consultation with Dr Goldstein may be appropriate.

 

LOW DOSE BIRTH CONTROL PILLS

 

 

From Dr Steven R. Goldstein, NYC Gyn

There are many misconceptions about Low Dose Birth Control Pills. When Dr. Goldstein was a medical student, pills came in 80 and 50 microgram strengths of estrogen. By the time he was a resident, they were 50 and 35 micrograms. Most of his career, they have been 35, 30, 25 and 20 micrograms. Now they make a 10 microgram. However, the lowest doses are not always the best choice for women under thirty.

Often a patient’s mother will come in with her teenage daughter and ask for birth control pills. Routinely, they often say, “I want the lowest dose pill.” When asked why, it appears they assume this it is the safest. Actually, these lowest dose pills are too low for young women.

Bone is a hormonally sensitive organ. There is good evidence that women even on 20 microgram estrogen pills will have less bone growth through age thirty than those who are getting their own cyclic menses.

Who can low dose birth control pills help?

However, low dose birth control pills are excellent choices for perimenopausal women, especially if there are small fibroids or excessive bleeding. The reason for this is because the pill suppresses a woman’s own ovarian function. Thus, the hormone in the pill is not on top of what a woman makes, actually it is instead of what she makes.

Thus, the lowest dose pills actually deliver less total effective circulating hormone than a woman’s own cycle. This is desirable in perimenopausal women, especially, as mentioned, if they have excessive bleeding or fibroids but is too low for women who are still growing their bone mass until age 30 or 35.

What about “natural” birth control?

Finally, a word about “natural.” Sometimes when Dr. Goldstein suggests birth control pills, patients will claim they are not “natural.” What did nature expect for women? As a higher order primate, left to nature, women would have eight children, probably two to three miscarriages, and have to nurse all the children for twelve to fifteen months, as there are no bottles or formula in nature. Thus, women would have probably approximately 250 menstrual cycles.

Modern women living in industrialized nations could have approximately forty years of reproductive life (age 11-51) with 13 cycles in each year and end up with as many as 500 menstrual cycles. This explains one of the reasons why ovarian, uterine and even breast cancers are on the rise in modern industrialized nations. Women are cycling too much! It is actually closer to natural to suppress the ovarian cycle with birth control pills than to have women ovulate month after month after month without having children.

Dr. Goldstein is not suggesting that women have eight children and nurse them for twelve to fifteen months but do understand, what is “natural” and what we have socialized into.

About Dr Steven R. Goldstein

Dr Steven R. Goldstein is a top NYC Gyn in private practice in New York City for over 25 years. He is a Professor of Obstetrics and Gynecology at New York University School of Medicine, a past President of the International Menopause Society, Certified Menopause Practitioner, and more. You can read more about him here

 

Specialist for Premature Ovarian Failure and Premature Ovarian Insufficency

 

 

Dr Steven R. Goldstein is a Menopause Specialist in NYC and one of the nation’s leading gynecologists. In private practice for over 25 years, Dr Goldstein has  treated many patients with early menopause, and is a specialist for Premature Ovarian Failure and Premature Ovarian Insufficiency. A co- author of the book “The Estrogen Alternative”, he is the first hormone specialist in NYC to write about Selective Estrogen Receptor Modulators (SERMs) for the relief of menopausal symptoms which are also associated with POF and POI. 

Experienced in both Menopause and Hormone Replacement Therapy (HRT), Dr Goldstein is uniquely qualified to help women suffering with Premature Ovarian Failure (POF) and Primary Ovarian Insufficiency (POI)

What is Menopause?

Menopause is defined as having no more ovarian function due to a depletion of eggs. The average age of natural menopause in the United States is 51.4. However, there is a great deal of range around that number for different people. In my own practice, the oldest patient I have had who was still making her own ovarian estrogen was three weeks before her fifty-ninth birthday. When a patient has a full hysterectomy, she becomes surgically menopausal at the time of the removal of her ovaries.

What is Early Menopause?

If natural menopause takes place prior to age forty-five, it is considered “early menopause”.

Obviously, early menopause, especially if it is before a woman has finished her desired childbearing, can be emotionally and psychologically devastating. Dealing with those aspects as well as educating a patient about what her childbearing options may still be going forward is an important part of healthcare for such individuals.

What is Premature Ovarian Failure (POF) / Premature Ovarian Insufficiency (POI)?

If natural menopause occurs prior to age forty, this is what defines premature ovarian failure (POF) or more recently labeled premature ovarian insufficiency (POI).

What can you do about Premature Ovarian Failure (POF) / Premature Ovarian Insufficiency (POI)?

As a Hormone Specialist in NYC, Dr. Goldstein says that Hormone replacement therapy (HRT) in such individuals, unless absolutely contraindicated by a personal history of breast cancer or a previous history of a blood clot (for instance in the legs or the lungs), is almost mandatory. Anything one has heard about the pros and cons of hormone replacement therapy was information gathered from women who went through typical menopause in their early fifties.

When someone goes through premature ovarian insufficiency (or early menopause prior to age 40), giving them hormonal support until they reach the average age (roughly fifty-one) is essential for their overall health. Furthermore, the doses of hormone that such patients require is often considerably greater than that required by a typical fifty-one-year-old who may be experiencing hot flashes, night sweats, and vaginal dryness resulting in painful sexual intimacy.

It is often also necessary to do a further workup for patients who do suffer premature ovarian insufficiency (early menopause prior to age 40). Often, these patients have antithyroid antibodies and sometimes an autoimmune process. In addition, they may have an abnormal number of DNA “copies” in one of their X chromosomes which may be relevant, especially if they have had children.

Women of a similar age who are still having regular cyclic menses are making a large amount of estrogen and progesterone naturally of their own, and so replacing similar amounts of estrogen and progesterone in patients with premature ovarian insufficiency is merely bringing them up to the level that their peer group is still making and what they would have made if they had not gone into premature menopause.

Early Menopause prior to age 40 requires individualized therapy

Thus, one can see that Premature Ovarian Insufficiency (POI) or early menopause prior to age 40 is a relatively unique subset of general menopause. It requires special testing, and individualized and unique therapy as well. Unfortunately, many healthcare providers are not aware of the unique nature of POI and simply treat such patients the same way they would treat an average fifty-one-year-old going through natural menopause.

Dr Steven R. Goldstein is Menopause Specialist in NYC. He is a past President of the International Menopause Society, a past President of the North American Menopause Society and a Certified Menopause Practitioner. As part of his expertise in this and menopause in general, Dr. Goldstein routinely consults and treats patients with POI or early menopause. He is specialist for Premature Ovarian Failure and Primary Ovarian Insufficiency (POI). If you feel this is a possibility in your case, consultation would be more than appropriate.

 

CAUSES OF HEAVY BLEEDING IN WOMEN

 

 

Dr. Steven R. Goldstein MD is a leading Gynecologist in NYC and an internationally renowned expert in Gynecologic Ultrasounds. In private practice for over 25 years, Dr Goldstein sees many female patients with medical complaints related to heavy periods (menorrhagia), heavy periods or abnormal vaginal bleeding.

 There are several causes of heavy bleeding in women and each needs to be evaluated by a board-certified Gynecologist. At times the bleeding is accompanied by pelvic pain or cramping. Dr Goldstein, a gynecologist in NYC for heavy bleeding, lists out a few of the reasons for heavy vaginal bleeding in women.

 One of the causes of heavy bleeding is uterine Fibroids. Fibroids are also known to cause heavy bleeding at the proper time due to growth of the uterine cavity such that there is more surface area and heavy menstrual bleeding at the proper time. Small Fibroids can also cause bleeding depending on where they are located in the uterus. Even small fibroids that impinge on the endometrial cavity (lining) can cause significant bleeding.

 Adenomyosis (endometriosis of the uterus or myometrium) may result in heavy menstrual bleeding at certain times. Historically, heavy menstrual bleeding (menorrhagia) and painful menstruation (dysmenorrhea) are the major symptoms of adenomyosis. This condition is benign, but can be very painful. It is due to the inner lining of the uterus protruding through the muscle wall of the uterus.

 Women with many children will see growth of the size of their uterus, which increases the surface area of the uterine lining. In this case bleeding may be heavy without there being any abnormality.

 The presence of uterine polyps in synchrony with the normal menstrual cycle can result in heavy menstrual bleeding at the appropriate time.

 What can a woman do about heavy bleeding? Dr Goldstein, a Gynecologist in NYC      

recommends that women have a Transvaginal Ultrasound or Sonohysterogram as the first means of diagnosis rather than invasive surgeries like blind endometrial biopsies.

These procedures produce clear, high-resolution images of the uterus, uterine lining, the wall of the uterus, fallopian tubes, ovaries which are used to make an accurate diagnosis.

 Dr Steven R. Goldstein 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. Dr Goldstein performs all transvaginal ultrasounds and Sonohysterograms personally.