EVIDENCE BASED MEDICINE IN GYNECOLOGY

 

 

Dr Steven R. Goldstein MD is a gynecologist in Manhattan who is considered to be one of the nation’s best doctors in Gynecology. Dr Goldstein practices “evidence-based medicine”. Evidence based medicine takes into account the patient’s values, the clinical expertise and experience of the physician and the best available research from well conducted and properly designed studies. The combination of these three factors greatly aids decision making by the physician along with their patient.

 Dr Goldstein uses the evidence-based approach in his practice, considering the patient’s values, his clinical expertise and experience and best available research. Let’s begin with the research.

 As a leading gynecologist and a Professor of Obstetrics and Gynecology at New York University School of Medicine, Dr Goldstein is up to date on the very latest research on Obstetrics and Gynecology from his peers and other sources. Dr Goldstein also serves or has served on many medical boards and societies such as the International Menopause Society, the North American Menopause Society, the American College of Obstetricians and Gynecologists and others. Dr Goldstein has also contributed vast amounts of research in the field of Gynecology and ultrasounds, much of which was adopted as the standard of care by the American College of Obstetricians and Gynecologists. So when it comes to being up to date on the best available research in the fields of gynecology, menopause and ultrasound technology, Dr Goldstein is always up to date on the latest.

 In private practice for over 25 years as one of the nation’s best gynecologists, a former Director of Gynecologic ultrasound at NYU Langone Medical Center for 25 years, the author of textbooks on Gynecology, and a track record of helping thousands of women over the years, Dr Goldstein has enough clinical experience and expertise required for evidence based medicine.

 When it comes to taking the patient’s values into account, Dr. Goldstein tailors the visit of each patient to their needs. He gets to know his patients, their preferences, goals, values, and more, blocking out a significant amount of time to sit with each patient and personally take the patient’s medical history, medical complaints, symptoms and other pertinent details as he learns about the patient.  He then brings his considerable knowledge and skills into the conversation to arrive at a mutually agreed upon course of effective treatment arrived at by shared decision making.

 For instance, Dr Goldstein’s experience and research continually demonstrates that surgery is not always the best option and many diagnoses are effectively treated through continued monitoring with ultrasounds and less-invasive methods such as sonohysterography and transvaginal ultrasounds or medication rather than surgery.

 The result of practicing evidence-based medicine is better outcomes. A course forward that is proven to improve a patient’s care. Evidence and communication between provider and patient is the best way forward. Make sure you have open communication with your gynecologist.

 If you are interested in using a gynecologist who practices evidence-based medicine, then an appointment with Dr Steven R. Goldstein, the best obgyn in Manhattan may be appropriate.

 

YOUR CYCLES DURING PERIMENOPAUSE

 

 

Dr Steven R. Goldstein is a Perimenopause Specialist in NYC who has written extensively on Perimenopause and treated many patients going through this stage of life.

 Menopause is defined as when there is no more ovarian function. The ovaries no longer make estrogen, and you no longer ovulate. Pre-Menopause means you are still making estrogen, though you may not be ovulating on a regular basis. Perimenopause is technically the first break in cyclicity.

 In other words, in the reproductive years most women have very regular cycles, and as you come off the reproductive years into perimenopause, the cycles can become somewhat irregular. To most patients, all the blood that comes out of their vagina is their period, but to Dr Goldstein, a menses is a bleed that is preceded two weeks before by ovulation. And so, if you don’t ovulate, you can still bleed. Those cycles are referred to as anovulatory, the “an” meaning without. You are making estrogen, but not any progesterone.

 So, Perimenopause is a time of fluctuating estrogen in a woman’s body without ovulation and without progesterone. This can cause some real havoc in the bleeding pattern, cycles, and also some havoc in what we call psychosocial symptoms such as worsening PMS, free floating anxiety, mood swings, inability to concentrate, sleep disturbances, brain fog, and so on, due to fluctuating levels of unopposed estrogen, rather than the absent estrogen of menopause.

 By the time most women have what we call vasomotor symptoms, hot flashes and night sweats, they kind of understand what’s going on. Hot flashes and night sweats can also happen in Perimenopause, though not necessarily from a lack of estrogen but from the precipitous drop in estrogen.

 A top gynecologist, he is the co-author of the book “Could it be….Perimenopause?” which was one of the first books ever written on the topic. Dr Goldstein is a past President of the International Menopause Society, past President of the North American Menopause Society and a Certified Menopause Practitioner.

 When it comes to Perimenopause, it affects many women in their thirties or forties, but many are unaware of what is going on with their bodies. It can be a confusing time, not only because of the symptoms, but the irregularity of the cycles. Sometimes women in Perimenopause are told it’s “all in their head”. It’s not. There is a change in the body’s hormones leading to vasomotor symptoms and irregularity in menstrual cycles.

 If you are a woman experiencing these symptoms, then schedule a consultation with Dr Steven R. Goldstein, a Perimenopause Specialist in NYC

 

WHAT IF YOU HAVE AN ABNORMAL PAP SMEAR?

 

 

Dr Steven R. Goldstein MD is a  Gynecologist in NYC who screens for cervical cancer in his patients. He strongly recommends annual pap smear exams to help detect the presence of cervical cancer cells. However, Pap smear recommendations should be closely aligned with sexual history and number of partners not just age. Thanks to the pap smear exam (also called a pap test), cervical cancer has been on the decline over the last decade.

 

An abnormal pap smear is one where there is the presence of abnormal cervical cells. The cervix is the area located at the lower, narrow end of the uterus. Abnormal pap smears are no need for alarm, as all they indicate is that there has been a change in the cervical cells can be due to infection, inflammation, or changes in the menstrual cycle. However, in some cases, pre-cancerous or cancerous cells are present.

 

We now understand that abnormal cervical cells are related to the HPV virus. There are over 100 strains of HPV. Virtually all sexually active women will be exposed to HPV but most clear the virus on their own.  High-risk HPVs can cause several types of cancer. There are 12 high-risk HPV types: HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. Two of these, HPV 16 and HPV 18, are responsible for most HPV-related cancers.

 

It is important to remember that HPV is NOT the disease. Most women will clear HPV on their own in many cases. The disease is cervical cancer, and that is why the cervical cells need to be monitored to ensure that cervical cancer is not present.

 

In the cases of an abnormal pap smear, Dr Goldstein, a  Gynecologist in NYC, will carefully review your case and determine if further tests are needed or if necessary, advise of the best available non-invasive treatment options available to you.

 

There are several additional tests which can be performed in the case of abnormal pap smear results:

 

1.     A Colposcopy is a procedure where a colposcope is used to see the vaginal and cervical cells in detail.

2.     An Endocervical curettage is a procedure where a small spoon-shaped tool (curette) collects a sample of cells from the endocervical canal.

3.     A Biopsy is where a small sample of cervical tissue is removed and sent to a lab to be studied under a microscope.

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

a.      A Cryotherapy destroys abnormal tissue through freezing.

b.     Laser therapy destroys or removes abnormal cells with the use of a narrow beam of intense light.

c.      Conization is where 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 and would like further evaluation, then a consultation with Dr Steven R. Goldstein, a  Gynecologist in NYC may be appropriate.