Menopause and vaginal atrophy

 

 

A follow up to the last article regarding an early symptom of Menopause – vaginal dryness by Dr Steven R. Goldstein, a top doctor for menopause in NYC. In this article we’ll address vaginal atrophy. When a woman’s ovaries cease producing estrogen, she enters menopause. Without any estrogen in menopause the vagina becomes atrophic (the tissue wastes away). It loses blood supply and elasticity. It also loses its normal pH (acid/base balance) because it cannot support the normal predominant bacteria called lactobacillus that feasts on glycogen and produces lactic acid, thus lowering the pH.

Estrogen stimulates the creation of the vagina’s tough, outer layer of cells, known as the epithelium, that protects the delicate tissues underneath. It also moistens the vaginal mucus membranes, which increases lubrication.

Dr Steven R. Goldstein is a Menopause Specialist in NYC who has helped thousands of women over his 25+ years in private practice and overcome the symptoms of Menopause and lead a better quality of life, including a normal sex life.

Recent studies have shown that as many as 50% of postmenopausal women are not aware that there are treatments that are safe to treat this atrophy. They believe this is just a function of, “getting older.” Thus, many women “suffer in silence” and, if still partnered, are experiencing painful intercourse.

However, there are several helps for vaginal atrophy. First, there are very low dose estrogen creams, also tablets and rings. There is also now one oral non-estrogen, which may have other beneficial effects in breast and bone, as well. A local vaginal insert, which is DHEA (dehydroepiandrosterone) is also helpful. It is non-hormonal but is, however, metabolized to estrogen and testosterone.

Dr Goldstein, a top HRT Specialist in NYC, tells of a  55 year old patient who was recently remarried said “I thought dry would mean what it used to mean when you weren’t turned on with a man and you had to work a little harder at it. No one told me how dry you actually get and how difficult sex really becomes. For me, it just keeps getting worse. Astroglide helped, but my sister told me that in another year, even that isn’t going to do me much good. I’m getting one bladder infection after another”.

In the case of this patient, without estrogen replacement, the tissues will continue to get dry and can easily be injured during sex. Estrogen replacement is necessary to increase blood flow to the vagina and enhance sexual arousal, or to become lubricated enough to have comfortable sex.

Menopausal women who are sexually active will benefit greatly from hormone replacement therapy and avoid vaginal atrophy. Dr Steven R. Goldstein, a past President of the International Menopause Society and a Certified Menopause Practitioner with the North American Menopause Society and a leading hormone specialist in NYC is available for consultation at his New York City office.

 

Perimenopause and Hormonal Factors

 

Have you heard of Perimenopause? This is the transition period to menopause and can begin 4 to 7 years before menopause. Some women in their late 30’s and forties may already be experiencing symptoms. During this perimenopause stage, “irregular” is what is considered regular in terms of menstrual periods. Shorter, longer, lighter, heavier, the character of a woman’s period can change so much during perimenopause, and at times this change can be subtle.

 

Why does this matter? It does because cycles when women do not ovulate are characterized by variable amounts of estrogen production without progesterone to balance it. This “imbalance” isn’t dangerous (although it can be in the case of unopposed estrogen for very long periods of time, which is unusual), but it is the basis of a host of symptoms that appear to be totally unrelated to the woman’s menstrual cycle - occasional hot flashes, sleep problems, vaginal dryness, free floating anxiety, memory lapses and “foggy memory”, inability to concentrate, feeling depressed at times and so on.

 

To be clear, the above symptoms can be due to many factors, but the fact that it can be due to Perimenopause and hormonal factors is unfortunately not considered as much as it should be.

 

Perimenopause is one of the most misdiagnosed conditions in women. Dr Steven R. Goldstein MD, the best doctor for Perimenopause in NYC, has seen women visit internists, mental health professionals, neurologists, etc. for an answer to their symptoms only to find no answer until they wound up in his office for their exam. One woman experiencing symptoms of Perimenopause was told to have a hysterectomy by her primary care doctor, prior to visiting Dr Goldstein. Another was told by her internist that she needed to be on Prozac. After being examined by Dr Goldstein, no Prozac was needed. No hysterectomy necessary. It was Perimenopause, one of the most misdiagnosed conditions in women who range from the mid 30’s to late 40’s.

 

Dr Goldstein is a premier Gyn in NYC and the author of over 6 books on gynecology. He actively serves on the editorial board of more than 6 scientific journals, is a Professor of Obstetrics and Gynecology at New York University School of Medicine and a much sought after lecturer. He is also a past President of the International Menopause Society and a Certified Menopause Practitioner.

 

If you are a woman with occasional hot flashes, sleep problems, vaginal dryness, free floating anxiety, memory lapses and “foggy memory”, inability to concentrate, feeling depressed at times, irregular periods, spotting and so on then a consultation with Dr Goldstein and an examination may be in order to determine if the symptoms you are experiencing are due to hormonal changes surrounding Perimenopause. If so, there are a number of treatment options that can be discussed. As a leading NYC Gyn, Dr Goldstein practices evidence based medicine and offers a high level of individualized patient care to each patient.

 

GYNECOLOGIC ULTRASOUND AND OVARIAN GROWTHS

 

 Dr Steven R Goldstein MD is a NYC Gyn who uses transvaginal ultrasounds and saline infused sonohysterograms to diagnose the cause of abnormal uterine bleeding, issues with the uterine lining, heavy periods (menorrhagia), heavy bleeding, fibroids, and other issues that women encounter.

 

Be careful if you’ve been told that you have a “mass”. The field of gynecologic ultrasound with the introduction of vaginal probe sonograms in the last 30 years has refined gynecologic diagnosis to the point where the overwhelming majority of masses detected are clearly benign and can be left alone without surgery. Enlargements found during bimanual pelvic exams need to be examined further with a sonogram. If a mass is detected, these growths are usually benign.

Unfortunately, many physicians and patients, do not understand that benign ovarian growths do not become malignant.

 

Dr Goldstein, a top NYC Gyn, says that perhaps this misconception is a result of the fact that virtually all other gynecologic cancers (cervix, uterus, and breast) have well defined premalignant stages that we attempt to identify before they become frank malignances. Dr Goldstein also believes that another major reason that the rate of surgery for ovarian cysts and hysterectomy in the United States is twice as high as European countries is because their ability to better understand that gynecologic ultrasound can reliably suggest “benign” is far ahead of most doctors in the United States.

 

What should you do if you’ve been told you have an ovarian “mass”? Evaluation with transvaginal ultrasound and color doppler ultrasound to distinguish if it is truly suspicious, and perhaps need surgical removal, or should be left alone. The effective use of transvaginal ultrasound and color doppler ultrasound depend on the skill of the operator. Dr Goldstein personally performs transvaginal ultrasounds and color doppler ultrasounds.

 

In private practice for over 25 years, Dr Goldstein is one of the most highly recognized and regarded individuals in the field of vaginal probe ultrasounds, and an internationally recognized expert in gynecological ultrasound and imaging.

 

He is the Recipient of the 2018 Joseph H. Holmes Clinical Pioneer Award from the American Institute of Ultrasound in Medicine (AIUM). This is in recognition of Dr Goldstein’s distinguished career in ultrasound in medicine, and making outstanding contributions to the growth and development of medical ultrasound. Dr Goldstein is a former director of Gynecologic Ultrasound at NYU Langone Medical Center from 1995 to 2019.

 

If you are a woman who has been told you are in need of exploratory surgery because you have a “mass”, and you are in need of a second opinion, then a consultation with Dr Steven R. Goldstein MD, an expert NYC Gyn, may be in order.  

 

Hormone Replacement Therapy (HRT) and Menopause

 

 Dr Steven R. Goldstein is a Hormone Specialist in NYC, and co author of the book “The Estrogen Alternative”. Dr Goldstein has treated thousands of women for the symptoms of menopause over his 25+ years in private practice. A past President of the International Menopause Society, and a Certified Menopause Practitioner, Dr Goldstein says that Menopause is not a disease. However, the symptoms of menopause are many and vary by woman. Some women decide to use “natural” methods to cope with the symptoms of menopause. But a woman gives up the protective benefits of estrogen when she decides against replacing what she lost at menopause.

 

Given the pros and cons, it’s important for every woman to consider her options and make her own choices. She needs to consider her family history and her overall health. Women with suspected cancer of the breast, or liver dysfunction or disease should not take hormone replacement therapy (HRT).

 

Hormone Replacement Therapy is not one size fits all. Women need to be carefully evaluated. It is not the quantity of estrogen prescribed that matters. It is the type of symptoms you are experiencing. HRT must be geared toward symptoms and not just flood the body with estrogen.

 

If your doctor says you are a candidate for hormone replacement therapy (HRT), you need to weigh the risks and benefits. As a woman, you are ten times more likely to die from heart disease than from breast cancer. Ask yourself, “does the protection against a fatal heart attack outweigh a possibly greater risk of breast cancer?” Is it going to be a better thirty years down the road to have bypassed Hormone Replacement Therapy (HRT) when you fracture your hip?

 

When Dr Goldstein,  a Hormone Specialist in NYC, prescribes hormone replacement therapy, it’s after a long discussion in which he explains everything and helps the patient weigh her risks and benefits. HRT must be tailored to meet the needs and symptoms of each woman with her family history in mind as well. Dr Goldstein believes it is important that a woman leaves his office not just with a prescription, but with the answers to her questions and a treatment designed specifically for her.

 

If you are already experiencing the symptoms of menopause such as hot flashes, foggy memory, vaginal dryness and so on and are interested in learning how hormone replacement therapy can help you then arrange for a consultation with Dr Steven R. Goldstein by contacting his office in New York City.