ENDOMETRIAL BIOPSY? NOT SO QUICK!

 

 

Dr Steven R. Goldstein is a highly regarded Gynecologist in NYC for abnormal uterine bleeding, Menopause, Perimenopause and more for women’s health. His research in the field of gynecological ultrasound has been ground breaking with much of it being adopted as the standard of care by the American College of Obstetricians and Gynecologists.

Many women who suffer from pelvic pain or irregular bleeding are told to have an “endometrial biopsy” as the first means of diagnosis. If you’ve been told to have an endometrial biopsy, then “not so quick.”

 Blind endometrial biopsies with these tiny plastic devices became very popular in the early 90’s. and became the standard of care after a report said they were 97.5% accurate. Before that, women had Dilatation and Curettage (D&C) or a scraping that was done under anesthesia. Both of these are painful, invasive, procedures that cause women a lot of discomfort and needless pain.

In 1995, a much better study of women with known cancer had a biopsy in the operating room before the hysterectomy. They missed 11 out of 65 of the cancer in those women, which meant that 16% of the time in these women with cancer who had a blind biopsy, the cancer was missed! In all of these cases, it was found that the cancer occupied less than half of the surface area of the uterine cavity. So, unless the cancer or precancer is detected by a blind biopsy, a gynecologist should not consider a blind endometrial biopsy as a stopping point for diagnosis.

Dr Goldstein, a NYC Gyn, says that a better option for diagnosis is a saline infusion sonohysterogram where some fluid is put into the uterus with a much thinner catheter tube. This enables the operator to see the uterine cavity better. The reason ultrasound is such a home run in obstetrics is because the baby is in a bag of water. This is why we get such beautiful images. So, by putting some fluid into the uterus, we can see better and get high resolution images of the entire uterine cavity instead of doing a blind biopsy and only sampling a small portion of the uterine lining for diagnosis.

A sonohysterogram has become the new standard of care in such situations. In the right hands, it is painless, takes a few minutes and is done right in your gynecologist’s office. The clear, high-resolution images produced show minute detail of the ovaries, fallopian tubes, uterus, endometrial lining etc. Such details cannot be obtained with painful, invasive endometrial biopsies that are unfortunately still performed by physicians who are not using up to date methods to diagnose patients.

Either that or, for some women, the use of disposable office hysteroscopes may be appropriate. With these, a physician can see inside the uterus in a matter of minutes painlessly, but the procedure requires more preparation and analgesia.

So, if you, a friend, relative or colleague are told to have an endometrial biopsy, ask first for a saline infusion sonohysterogram. As usual, Dr Goldstein, a leading Gynecologist in NYC is always available for a consultation.

 

LIBIDO IN THE PERIMENOPAUSE

 

 

Dr Steven R. Goldstein is a Perimenopause Specialist NYC in private practice for over thirty five years. He has helped many women through the Perimenopause and Menopause stages of life.

 During the menopause transition, women face significant emotional and physical changes which may impact on their sexual health. For some, irregular bleeding, fatigue, hot flashes, dyspareunia (pain during intercourse), irritability and other perimenopausal symptoms may affect libido. A common cause for sexual dissatisfaction in the maturing woman is lack of a partner, resulting from divorce or death. It is important that the healthcare provider address these and other factors, which may be associated with the woman’s sexual health.

 As a Menopause Specialist NYC, Dr Goldstein has observed that patients often want a pill that will act as a panacea for all their problems, including decreased libido. The media have given much press to the benefits of androgens, and yet hormones may not be causative factors for changes in libido, in some patients.

 Instead for some, night sweats and disturbed sleep may affect a woman’s sense of well being and may deprive her of her perceived sexual drive. These factors must be evaluated before any type of hormonal therapy is begun. A symptom diary may help pinpoint causes for decreased libido for some patients. For example, one patient presented requesting androgens for her decreased libido. On intake history, initially, she vehemently denied that her decreased libido was associated with her spousal relationship. After keeping her diary, she was able to make an association between arguments regarding television and in-laws and successfully adjust her behavior so that she was able to improve her libido without any type of androgen therapy.

 However, for some women, testosterone levels can change during perimenopause, menopause and postmenopause. For patients with low free testosterone levels and severe menopausal symptoms, especially low libido and energy, whose symptoms are not relieved with estrogen or estrogen with progestin, then androgen therapy might be considered.

 Androgens are a group of hormones that play important roles in both men and women. In women, they are involved in reproductive health, bone health, muscle mass and strength, sexual function and their metabolic health. Androgens are most useful for women who have had oophorectomy prior to natural menopause. However, more research is needed regarding the safety of long term androgen use.

 Potential problems associated with androgens include its negative effect on serum lipids, hirsutism, aggressive behavior, and permanent voice deepening. Although androgens can be given alone, doses can be lowered when combined with estrogen and therefore, negative effects may be reduced.

 If you are late thirties to late forties and suspect you may be going through Perimenopause or have questions, a consultation with Dr Goldstein, a Perimenopause Specialist NYC , may be in order.

 Dr Steven R. Goldstein is a past President of the International Menopause Society and is a Certified Menopause Practitioner. He is a leading Menopause Specialist NYC .

 

BEATING OSTEOPOROSIS IF YOU ARE MENOPAUSAL

 

 

Dr Steven R. Goldstein is a Menopause Specialist NYC and was the Co Directory of Bone Densitometry and Body Composition at NYU Langone Medical Center from 1997 to 2016. He writes the Bone Health update for the OBG Management Journal and has worked with thousands of women to help them through the menopause stage of life where many experience issues with bone health. One of the ways to strengthen bone and improve your bone health during menopause is by weight bearing exercises.

 

Many patients ask if they need to worry about doing weight bearing exercises, watching their diet and general health while on hormone replacement therapy for menopause. In a word, yes. If you are smoking cigarettes, find a way to stop. If you are overeating, find a way to lose weight and keep your weight under control. There are hundreds of apps and other means of finding help to lose weight.

 

It’s old news that women can benefit from weight bearing exercise, especially during menopause. Chances are if you aren’t already doing it, it’s because you tried it and didn’t enjoy it or didn’t get the benefit you wanted in the time you gave it. Or your experience might have been like one of my patients who told me:

 

 “The weight room at my health club is filled with twenty year old muscled men pumping major iron in a testosterone feast. It’s pretty intimidating to walk in there. Even so, I’d give it a try again if it wasn’t for the fact that I need to lose twenty pounds, and have little time as it is to exercise. I understand about my bones and all, but given half an hour three times a week, I’m just more motivated to burn off the piece of pie I ate the night before than do weight training. So I go for the aerobic stuff. At least on the Stairmaster, I can read briefs etc. and burn calories.”

 

Many people confuse the suggestion to do weight bearing exercises with working out with weights. Weight bearing is not the same as weight training. The Stairmaster is weight bearing exercise. Your own weight is what you are bearing. There are certainly options beyond the weight room for women who want to gain strength, flexibility, and bone mineral density.

 

Dr Steven R. Goldstein MD is a Menopause Specialist NYC and a tenured Professor of Obstetrics and Gynecology at New York University School of Medicine. He is a past President of the International Menopause Society, a Certified Menopause Practitioner and a Past President of the North American Society.