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.

 

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.

 

What are the causes of Abnormal Uterine Bleeding?

 

 

 Dr Steven R. Goldstein MD is an Abnormal Uterine Bleeding Specialist in NYC and has been in practice for over 25 years. He is regarded as one of the nation’s top gynecologists. There are several reasons for abnormal uterine bleeding. One of these is uterine polyps. These are growths of the endometrial lining tissue. They are characterized by having their own central feeder vessel. They are sometimes inactive, although, they may be in synchrony with the menstrual cycle. They are rarely malignant. However, they can cause either heavy menstrual bleeding or bleeding between normal periods. They may also impact fertility.

 Dr Goldstein can easily diagnose these uterine polyps in an office setting with minimally invasive techniques that he has championed such as Sonohysterograms or the newer disposable office hysteroscopes. If polyps truly are present and need to be removed, this is done in a simple outpatient procedure with anesthesia.

 Another reason for abnormal uterine bleeding is uterine fibroids. As many as one in five women develop uterine fibroids during their child-bearing years. Fibroids refer to small, benign tumors that develop in a woman’s womb. Common symptoms of uterine fibroids include abnormal bleeding, frequent urination, pelvic cramping or pain with periods, sensation of fullness or pressure in the lower abdomen and pain during intercourse.

Pelvic exams and ultrasounds are often used to identify the presence of fibroids in the uterus however these fibroids are like real estate – location, location, location. Only with transvaginal ultrasounds can we determine the proper location of fibroids. The ones that impact the uterine cavity will have the most effect on bleeding and / or fertility.

In many cases, the reason for abnormal uterine bleeding is a hormonal imbalance typically too much estrogen or not enough progesterone. A non-invasive examination of the uterine lining by transvaginal ultrasound or Sonohysterogram can quickly determine if a hormonal imbalance is the cause of the abnormal uterine bleeding.

The above are not all the reasons, an intrauterine device (IUD), growths, benign tumors, birth control pills, cancer, and more can also cause abnormal uterine bleeding.

 Dr Steven R. Goldstein MD, an Abnormal Uterine Bleeding Specialist in NYC , is recognized as a pioneer in the field of gynecologic ultrasound. His research in the field has significantly changed the way gynecology is practiced and, in many instances, has become the standard of care with the ACOG.

 Dr Goldstein uses painless, non-invasive methods as a first means of diagnosis to determine the cause of abnormal uterine bleeding. As a Transvaginal Ultrasound Specialist in NYC, Dr Goldstein uses transvaginal ultrasounds to see the uterus, the uterine lining, fallopian tubes, uterine cavity, cervix, for a thorough evaluation and reason for the bleeding.

 Sonohysterograms or water sonograms as they are often referred to, provides a degree of magnification that allows the operator to see clearly and in high resolution the tiniest of detail in the uterus, far greater than what can be seen with the naked eye. For instance, using Sonohysterograms, Dr Goldstein can see a heartbeat within a 3 millimeter embryo. So when it comes to abnormal uterine bleeding, Sonohysterograms are ideal as the first means of diagnosis. They are both painless and non-invasive. 

 As a leading Abnormal Uterine Bleeding Specialist in NYC , Dr Steven R. Goldstein highly recommends to women experiencing abnormal uterine bleeding to avoid painful surgeries as a first means of diagnosis and opt first for transvaginal ultrasounds or Sonohysterograms as a first means of diagnosis.

 

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.

 

USING TRANSVAGINAL ULTRASOUNDS TO HELP DIAGNOSE ENDOMETRIOSIS

 

 

 Endometriosis is a painful condition which occurs in women. It is a very unusual gynecologic disease, whereby the glands that normally lie inside the uterine cavity and are the ones that are shed with a normal period, somehow come to lie outside the uterine cavity almost always in other places in the pelvis. Thus, when bleeding from a period occurs, these glands will have a tiny amount of bleeding internally. This can cause some scarring (adhesions) as well as inflammatory changes that are a well-known source of pelvic pain and sometimes infertility.

 

Usually, the pain is worse with the menses, although it can often occur between periods as well. Implants of endometriosis can occur anywhere; however, the more common areas of involvement include the bladder wall, ureter, and anterior abdominal wall in patients who have had abdominal surgery such as a prior C section or laparoscopy.

 

Endometriosis of the bladder wall appears as a fusiform solid thickening of the wall itself. A non-functioning kidney may be the result of chronic ureteral obstruction that is silent and present as a result of endometrial implants impinge on the ureter. In patients who have had prior abdominal surgery, endometriosis may present as a hard, solid mass in the anterior abdominal wall in the region of the scar.

 

Dr Steven R. Goldstein, a leading NYC Gyn, uses painless, non-invasive Transvaginal Ultrasounds to diagnose whether women experiencing pelvic pain, painful periods and heavy bleeding during periods have endometriosis.

 

Transvaginal ultrasound, something that Dr. Goldstein has pioneered, can help to make a strong enough presumptive diagnosis of endometriosis so that patients can be treated without the surgical procedure of laprascopy. Laprascopy was the gold standard for making a differentiation for pain that might be from endometriosis versus “dysmenorrhea,” which is Latin for painful periods. Thus, not all patients with severe period pain have endometriosis. Dr. Goldstein does not recommend laparoscopies, but uses painless, non-invasive Transvaginal Ultrasounds to diagnose your condition.

These transvaginal ultrasounds are performed in the comfort of Dr Goldstein’s office in a few minutes without anesthesia or the painful effects of surgery. In addition to what Dr Goldstein sees on the screen, these transvaginal ultrasounds lead to the production of clear, high-resolution images of the uterus, endometrial lining, fallopian tubes, ovaries and so on to allow Dr Goldstein to make a precise diagnosis and preserve the images for any other specialist who may need to see them.

 

Dr Steven R. Goldstein MD is a top NYC Gyn.  He has been in private practice for over 25 years and 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.

 

Women experiencing painful periods or heavy bleeding during periods may schedule a consultation with Dr Steven R. Goldstein MD, a top ranked NYC Gyn.