ESTROGEN, PROGESTERONE AND YOUR MENSTRUAL CYCLE

 

 

Dr Steven R. Goldstein MD, a hormone specialist in NYC, is the co-author of the books “The Estrogen Alternative” and “Could it be….Perimenopause?”. A past President of the International Menopause Society and a Certified Menopause Practitioner, Dr Goldstein has worked alongside thousands of his patients in over 2 decades of private practice using hormone replacement therapy (HRT) to help them cope with the symptoms of menopause and hormone imbalances that may result in gynecological conditions such as bleeding.

 

Let’s take a closer look at the hormones estrogen and progesterone. Estrogen is made from follicles that develop each month in the ovaries. A follicle is a saclike structure inside the ovary that contains an egg. At the end of a cycle, if pregnancy does not ensue, the menstrual lining of the uterus is shed. The first day of the period begins day one of a new cycle. At that point, both ovaries recruit about a half dozen follicles under the influence of the follicle stimulating hormone (FSH) from the pituitary gland in the brain. Around day nine, one follicle takes off geometrically and becomes the dominant follicle. It is a small 2.5 cm cystic structure prior to it bursting. This is ovulation.

At midcycle, (day fourteen), a surge of luteinizing hormone (LH) from the pituitary causes the follicle to rupture, releasing the ovum to be picked up by the fallopian tube.

 

The follicle is now known as the Corpus Luteum (CL), and it begins to produce large amounts of Progesterone.

 

Progesterone causes the glands of endometrium (lining of the uterus), to become lush in preparation for receiving the fertilized egg. If no pregnancy ensues, estrogen and progesterone levels decrease and the woman gets her period fourteen days after ovulation. Recall that the beginning of bleeding day one of the new cycle. Thus, in an idealized twenty eight day cycle, a woman ovulates on day fourteen and fourteen days later she gets a menses.

 

Dr Goldstein, one of the top hormone doctors in NYC, says that it is important to remember that a menses (or a period) is a bleed that is preceded by ovulation. Not all bleeding is a menses. Without progesterone to trigger menstruation, the endometrium can keep building up and eventually be shed, giving the woman the impression she has had her period.

 

These hormonal imbalances can lead to irregular bleeding, where there is estrogen but no progesterone. Irregular bleeding and a host of other symptoms can follow. Unopposed estrogen (estrogen without progesterone) for long periods of time can lead to pre cancer.

 

Dr Steven R. Goldstein MD is a leading hormone specialist in NYC who uses HRT such as Selective Estrogen Receptor Modulators to help women cope with symptoms of menopause. Women who are experiencing excessive bleeding should also see Dr Goldstein as it may be due to a hormonal imbalance that gives rise to a thick uterine lining. If you are experiencing those symptoms or irregular periods then a consultation with Dr Steven R. Goldstein may be appropriate.

 

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.

 

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.

 

HEALTHY AGING

 

Dr Steven R. Goldstein MD, Hormone Specialist NYC, has worked closely with his patients for over twenty five years in private practice to help them through Perimenopause, Menopause and various gynecologic changes in their bodies as they age.

 

For thousands of years people have been searching for the fountain of youth and never found it. Dr Goldstein believes that the key is healthy aging. He says Ponce de León left Spain six hundred years ago looking for the fountain of youth. We are still looking. The key is “healthy aging” not anti-aging.

 

As women age and enter Menopause (average age 51), the ovaries stop producing estrogen. Twelve consecutive months without a period is generally accepted as the transition of a reproductive woman over to a menopausal one. The lack of estrogen in a woman’s body negatively impacts over three hundred tissues and over two hundred bones. While the vasomotor symptoms such as hot flashes and night sweats are well known and are devastating to endure, there are even more severe effects on a woman’s body. Consider that a lack of estrogen during menopause can affect cardiovascular health as studies have shown an escalation of LDL (bad cholesterol) in menopausal women.

 

There are also effects on bone health, as estrogen helps to reduce the risk of osteoporosis related fractures in women. Women without estrogen will experience brittle bones (osteopenia) and eventually osteoporosis. Muscles are also affected by the loss of estrogen, and sarcopenia (muscle wasting) results. Women in Menopause will also notice an increase in their waist line as central adiposity increases because of a lack of estrogen. Add to the above vaginal atrophy and vaginal dryness, both of which result in painful intercourse and affect intimate relations with a partner.

 

Faced with all of the aforementioned, how is a woman to age healthy? Eating right, exercising, doing all the right things to stay healthy. However it is not enough to ward off the devastating effects of a lack of the hormone estrogen.

 

Dr Steven R. Goldstein, a Hormone Specialist NYC, uses hormone replacement therapy (HRT) to replace the estrogen lost during Menopause. Hormone replacement therapy for menopause is not a one size fits all approach. Dr Goldstein works with each patient to custom tailor a therapy for them. Unfortunately, a lot of “therapists” who are part of the anti-aging movement believe that simply flooding the body with estrogen via “natural” means such as compounded substances is the answer. It is not so.

 Proper Hormone Replacement Therapy (HRT) focuses on the woman’s symptoms, not her levels of estrogen. And the estrogen needs to be balanced with sufficient progesterone (progestin) to avoid cancer.

With estrogen replacement via Hormone Replacement Therapy (HRT), exercise, proper diet and a healthy lifestyle with healthy habits such as not smoking, a woman will continue to age but will age healthy and without the ailments brought on by a loss of estrogen.

 Dr Steven R. Goldstein MD is a Certified Menopause Practitioner, a past President of the International Menopause Society, and a Past President of the North American Menopause Society in addition to many other accreditations and positions held.