THE LATEST ON HORMONE REPLACEMENT THERAPY

 

 

Dr Steven R. Goldstein MD is a past President of the International Menopause Society, a past President of The Menopause Society, and a Certified Menopause Practitioner. A Past Chairman of the American College of Obstetrics and Gynecology (ACOG), Dr Goldstein was the author of their practice guidelines on SERMs (Selective Estrogen Receptor Modulators), a form of hormone replacement therapy (HRT). In private practice for over 35 years as a Menopause Specialist in NYC, Dr Goldstein has helped thousands of patients combat the symptoms of Menopause by using SERMs.

Here is a summary of what these SERMs are in HRT and how they can be used by women to alleviate the symptoms of Menopause while protecting other organs.

A SERM (selective estrogen receptor modulator) is a molecule that combines to the estrogen receptor and produces estrogenic effects in some tissues like bone, vagina, sometimes uterus, while being an estrogen blocker in other tissues – breast, sometimes uterus. There are a number of SERMs, many of which you have heard of and some which you have not. 

 

TAMOXIFEN

The original SERM was tamoxifen. Most of you have heard of this as a breast cancer drug. It binds to estrogen receptors in the breast and acts as an anti-estrogen. It also acts as estrogen in bone metabolism; thus it is good for protection against breast cancer and helps maintain bone health.

Any bleeding whatsoever in a patient on tamoxifen has to be reported immediately and must be evaluated because a very small number of women will develop endometrial cancers and precancers while on it. More women will develop benign endometrial polyps.

 

RALOXIFENE

Originally marketed as Evista but now generic, is a cousin of tamoxifen without the baggage in the uterus. It acts as an anti-estrogen in breast and estrogenic in bone. In 1997, it was approved for prevention and treatment of osteoporosis. So, raloxifene, also known as Evista, is approved for prevention and treatment of osteoporosis and breast cancer prevention. What is also little known is that on average, it will lower cholesterol approximately 20%. It is neutral in the uterus unlike tamoxifen, but it does not improve vaginal dryness or atrophy which are often the causes of painful intercourse in menopause.

 

OSPEMIFENE

Still another SERM is called ospemifene and marketed under the name Osphena. This is estrogenic in the vagina and is approved by the FDA to treat dryness and atrophy of the vagina which results in painful intercourse and discomfort in menopausal women, which simply gets worse the further into menopause a patient gets. Osphena, may have some benefit in bone and breast but the magnitude of that benefit is unstudied. In addition, because it is unstudied, it is not carried in the label. Very, very few healthcare providers are aware that Osphena has any benefit in bone and breast.

 

BAZEDOXIFENE

Bazedoxifene is yet another SERM which gives the best protective effect in the uterus. Pfizer produces a hormone replacement product called Duavee which combines their estrogen Premarin with the SERM bazedoxifene. The bazedoxifene is given for uterine protection. Thus, this is hormone replacement which is progestogen-free.

Hormone Replacement Therapy (HRT) has come a long way. These SERMs are rigorously tested and FDA approved for use. As a leading  HRT Specialist in NYC, Dr Goldstein has worked with pharmaceutical companies in testing these drugs for uterine safety.

 If you are a woman in the Menopause stage of life or are post-menopausal and need help coping with Menopause, then perhaps SERMs may be a course of treatment for you. A consultation with Dr Steven R. Goldstein, a Menopause Specialist in NYC may be in order.

 

HORMONE REPLACMENT THERAPY – IS NATURAL BETTER?

 

 

Dr Steven R. Goldstein is co author of the book “The Estrogen Alternative” and a leading HRT Specialist NYC. He prescribes a form of Hormone Replacement Therapy (HRT) known as Selective Estrogen Receptor Modulators (SERMs) to help patients cope with they symptoms of menopause. They are a class of drugs that are approved by the FDA after undergone long periods of trials.

 Many patients ask about a “natural” approach to health after Menopause. Botanical remedies (over the counter remedies derived from herbs and plants) are what they usually mean by “natural”. The remedies most talked about include dong quai, black cohosh, yam root and soy. Before we discuss specific herbs, there is an important point about the difference between natural and risk free.  

 Natural isn’t risk free. Just because a supplement comes from plants and is available at a health food store doesn’t make it safe. Granted many of the over the counter botanicals are basically diluted medications that happen to come from plants, but this doesn’t guarantee their safety. Herbs and extracts can be potent. All of modern medicine gets its start from plants, however in the wrong doses they can hurt you.

 In terms of HRT, there is no reason to believe any of the botanicals are preferable to medication that is FDA regulated, tested on thousands of women, and successful with millions of patients. For the most part, all we have is anecdotal evidence – women taking the substance said it helped them. Before you decide that this is enough for you, realize that we do not, for the most part, have studies comparing women taking the substance to other women taking placebos, with the first group saying it helped them more.

 If a substance is relieving your hot flashes, you can bet your liver is seeing it as estrogen even if it is called something else. And if you think you are going to avoid the risk of any side effect by using natural remedies, the reality is, if they’re stopping your hot flashes, they’re affecting your body. They’re also going to pass through your liver on the way through your body, so purity is important. Are they pure? These natural remedies are not subject to the same intense scrutiny the FDA mandates for prescription drugs. Although they are touted as having medicinal properties, they aren’t labeled as such.

 Dr Steven R. Goldstein MD is a Menopause Specialist NYC and a Professor of Obstetrics and Gynecology at New York University School of Medicine.

Dr Goldstein is also a past President of the International Menopause Society, a Certified Menopause Practitioner and a Past President of the North American Society.

 

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.