Perimenopause and the Biological Clock

  

Dr Steven R. Goldstein is a Perimenopause Specialist NYC who has helped thousands of women navigate Perimenopause, the transitional phase to Menopause. From the late thirties to the late forties, women may enter Perimenopause, which is a preparatory stage for menopause, both biologically and symptomatically.

 

Women in their late thirties or forties who are not yet married often ask about the “Biological clock”.  The term "biological clock" is more than just a phrase—it refers to the natural, age-related decline in fertility that women experience over time.

 

From a medical standpoint, a woman is born with all the eggs she will ever have—around 1 to 2 million at birth. By puberty, that number drops to about 300,000. With each menstrual cycle, a group of eggs begins to mature, but typically only one reaches ovulation. Over time, both the quantity and quality of these eggs diminish.

 

This decline becomes more noticeable in a woman’s mid-30s, and by the time she reaches her early 40s, fertility has significantly decreased. It's not just about getting pregnant—it's also about a higher risk of miscarriage, chromosomal abnormalities like Down syndrome, and complications during pregnancy. The "biological clock" isn’t meant to pressure or scare—it’s simply a biological reality.

 

Dr Steven R. Goldstein, a Perimenopause Specialist NYC says that a woman’s chance of conceiving naturally within a year over the age of forty is 25 to 30 percent. Still, midlife motherhood is definitely on the rise. Dr Goldstein has had patients in their late thirties and early forties who conceived the first time they had unprotected sex, merely by carefully charting their menstrual cycles and copulating on the appropriate days. However, it’s estimated that 75 percent of women over forty will need some help from technology to conceive.

 

What makes it so difficult to have a baby during Perimenopause? First and foremost, you may not ovulate every month, giving you fewer chances to become pregnant. Next, women simply have fewer and older, less viable eggs. By the time of Perimenopause, it is estimated that she has about ten thousand left. Less viable eggs are those that are harder for sperm to penetrate.

 

Some women have scar tissue that comes from the ovary having to repair itself after each ovulatory cycle. The more difficult a time the egg has navigating thru this scar tissue to the place where it can be released, the more difficult conception becomes. Scarring can also come from pelvic inflammatory disease, caused by sexually transmitted disease such as chlamydia. If it goes untreated for long, it can cause enough scarring to block the fallopian tubes or damage the ovaries. The fallopian tubes, which link the ovaries to the uterus, must be unobstructed for pregnancy to occur.

 

The cervix can also cause problems. If it is scarred from previous childbirths or narrowed for any reason, it can block the sperm from reaching the egg. In rare cases, a woman’s cervical mucosa contains substances that immobilize sperm.

 

Many women of Perimenopausal age have had gynecological surgery. If you’ve had a fibroid or some other benign growth removed, there may be scar tissue as a result.

 

Your body is probably still making estrogen in perimenopause – and progesterone when you ovulate. But how high are those levels? It’s not uncommon for women to find that they don’t secrete enough progesterone to prepare the endometrium for the fertilized egg. The egg can’t embed itself, and therefore no pregnancy ensues. This condition is sometimes called “luteal phase deficiency”.

 

If you are perimenopausal and the state of your fertility is important for you to know, the use of follicle stimulating hormone (FSH) measurements on day three of your cycle is the trick of the reproductive endocrinologist. It has been noted that if FSH on day three of the cycle is already climbing (20 or greater), then the patient’s chances of conceiving naturally are not very good.

 

If you are thirty five plus, have decided you want to pursue pregnancy, and you know that you are not ovulating regularly, see a specialist as soon as you can if you fail to get pregnant after six months of having intercourse the time of ovulation. You will need to pursue a structured plan to overcome fertility problems.

 

If you are perimenopausal and considering pregnancy, then perhaps a consultation with Dr Steven R. Goldstein, a Perimenopause Specialist NYC  may be in order. Dr Goldstein is a past President of The Menopause Society and the International Menopause Society. He is also a Certified Menopause Practitioner and considered one of America’s top gynecologists.

 

Addressing Vaginal Atrophy in Menopausal Women

 

 

Dr Steven R Goldstein MD is a  menopause specialist in NYC. He was awarded the Thomas A Clarkson award for his many outstanding contributions to menopause related clinical or basic science research and is a Past President of both The Menopause Society and the International Menopause Society. He is a Certified Menopause Practitioner.

Menopause marks a significant transition in a woman’s life, often accompanied by a range of physical and emotional changes. Among these, the decline in estrogen production is a defining biological event. This hormonal shift leads to a variety of physiological changes, one of the most impactful being vaginal atrophy. Despite its prevalence and the significant effect it can have on quality of life, vaginal atrophy remains a largely under-discussed condition, with many women unaware that effective, safe treatments exist.

When estrogen production ceases during menopause, the vaginal tissues undergo substantial alterations. The vagina becomes atrophic—it loses its blood supply and elasticity, and its natural pH balance is disrupted. These changes result in a thinning and drying of the vaginal walls, leading to symptoms such as discomfort, itching, and most notably, painful intercourse.

This condition, known clinically as genitourinary syndrome of menopause (GSM), is not merely a natural consequence of aging but a medical condition with clear underlying causes and viable treatment options.

Unfortunately, societal stigma and lack of education contribute to a widespread silence surrounding these symptoms. Recent studies have revealed that up to 50% of postmenopausal women are unaware that treatments for vaginal atrophy are available and safe. Many women mistakenly accept these symptoms as an inevitable part of aging. As a result, they suffer in silence, often experiencing a diminished quality of life and strain in intimate relationships. The misconception that nothing can be done prevents them from seeking help, and their concerns remain unaddressed.

Dr. Goldstein, a leading menopause specialist NYC, emphasizes the importance of maintaining sexual intimacy in partnered relationships. According to him, sexual health is an integral part of overall well-being, and vaginal atrophy should not be a barrier to intimacy or personal comfort. Importantly, there are several evidence-based treatment options available that can effectively manage the symptoms of vaginal atrophy, many of which have been in use for years and are well-tolerated.

Among the most commonly prescribed therapies are low-dose estrogen treatments, which come in various forms including creams, tablets, and vaginal rings. These treatments work by delivering a small amount of estrogen directly to the vaginal tissues, restoring moisture, elasticity, and normal pH levels without significantly affecting systemic hormone levels. As a result, they offer targeted relief with minimal risk, especially for women who may have concerns about hormone therapy.

In addition to traditional estrogen therapies, there are newer, non-estrogen alternatives. One such option is an oral medication that has shown promise not only in treating vaginal atrophy but also in potentially supporting bone and breast health—an important consideration for postmenopausal women. Another innovative approach involves the use of DHEA (dehydroepiandrosterone) in the form of a local vaginal insert. While DHEA is not classified as a hormone therapy, it is metabolized within the vaginal tissues to produce both estrogen and testosterone, offering symptom relief without systemic hormonal exposure.

The availability of multiple treatment options means that women can work with their healthcare providers to find a solution tailored to their individual needs and medical history. However, the first and most critical step is awareness. Healthcare professionals must take a proactive role in discussing vaginal health with menopausal patients. Likewise, public health campaigns and educational resources should strive to destigmatize this topic and empower women with information.

In conclusion, vaginal atrophy is a common but treatable condition that affects many women during and after menopause. The silence and misconceptions surrounding this issue only serve to exacerbate the suffering of those affected. By fostering open conversations, promoting awareness, and encouraging access to safe and effective treatments, we can help ensure that no woman has to endure these symptoms alone. Menopause is a natural stage of life, but living with untreated vaginal atrophy does not have to be.

Women who are experiencing vagina atrophy or painful intercourse, may schedule an appointment with Dr Goldstein a leading hormone specialist NYC .

 

Perimenopause, Menopause, and Post-Menopause: The Phases of Menopause

 

 

As a woman approaches midlife, her body begins to undergo a series of natural and sometimes disruptive changes. These transitions, particularly perimenopause and menopause, can significantly impact a woman's physical, emotional, and mental well-being. While menopause is frequently discussed, perimenopause—the transitional period leading up to it—often receives far less attention. Dr. Steven R. Goldstein, MD, is a Certified Menopause Practitioner and a Menopause Specialist in NYC.

With decades of experience treating thousands of women through every stage of this transition, Dr Goldstein would like to help you better understand what’s happening in your body and what your options are for feeling like yourself again.

What Is Perimenopause?

Perimenopause is the stage leading up to menopause, marked by a gradual decline in the hormones estrogen and progesterone. Most women begin to notice perimenopausal symptoms in their early 40s, though for some, these changes may begin as early as their 30s. This transition period can last anywhere from 4 to 7 years, though the timeline varies widely among individuals.

Symptoms of perimenopause can be diverse and, at times, disruptive. They often include irregular periods, occasional hot flashes, difficulty sleeping, mood swings, vaginal dryness, reduced concentration, and even episodes of free-floating anxiety. These symptoms are caused by fluctuating and destabilizing hormone levels, as ovulation becomes less regular.

It’s important to understand that if you're experiencing any of these symptoms, you are not alone—and more importantly, you’re not imagining things. These changes are real and physiologically based. As a specialist in perimenopause and menopause care, Dr Goldstein works with women every day to evaluate these symptoms and develop individualized plans to help manage them effectively.

Menopause: A Natural Life Stage

Menopause itself is officially diagnosed when a woman has gone twelve consecutive months without a menstrual period. While some women transition through menopause with few complications, others may experience significant symptoms that interfere with daily life. These may include hot flashes, night sweats, mood changes, low libido, vaginal atrophy, and changes in weight.

Beyond these more noticeable symptoms, menopause can also have serious implications for long-term health. Estrogen plays a critical role in maintaining bone density and cardiovascular health. As estrogen levels drop, the risk for osteoporosis and heart disease increases.

It’s crucial to recognize that menopause is not a disease—it is a natural biological process. However, that does not mean women need to suffer through it without support or treatment. Each woman’s experience is unique, and there is no “one-size-fits-all” approach to managing symptoms. Which is why Dr Goldstein, a Menopause Specialist in NYC, practices individualized patient care where he personally sits with each patient to understand their medical history, symptoms and more in order to come up with an individualized treatment plan for their Menopause.

How Hormone Replacement Therapy (HRT) Can Help

One of the most effective ways to manage moderate to severe symptoms of menopause is hormone replacement therapy (HRT). HRT involves replenishing the estrogen—and in some cases, progesterone—that your body is no longer producing at the same levels.

As a HRT Specialist NYC, Dr Goldstein assesses each patient's unique medical history, symptoms, and lifestyle before recommending any treatment. This careful, individualized approach ensures that any therapy is tailored to the patient's specific needs and health goals. While HRT is highly effective for many women, it is not suitable for everyone, and part of his job is helping you weigh the benefits and risks in the context of your overall health.

Post-Menopause: Monitoring for Important Signs

The post-menopausal phase begins after a woman has fully transitioned through menopause. At this stage, many of the earlier symptoms may ease or resolve. However, there are still important health considerations.

One of the most concerning symptoms that can occur post-menopause is any form of vaginal bleeding. Even light spotting, short in duration or infrequent, must be taken seriously. In medical training, we emphasize a rule of thumb: “Postmenopausal bleeding is uterine cancer until proven otherwise.” While the cause may often be benign, it is essential to conduct a thorough evaluation to rule out serious conditions, including endometrial cancer.

If you are postmenopausal and experience any bleeding, do not ignore it. Prompt assessment is key to ensuring your continued health and peace of mind.

Personalized Care from a Menopause Expert

In his practice, Dr Goldstein, an HRT Specialist in NYC, treats women at every stage of this journey—whether you're beginning to notice early signs of perimenopause, going through the height of menopausal symptoms, or are well into post-menopause. The goal is always the same: to provide compassionate, evidence-based care that helps you understand your body and make informed decisions about your health.

As a Certified Menopause Practitioner and a Past President of the International Menopause Society, Dr Goldstein brings both experience and a global perspective to his practice. He also co-authored The Estrogen Alternative, a book focused on empowering women to navigate hormone therapy options safely and effectively and textbooks on Menopause and Perimenopausal gynecology.

If you're experiencing symptoms of perimenopause, menopause, or post-menopause—or simply want a trusted medical professional to talk to about your concerns, schedule a consultation. Together, we can create a plan to support your health and well-being through this important stage of life.