WHAT CAN CAUSE HEAVY PERIODS?

 

 

Dr Steven R Goldstein MD, an NYC Gyn and a Professor of Obstetrics and Gynecology at New York University School of Medicine, has been in private practice on the East side of Manhattan for over 25 years. Many patients present with heavy periods (heavy bleeding). In contemporary gynecology, heavy bleeding is known as “menorrhagia” or uterine bleeding characterized by excessive flow or long duration. It is defined as more than 80cc or 5 tablespoons in a period or more than the regular number of days.

 

The trouble is, what’s normal for one woman may be excessive for another, and women aren’t measuring their menses in a test tube. If your menses can be dealt with by a super-plus tampon, it’s probably within a normal range. Women who have always had three day periods where they never bled through a sanitary pad or a tampon, and all of a sudden the last two have lasted for seven days, ruining three pairs of pants, this is abnormal for them.

 

If a woman experiences a heavy, clotty bleed, miscarriage is the first thing to rule out. But heavy or prolonged bleeding is very common, and it can come from a host of causes. Fibroid tumors are one cause. Pelvic infection or an IUD that’s gone awry are also reasons for heavy bleeding. Pain in the lower abdomen, pain that came on slowly, is there a fever or discharge from the vagina are all reasons to be concerned.

 

It is also true that a woman can have abnormal bleeding – either heavy or at the wrong time or both – from cancer, hyperplasia, or polyps. Endometriosis, a disease in which the tissue from the lining of the uterus grows in other areas of the pelvis, is a very common cause of heavy and painful bleeding. A dysfunction of the hypothalamus, pituitary, or adrenal glands can cause heavy bleeding. So can thyroid problems.

 

If you are experiencing any of the above, then it is time to see a gynecologist for a thorough evaluation. Dr Goldstein, a NYC Gyn recommends opting for painless, non-invasive Transvaginal Ultrasounds or Sonohysterograms as a first means of diagnosis. Dr Goldstein uses these technologies to see first hand the uterus, uterine lining, fallopian tubes, ovaries, cervix and more in order to properly diagnose the cause of heavy or unscheduled bleeding. Opt for these means of diagnoses first before enduring painful, inaccurate exploratory surgeries.

 

IDEAL CANDIDATES FOR THE SERM RALOXIFENE

 

 

Selective Estrogen Receptor Modulators (SERMs), are a category of hormone therapies that manage how Estrogen works in a woman’s body. They are manufactured by pharmaceutical companies, go through rigorous testing for years, human trials and are FDA approved. Dr Steven R. Goldstein is a  Hormone Specialist in NYC and co-author of the book The Estrogen Alternative, the first book of its kind to outline the options and benefits of using synthetic hormones like Selective Estrogen Receptor Modulators (SERMs).

One of these Selective Estrogen Receptor Modulators (SERMs) is called Raloxifene (Evista). Who is the ideal candidate for this SERM? Most doctors agree that Raloxifene would be a very viable choice for women who are past menopause and have the following characteristics:

She cannot, should not, or will not take estrogen. Perhaps given her health history, she was told by her doctor that she cannot take estrogen, even if she wanted to. It’s not a question of the pros and cons of hormone replacement therapy, but the fact that she is simply not a candidate. Raloxifene gives this woman an entirely new option, and was, in fact, created for women like her.

Secondly, she doesn’t suffer from bad hot flashes, night sweats, either because she is over them or never had them. If she does have these symptoms, they are mild enough not to be bothersome or controlled by over the counter remedies.

Thirdly, avoiding breast cancer is her major concern, perhaps because of family history or fear of getting the disease. However, she wants to prevent osteoporosis.

Lastly, she may have tried hormone replacement therapy, but did very poorly. Perhaps it was the progestin phase of the HRT, or just that after trying it over a period of time she simply could not tolerate it.

Dr Steven R. Goldstein, a leading Hormone Specialist in NYC has helped thousands of women over three decades of private practice to cope with the vasomotor symptoms of menopause such as hot flashes, night sweats, foggy memory, vaginal dryness, low libido and more severe symptoms like osteoporosis, cardiovascular disease and so on. He is a Certified Menopause Practitioner, a past President of the International Menopause Society, a past President of the North American Menopause Society.

If you are a woman suffering through the symptoms of menopause, have a discussion with your doctor and hormone specialist and see if Raloxifene is right for you.

HOW DOES A WOMAN KNOW IF SHE'S OVULATED?

 

 

Dr Steven R. Goldstein is an obgyn in Manhattan and considered one of the nation’s top doctors in Gynecology. There are women who seem to know when they ovulate, and there are women who have no clue. Ovulation is the process whereby a mature egg is released from the ovary. This egg then moves down the fallopian tube where it will remain for twelve to twenty-four hours, where it can be fertilized. Ovulation typically occurs fourteen days before the beginning of the next menstrual period. However, this period varies from one woman to the next.

 Regular, cyclic menses is the hallmark of ovulation. There are thirteen lunar months in a calendar year, so if a woman gets a menses every twenty-eight days, that will be thirteen cycles in a calendar year. In addition to regular, cyclic menses, a very predictable premenstrual pattern of symptoms indicating ovulation. Whether it be craving of chocolate or getting a pimple or bloating or whatever, it is predictable.

 An anovulatory cycle is a menstrual cycle in which ovulation (the release of an egg from the ovaries), does not occur. This could be due to hormonal imbalances or other factors. The hallmark of an anovulatory cycle is its unpredictability. It varies in terms of menstrual flow and also in terms of the presence or absence of premenstrual symptoms.

 Ultrasound is a sure way to know if a woman has ovulated by showing the presence of a corpus luteum in the ovary and secretory endometrium in the uterus – both indicative of ovulation. Some women rely on basal body temperature to tell if they have ovulated. Dr Goldstein, an obgyn in Manhattan finds this highly unreliable. Changes in vaginal secretions are also signs of ovulation. Clear, wet, and stretchy before ovulation and just after ovulation it becomes cloudy, thicker and less noticeable.

 If you are looking to get pregnant, it would help if you can understand your cycle and signs of ovulation. Having intercourse five days before and on the day of ovulation can improve the odds of conceiving.

In private practice for over 25 years as a gynecologist in Manhattan, Dr Goldstein sees patients who need a gynecologic exam before attempting to get pregnant, and those who are pregnant and need early pregnancy monitoring.

 

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.