OVARIAN MASSES AND CANCER

 

 Doctor Steven R. Goldstein MD  is a Gynecologist in NYC who advocates for regular ovarian and cervical cancer screening, particularly for those with a personal or family history of these diseases. In his writings Dr Goldstein elaborates on the statistics that show the high survivability rate if ovarian cancer is detected early.

 

There is confusion among women about ovarian cysts and cancer. Many are told they have an ovarian cyst, become very fearful and insist that they want it out before it “becomes cancer”. While a normal reaction, let’s examine the relationship between ovarian cysts and ovarian cancer. 

 

Ovarian cysts never become ovarian cancer. These “functional cysts” consist of those that are formed prior to ovulation and called “follicular cysts” and those that are formed after ovulation from a small amount of bleeding into the area of ovulation. These are called “haemorrhagic cysts”. Neither of these are tumors and will not become cancerous. Now let’s look at Ovarian Tumors.

 

OVARIAN TUMORS AND CANCER

 

Cystic changes in ovaries that are not functional or dysfunctional would be considered a “new growth” (not an ovarian cyst) and represents a tumor, however, most of these tumors are benign while some may be malignant. It is important to note that with ovarian tumors they are benign or malignant from the start.

 

Therefore, if we can reliably diagnose an ovarian mass as being benign the chances of it transforming into malignancy are virtually zero. How is this diagnosis done?

 

It is done Sonographically by using painless Transvaginal ultrasound using the color flow doppler feature to assess blood flow within the pelvic organs. This helps to distinguish if it is truly suspicious, and perhaps needs surgical removal, or if it shuld be left alone. Dr Goldstein, a NYC Gyn, is one of the most highly regarded individuals in the field of gynecologic ultrasound. Here is what he looks for:

 

1)    the lack of any solid area coming off the cyst wall, and

2)    the lack of any vascularity as measured by color flow Doppler ultrasound.

 

Tumors need blood to grow, to divide, to invade, and the lack of any vascularity on color flow doppler means a lack of blood flow. This is an extremely reassuring sign. When people have what appear to be benign growths of ovaries, rather than remove them, we continue to watch them and be sure that they maintain those sonographic features that are reassuring of their benign (non-cancerous) nature.

 

If you have been told you have an ovarian cyst or an ovarian mass (tumor) and need to be screened for ovarian cancer, perhaps a consultation with Dr Steven R. Goldstein MD, a leading Gynecologist in NYC may be in order. Dr Goldstein uses transvaginal ultrasounds with color flow doppler and state of the art radiology to provide painless,  screening for ovarian cancer, the examination of ovarian masses and to look at ovarian cysts. A former Director of Gynecologic Ultrasound at NYU Langone Medical Center, Dr Goldstein personally performs all transvaginal ultrasounds. He does not rely on a technician or use reports to diagnose patients.

 

 

 

 

EXERCISE AND MISSING PERIODS

 

 Dr Steven R. Goldstein is co author of the book “Could it be….Perimenopause?” and the textbook on Perimenopausal Gynecology. He is a Perimenopause Specialist in NYC. Dr Goldstein has been in private practice for over 25 years in New York City. One of the issues women in Perimenopause experience is a missing period. However, it is not just perimenopause that can cause this, one of the reasons for missing a period could be exercise.

 

Exercise is vital to health and even more vital as we age. For women, it is important to their bone and muscle health as they age. However, exercise while generally helpful to you, can cause menstruation to come to a halt if you go at it in a way that’s extreme.

 

There are many women who get into exercise with a vengeance for the first time in their thirties or forties. Perhaps its discovery of a new spinning class, or a particularly fun aerobics teacher or falling in love with high intensity exercises. Or maybe it’s a desire to see if at this point in life one is still fit enough to run a marathon.

 

This new regimen is stressful to the body. Once your body fat level dips too low, there’s a good chance your period will stop. Your body is not producing enough estrogen for ovulation to occur. A rapid weight loss for many reasons, mainly fad diets, can also cause your period to stop. So can a large weight gain. Fifteen pounds may not do it, but extreme weight change can. Weight gain can also raise insulin levels, which can stimulate the body androgens, hormones that produce male or masculine characteristics.

 

It is particularly important to seek treatment if you have gone without your period for six months if you aren’t pregnant, lactating or in menopause. You want to guard against possible bone loss (from low estrogen), and overstimulation of the endometrial lining (from high estrogen) which is one cause of endometrial cancer. Hormone therapy is often recommended for athletes who find themselves in this situation.

 

Nine times out of ten, if you are between the ages of thirty five and fifty, the answer to your missing period is Perimenopause, a transition state to menopause where “irregular becomes regular” regarding periods. If you are a woman in your late thirties or forties and having irregular periods and/or irregular bleeding then perhaps a consultation with a Perimenopause Specialist in NYC, may be in order.

 

Dr Steven R. Goldstein specializes in the use of transvaginal ultrasounds and sononysterograms to examine the uterine lining. This is important because the uterine lining tells a “story”. It doesn’t just tell of the physiology of the uterus, but of its function and can help provide more information on the gynecological health of perimenopausal women. Dr Goldstein is also a past President of the International Menopause Society, past President of the North American Menopause Society, and a Certified Menopause Practitioner.

 

MENOPAUSE AND ESTROGEN DEPRIVATION

 

 Menopause Specialist in NYC Dr Steven R. Goldstein is a past President of the International Menopause Society, past President of the North American Menopause Society, a Certified Menopause Practitioner and co-author of the books “Could it be….Perimenopause?” and “The Estrogen Alternative”.  

 

There are very real medical issues that accompany estrogen deprivation after there is no more ovarian function (the medical definition of menopause). Other higher order primates live a very short time after they stop reproducing. My patients will spend more than 40% of their lives in a post reproductive state. There are very real consequences medically of the lack of estrogen production that menopause brings.

 

Loss of bone mass occurs quite rapidly, and osteoporotic fractures are a significant medical issue as the population ages more and more. A 50-year-old woman who does not already have cancer or heart disease has a life expectancy of 91. If a woman suffers a hip fracture her chances of being dead within the next year are 20–30% and she has a 25% chance of never living independently again.

 

There are also serious changes in the vagina as a result of a lack of estrogen. A change in the normal bacteria causes diminished production of lactic acid and thus the pH will change dramatically, as does the cell count. This leads to dryness and lack of normal lubrication which, in patients who are sexually active, can result in severe discomfort.

Almost all of you are aware of the symptoms of hot flashes and night sweats, the most common of the menopausal transition. Fortunately, for the majority of women, these will ameliorate by 4–5 years, although some women will have these indefinitely. In addition, lack of estrogen can result in joint pains.

 

After the Women’s Health Initiative published its findings in 2002 showing that estrogen plus progesterone therapy caused an increase in breast cancer and heart disease, 50% of women stopped their hormones immediately but 25% went back on. The most common reason for resuming was hot flashes and night sweats as you would think. The second most common reason was joint pains. Furthermore, menopause, with its lack of estrogen, on average causes an increase of 15 -20% in total cholesterol and LDL cholesterol (the bad cholesterol). In addition, estrogen helps promote lean body mass and after menopause women tend to accumulate more fat centrally (that old “midriff bulge”).

 

I am not trying to medicalize menopause. However, we cannot ignore the effects of estrogen deprivation on a variety of organ systems especially as women are living longer and longer. There are new approaches to replacing estrogen without the use of progesterone. As evidenced by the Women’s Health Initiative, it is the addition of progesterone in order to protect the uterus that seems to be the culprit in causing most of the negative findings. These new approaches are, in my opinion, much safer than what we’ve done for the past half century. They involve combining the estrogen Premarin with a different category of drug than progesterone. That category is SERM (selective estrogen receptor modulator). There are a number of SERMs already on the market for breast cancer prevention and prevention and treatment of osteoporosis. 

 

In summary, yes menopause can and should be a time of healthy aging and continued productivity and personal satisfaction indefinitely. The pros and cons of replacing estrogen need to be individualized and discussed on a case by case basis. 

 

If you are a woman going through Menopause or approaching Menopause, then a consultation with Dr Goldstein, a hormone specialist in NYC, may be in order

 

HOW OFTEN SHOULD YOU HAVE A PAP SMEAR?

 

 

Dr Steven R. Goldstein, a leading Gynecologist in NYC highly recommends that women have a Pap Smear as part of their gynecological exam. Dr Goldstein says that the pap smear is one of the single biggest success stories of modern medicine (barely behind the discovery of polio vaccine). 

 

The number of cases of invasive cervical cancer in this country has fallen dramatically over the last 60 years mainly because of the pap smear.  Currently, 50% of new cases of cervical cancer today are in women who have never had a pap smear and another 10% in women whose pap smear is abnormal, but have never bothered to follow-up!  In Dr Goldstein’s 25 plus years of practice he has had two cases of invasive cervical cancer and both of those women walked into his office with the disease already.  No one who has been under his care has developed invasive cancer.

 

Dr Goldstein, a NYC Gyn, writes: Several years ago, the USPSTF (United States Preventative Services Task Force) made the recommendation for less screening in women. That decision to reduce pap smear frequency is strictly a financial one, called a cost-benefit ratio.  They did this in England years ago.  They knew that there would be more cases of cervical cancer, but it was felt that it was cheaper to treat the small incremental increase in the number of cases of cancer than it would be to screen every woman annually.   I suppose if I were the Secretary of HHS (Health and Human Services) I too might be looking at the population as a whole, but as your physician I’m only concerned with you.  Let me explain:

 

If a woman has a hysterectomy for an advanced pre-cancer then the system considers that a victory because she never developed invasive cervical cancer.  If one of my patients were to have such an advanced premalignant lesion that she required a hysteroscopy, I would feel that I had failed her miserably.  My goal is to pick up abnormalities at a stage where they can be treated much more simply than with surgery as radical as a hysteroscopy.  I guess it depends on whether you believe my job is to 1) put out forest fires, 2) put out brush fires, or 3) blow out matches.  I prefer to blow out matches.

 

Finally, my biggest concern is that if the message is "you do not need a pap smear," many women will assume that they do not need a visit to the gynecologist.  Many women have come equate the pap smear with the visit.   Thus, if there is no need for a pap, they would feel that there is no need for a visit.  Nothing is further from the truth.  A visit to me is important for a myriad of reasons including the breast exam, blood pressure check, concerns about bone health, vaginal health, contraception, menstrual function, and in my opinion, perhaps most importantly, a transvaginal ultrasound evaluation of your ovaries and uterus.

 

Dr Steven R. Goldstein, a Gynecologist in NYC, likes to see his patients every six months. If they develop HPV, he’d like to know as soon as possible so that the HPV can be monitored so it does not become cervical cancer.