PERIMENOPAUSE AND INSOMNIA

 

 

Imagine if you are a woman, early forties to late forties or so, and can’t remember the last time you had a good night’s sleep. Dr Steven R. Goldstein, a Perimenopause Specialist NYC has seen women come into his office with a range of symptoms that appear to have nothing to do with their menses or gynecological health. They have been to allergists, psychologists, psychiatrists and other specialists but never thought their issue was related to their gynecological health.

 

Perimenopause is the transition into menopause when a woman begins to slow the production of hormones. Some of the symptoms are irregular periods, hot flashes, and generally one of the least understood and most misdiagnosed stages of a woman’s life. One of the symptoms of Perimenopause is insomnia, the ability to sleep.

 

Insomnia generally gets worse as one gets closer to the last period. This is because night sweats – hot flashes that occur when you are sleeping – trouble many women when their bodies stop making estrogen.

 

While night sweats are a signal that you are close to actual menopause, many women complain about waking up in a sweat years before menopause happens. Or they complain that they wake up for no reason in the middle of the night and can’t go back to sleep.

 

Sleeping poorly is a big complaint for people, regardless of their age. For millions of people, bedtime is an invitation to hours of worry. Small annoyances like a truck driving by or a humidifier turning on interrupts sleep. Then come the worries of the day: Did I pay the gas bill or didn’t I?

 

If this is happening to you and you are a woman late thirties to late forties, then rule out stimulants such as the ones in cold medicines, some of the “natural” health pills, and diet sodas can keep you awake. Alcohol can send you to sleep only to wake up three hours later – for the rest of the night. A sedentary lifestyle and sleeping late can also be culprits.

 

Insomnia alone is not an indicator of Perimenopause. The stress of having subtle symptoms you’ve never experienced before can keep you up at night. Insomnia can exacerbate every other symptom of Perimenopause, so it’s important that if you’re having trouble sleeping, you talk to your doctor about it and formulate a plan for improving your sleep. The quality of your sleep is a major part of your sense of well being.

 

 Dr Steven R. Goldstein is a past president of the International Menopause Society, a Certified Menopause Practitioner and co author of the book “Could it be….Perimenopause?”. If you suspect you have Perimenopause, Dr Goldstein, a Perimenopause doctor in NYC  is available for consultation at his office in Manhattan

 

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.

 

SURGERY FOR FIBROIDS?

 

 

Dr Steven R. Goldstein, an Obgyn in Manhattan, regularly sees patients who come in with fibroids and are very concerned that they are cancerous.

One can hear the word tumor and feel terrified. But a fibroid tumor isn’t cancer. It’s a mass of muscle and connective tissue in the uterus. Fibroids arise in the wall of the uterus. If a fibroid stays within the wall, it’s called intramural. If it grows into the endometrial cavity, it’s called submucosal.

 Fibroids range in size from as small as a pea to the size of an orange and occasionally even to the size of a basketball. But even patients with relatively large benign fibroids do not necessarily need to be operated on.

 Today, transvaginal ultrasound imaging makes it possible to look closely at the ovaries despite the presence of fibroids. In the past, without transvaginal ultrasounds, physicians recommended that large fibroids be removed so they could evaluate the ovaries. Thanks to advances in ultrasound, this is no longer the case, and there is no absolute size at which fibroids must be removed. Dr Goldstein, a Gynecologist in Manhattan, received the Ian Donald Gold Award from the International Society of Ultrasound in Obstetrics in Gynecology for changing the way ultrasound is practiced through research and innovation.

 Women with fibroids often talk about pressure symptoms. Fibroids sometimes lean on the bladder. Still, fibroids are slow growing, and the adjacent organs accommodate very nicely in the overwhelming majority of cases. In addition, if you operate for “symptoms” from fibroids, these symptoms are not relieved. As women get older, they tend to feel the need to urinate more frequently. This is often unrelated to fibroids.

 If your fibroids are not large, not causing extreme bleeding, and not growing rapidly, it may be fine to watch and wait. If you bleed heavily, you will want to include plenty of iron in your diet to ward off the possibility of iron deficiency anaemia.

 The decision to opt for surgery is ultimately yours. After menopause, when estrogen levels are lower, fibroids shrink naturally. However, if you are having painful cramps or heavy menstrual bleeding, you may want to consider surgery. Consider it only if you have been thoroughly evaluated with transvaginal ultrasound and possibly saline infusion Sonohysterography.

 Myomectomy – surgical removal of the fibroid while leaving the uterus in place, is one possibility for women who still want to have children. However, this type of surgery is every bit as complicated from a surgical point of view as a hysterectomy.

 Make sure you check with your gynecologist and evaluate all your options first before deciding on surgery. The above is presented for informational purposes only.

 Dr Goldstein is a Professor of Obstetrics and Gynecology at New York School of Medicine, and a former Director of Gynecologic Ultrasound at New York University Medical Center. If you are suffering from fibroids and  are in the NY area, then a consultation with Dr Steven R. Goldstein, a leading

Obgyn in Manhattan, may be in order.