Dr. Steven R. Goldstein MD - Menopausal Changes That Don’t Have To Be

In a recent issue of Science Times there was an article entitled, “Menopausal vagina monologues.” It was an excellent article talking about the fact that without any estrogen in menopause the vagina becomes atrophic. It loses blood supply and elasticity. It loses its normal pH (acid/base balance) because it cannot support the normal predominant bacteria called lactobacillus that feasts on glycogen and produces lactic acid, thus lowering the ph. Studies have shown that in terms of menopause-related hot flashes and night sweats, which can range from absent to mild to debilitating – that by 4-5 years into menopause 75-80% of women will have little or no symptoms. In other words, in most women such symptoms will eventually diminish. However, the opposite is true in the vagina. Women are spending 40% of their lives in a menopausal state. Other higher order primates (gorillas, chimpanzees) live perhaps only 1-2 years after they stop reproducing. It is unnatural to have a non-estrogenized vagina. And with time these changes from atrophy get more and more pronounced.

Recent studies have shown that as many as 50% of postmenopausal women are not aware that there are treatments that are safe to treat this atrophy. They believe this is just a function of, “getting older.” Thus, many women “suffer in silence” and, if still partnered, are experiencing painful intercourse.

I believe that some degree of sexual intimacy is important to a partnered relationship. It does not and should not have to hurt. There are very low dose estrogen creams, tablets and rings, which have been around for quite some time. One problem is the FDA insistence on “class labeling.” Vaginal estrogen is as little as 1/300th the oral dose used for hot flashes and night sweats. It is virtually not absorbed into the blood stream. It stays in the vagina. Yet because it is the same drug as what is given orally, the FDA gives it the same warnings. As past president of the North American Menopause Society, I helped write an editorial (link to editorial) and petition the FDA to modify that label and its unnecessary frightening warnings. They have not budged.
There is now one oral non-estrogen, which may have other beneficial effects in breast and bone, as well. There is also a local vaginal insert, which is DHEA (dehydroepiandrosterone). It is a non-hormonal but is, however, metabolized to estrogen and testosterone.

Dr Steven R Goldstein MD is the best menopause gynecologist in New York and a menopause bleeding treatment gynecologist who can evaluate patients who are either in menopause or are post-menopausal and are experiencing unscheduled bleeding. You can schedule an appointment with Dr Goldstein by visiting his website at www.goldsteinmd.com.

Dr. Steven R. Goldstein MD - Sonohysterorgram Gynecologist in New York City

Dr. Steven R Goldstein MD is a Sonohysterogram Gynecologist in New York City and one of the most highly recognized and regarded individuals in the field of vaginal probe ultrasounds.

Sonohysterography can be used in female patients experiencing infertility problems.

Submucosal myomas may be a source of decreased fertility or increased risk for pregnancy loss. Endometrial polyps are also more common in patients with fertility problems.

Fluid enhanced Sonohysterography facilitates differentiation of these entities and can consistently diagnose intra and pericavitary lesions in infertile women. Saline infusioin Sonohysterography is widely used to diagnose the shape of the uterine cavity in cases of suspected uterine malformation.

Intrauterine adhesions after previous pregnancy associated procedures can also be detected with saline infusion Sonohysterography.

Sonohysterograms are a non-invasive, painless, less expensive way of diagnosing conditions in women and take only a few minutes in the office of the gynecologist.

Dr Steven R. Goldstein MD has argued against blind endometrial biopsies since 1995 and has championed saline infused sonohysterography, finally endorsed by the ACOG in its Practice Bulletin in 2012. His clinical research has had a significant influence on the way Gynecology is practiced.

Dr Goldstein has been in practice for over 25 years and is a Professor of Obstetrics and Gynecology at New York University School Of Medicine. He is also a Past Chairman of the American College of Obstetrics and Gynecology, New York section, Past President American Institute of Ultrasound in Medicine and is currently the Director of Gynecologic Ultrasound at NYU Langone Medical Center.

If you are a woman suffering from infertility problems then schedule a consultation with Dr Steven R Goldstein, a Sonohysterogram Gynecologist in New York City for a non-invasive Sonohysterogram.

Dr. Steven R. Goldstein MD - Vaginal Sonogram Specialist & Expert in Ectopic Pregnancy Detection by Ultrasound in New York

Dr. Steven R. Goldstein MD is a Vaginal Sonogram Specialist, New York and a Professor of Obstetrics and Gynecology at New York University School Of Medicine. He is also a Past Chairman of the American College of Obstetrics and Gynecology, New York section, Past President American Institute of Ultrasound in Medicine and is currently the Director of Gynecologic Ultrasound at NYU Langone Medical Center.

In his practice Dr Goldstein consults with patients on early pregnancy monitoring. One of the conditions Dr Goldstein checks for is an Ectopic pregnancy, which is when the developing embryo is located outside of the normal uterine cavity. 98% of these are in the fallopian tube. If they develop and rupture, they can cause hemorrhage requiring emergency surgery and transfusion.

Unfortunately, in the United States, ruptured ectopic pregnancy is still the most common cause of death in the first trimester of pregnancy. Sometimes there are risk factors for ectopic pregnancy but most cases are not predictable. Thus, it is extremely helpful when a pregnancy occurs to verify its location as being in the uterus as early as possible. This is done definitively with vaginal sonograms by locating the tiny gestational sac within the uterus. Usually this is seen by as little as one week after a patient is late for her period.

Fortunately, most of Dr. Goldstein’s patients call when they have had a positive home test and they can be seen relatively early so as to insure that the pregnancy is located within the uterus and, by serial observation, to be sure that the pregnancy is developing normally.

As a Vaginal Sonogram Specialist in New York, Dr Goldstein personally performs all Vaginal Sonograms, diagnoses the condition and then discusses treatment options with the patient.Dr Goldstein is one of the most highly recognized and regarded individuals in the field of vaginal probe ultrasounds and an internationally recognized expert in the field of gynaecological ultrasound and imaging.

If you are pregnant and are considering early pregnancy monitoring, contact Dr. Goldstein’s office to schedule a consultation.

Best Female Hormone Replacement Therapy Gynecologist - Dr. Steven R. Goldstein MD

In the August 8^th 2017 New York Times Science section, there was an extremely interesting article entitled, “Researchers Track an Unlikely Culprit in Weight Gain.” It has been known for quite some time that estrogen promotes lean body mass. At menopause, women no longer make estrogen and many patients experience the upsetting phenomenon of developing redistribution of weight to the abdomen; in medical terms known as “centripetal adiposity,” or what it says in the article, turning women from “pears” to “apples.” In addition, most of you know that at menopause, women lose bone because bone is an estrogen dependent organ. When women stop making estrogen at menopause, there is a fairly rapid loss of bone.

Now for the interesting part. Estrogen is produced by ovaries in response to a substance that comes from the pituitary gland known as FSH (follicle stimulating hormone). Follicle stimulating hormone causes follicles in the ovary to produce estrogen. At menopause the ovary is incapable of producing estrogen and so the pituitary puts out more and more FSH in an attempt to get the ovary to respond. In premenopausal women there is what is called a negative feedback loop. That means that when estrogen is produced it drives the level of FSH from the pituitary to a very low level. Thus in menopause, FSH is high and estrogen is low, in premenopause estrogen is high and FSH is low.

The article in yesterday’s Times talks about the fact that it may be FSH by itself that results in the deposition of fat to the midriff as well as a loss of bone. Apparently, researchers blocked FSH with antibodies without giving estrogen and found that in experimental animals, in this case mice, they did not deposit fat nor did they lose bone.

This is very intriguing. However it is unlikely that such antibodies would be developed any time soon for use in menopausal women. Those women who do choose to go on estrogen in the form of hormone replacement at the time of menopause will, in fact, drive down FSH levels achieving much of the same outcome. Thus, regardless of whether it is actually the elevation in FSH or the actual use of estrogen that helps maintain bone mass and prevent accumulation of central fat in the belly, the end result will be the same in menopausal women who use HRT.

Fortunately, many of you have heard me speak of a new paradigm for delivering female hormone replacement therapy (HRT) in a much safer fashion than previously thought. The product, Duavee, is estrogen with a SERM rather than an estrogen with progesterone. Both the estrogen in Duavee (Premarin) and SERMs, in general, have been shown to reduce breast cancer. Thus, this new combination is a much better form of delivering the benefits of the estrogen (relief of any night sweats and hot flashes, prevention of bone loss, and promoting lean body mass, not to mention prevention of vaginal atrophy) than traditional estrogen plus progesterone. So many of my patients who are on Duavee for hormone replacement therapy come and say to me that their friends all tell them, “you are crazy to be on HRT.” My comment to these patients is to tell their friends that, “this is not your mother’s HRT.”

Dr Steven R. Goldstein MD has over 25 years of experience in practice and is considered one of the nation’s top gynecologists. He is a Professor of Obstetrics and Gynecology at New York School of Medicine, serves as Director of Gynecologic Ultrasound at New York University Medical Center and is a Certified Menopause Practitioner.

If you are a menopausal woman struggling with the effects of menopause and the loss of estrogen, then contact the office of Dr Steven R Goldstein MD for a consultation to see if female hormone replacement therapy can work for you. All appointments are tailored to the patients and Dr Goldstein is the only medical specialist a patient will see.

Second Opinion before Gynecologic Surgery in New York - Dr. Steven R. Goldstein MD

Doctor Steven R. Goldstein is a top gynecologist in New York in practice for over 25 years, and is available for a second opinion before gynecologic surgery in New York. 

Many women have been told they need a uterine or endometrial biopsy for diagnosis purposes. Do not do so. Blind endometrial biopsies became very popular in the early 1990’s and became the standard of care after a report said they were 97.5% accurate. Before that women had Dilation and Curettage (D&C) or a scraping that was done under anaesthesia. Both of these are painful, invasive, procedures that cause women a lot of discomfort and needless pain.

In 1995 a well-known study showed that for women with cancer who had a biopsy in the operating room, the biopsy missed 11 out of 65 of those cancers, (16.9%). However when they cut open those uteri they found that the cancer occupied less than half of the surface area of those uteri.

Dr Goldstein lectured on this since 1995, but in 2012 the ACOG finally put in their practice bulletins that when these biopsies are negative, it is not a stopping point. Unfortunately the majority of practicing gynecologists do not know this and continue to do a biopsy as their first choice. Studies have shown these gynecologists are very likely to miss the abnormality with a blind biopsy.

Instead a saline infusion sonogram, where some fluid is put into the uterus allows the operator to see better and produce clear, high resolution images of the entire uterus. If you’ve been told that you need a uterine biopsy for diagnosis, ask first for a saline infusion sonogram, a painless, non-invasive procedure which is performed right in the office in a few minutes.

Dr Steven R. Goldstein is one of the nation’s top Obstetricians and Gynecologists and is well known internationally for ground breaking work in gynaecological ultrasound and imaging. He is a Professor of Obstetrics and Gynecology at New York School of Medicine, serves as Director of Gynecologic Ultrasound at New York University Medical Center and is President of the American Institute of Ultrasound in Medicine. He is available for consultation for a second opinion before gynecologic surgery in New York.

You may contact Dr Goldstein at his New York office to schedule a consultation by visiting his website at www.goldsteinmd.com

Dr. Steven R. Goldstein Top Vaginal Sonogram Specialist New York

Dr. Steven R. Goldstein MD is a Vaginal Sonogram Specialist, New York. He is one of the most highly recognized and regarded individuals in the field of vaginal probe ultrasounds and an internationally recognized expert in the field of gynaecological ultrasound and imaging. 

In his practice Dr Goldstein sees many women with a variety of gynecological medical complaints. As a Vaginal Sonogram Specialist in New York, Dr Goldstein uses vaginal sonograms (transvaginal ultrasounds) to examine the uterus, ovaries, and fallopian tubes to determine if there are tumors, fibroids, ovarian cysts, issues with the uterine lining and so on.

The use of transvaginal ultrasounds for pelvic imaging offers tremendous advantages for women. Often, diagnoses can be made on the spot, allowing more timely therapy, or in the case of normal findings, relieving patient anxieties. It saves time for both the physician and the patient. Patients uniformly prefer vaginal scanning over the discomfort of a full bladder transabominal approach.

Patients can also better understand their care; the pictures generated on the screen are very helpful in communicating the diagnosis and possible treatment options to the patient.

Dr Goldstein uses these non-invasive, non-surgical Vaginal Probe Ultrasounds to diagnose why a woman is bleeding abnormally or many other conditions. The clear images produced from these Vaginal Sonograms tell whether the bleeding is from tumors, polyps, cysts, or from simply hormonal imbalances.

As a Vaginal Sonogram Specialist in New York, Dr Goldstein personally performs all Vaginal Sonograms, diagnoses the condition and then discusses treatment options with the patient. Women with any type of abnormal bleeding can consult Dr Goldstein at his New York City office to determine the cause of bleeding and seek treatment for the condition.