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.

 

TISSUE SELECTIVE ESTROGEN COMPLEX – TSEC. WHAT IS IT?

 

 

Dr Steven R. Goldstein is a leading Menopause Specialist in NYC. He is a Certified Menopause Practitioner with the North American Menopause Society and a past President of the International Menopause Society as well as a past President of the North American Menopause society. In private practice for over 25 years in New York City, Dr Goldstein has successfully helped thousands of women cope with the symptoms of menopause.

 Dr Goldstein, a Menopause Specialist in NYC says one of the novel “new” hormone therapies for coping with menopause is the Tissue Selective Estrogen Complex” (TSEC). The concept grew out of the women’s health initiative. There were 2 arms, the Premarin and Provera arm which news broke in 2002 that the use resulted in an increase in breast cancer and cardiovascular disease. Little mention was given to the fact that women who had hysterectomy and took Premarin by itself had a 25% reduction in breast cancer when followed up over 11.3 years and no increase in heart disease over the long haul. So clearly the culprit was the Provera, the progestogen.

 

This progestogen was given to protect the endometrium for those who had a uterus. Question is, can you protect the uterus without giving the progestogen? The answer is Estrogen plus a SERM (Selective Estrogen Receptor Modulator). Examples of these SERMs are Raloxifene, Tamoxifen, Bazedoxifene etc. SERMS are unique compounds that can be estrogenic in some tissues and estrogen antagonistic in other tissues. For instance:

 All of them are Estrogen-like in bone and estrogen blockers in the breast

 In the endometrium (the innermost lining layer of the uterus), they are variable. For instance, Basodoxifene has been shown to reduce endometrial thickness under transvaginal ultrasound. So, the Premarin was paired with the SERM Basodoxifene instead of with the progestogen. This combination became approved after clinical trials for treating vasomotor symptoms in menopausal women such as hot flashes and night sweats. The occurrence of these vasomotor symptoms was reduced from around ten to two per day in menopausal women.  

 Where would this one pill combination be best used instead of traditional hormone replacement therapy like estradiol and estrogen? Dr Steven R. Goldstein, a leading hormone specialist in NYC, says it is best used to reduce breast cancer risk because each component in it is an anti estrogen in breast.

 The type of patient this would be best for is any woman who would be considered for combination oral therapy. She should be considered for this Tissue Selective Estrogen Complex (TSEC) first. Dr Goldstein remains in practices as a Menopause Specialist in NYC and continues to help menopausal women find relief from the troublesome symptoms by using hormone replacement therapy (HRT) involving SERMs and TSEC.