IS THERE ANYTHING WOMEN CAN DO TO AVOID PERIMENOPAUSE?

 

Dr Steven R. Goldstein is a Perimenopause Specialist in NYC who has helped thousands of women navigate the difficult stage of life called Perimenopause (the decade or so before menopause). Some patients ask whether there is anything a woman can do to delay the onset of Perimenopause, perhaps because their mothers and old sisters went through menopause in their forties.

 

It is impossible to say how much of perimenopause / menopause is genetic. Certainly, when a woman says that her mother and both of her older sisters went through their “changes” in their early forties, it is understandable why she thinks she will as well.

 

Dr Goldstein usually tells his patients that genes are incredibly powerful. Although menopause is not like blue eyes (if your mother and father both have blue eyes, you will definitely have blue eyes), one should never underestimate its hereditary component. However, there is no question that most things have a genetic predisposition and then need environmental influences to cause their expression.

 Some of the other factors that seem to be good predictors that a woman will reach menopause slightly younger than her peers include:

  

 Smoking cigarettes, especially more than half a pack a day

·        Being more than ten pounds underweight
·        Having had surgery to remove all or part of an ovary
·        Having been treated for cancer with chemotherapy or abdominal-radiation therapy.

 

The median age of the onset of perimenopause is 47.5, though it can start earlier or later. As many as 70 percent of women in their forties experience a change in their menstrual cycles. About 35 percent of women experience their first episodes of depression during perimenopause. Twenty to forty percent complain of sleep problems. Up to fifty percent ultimately experience hot flashes as they get close to actual menopause. And yes, there are women who experience nothing at all. There are also women who do not attribute these symptoms to their changing patterns of ovulation and never seek medical intervention or even tell their medical doctors about what they’re experiencing psychologically.

 

All in all, there are many women who avoid the roller coaster of transition or whose symptoms are very mild.

 

Dr Steven R. Goldstein,  a Perimenopause Specialist in NYC, and past President of the International Menopause Society, past President of the North American Menopause Society, is a Certified Menopause Practitioner and co-author of the book “Could it be….Perimenopause?” If you are a woman in her late thirties or forties and going through this phase of subtle symptoms such as period irregularities, then a consultation with Dr Goldstein may be in order.

 

HAVE YOU BEEN TOLD THAT YOU HAVE AN ABNORMAL PAP SMEAR?

 

 

Dr Steven R. Goldstein MD, a leading obgyn in Manhattan strongly recommends women have a Pap Smear exam done annually to help detect the presence of any cervical cancer cells early and prevent the need for aggressive treatment. He feels strongly that the benefits of a pap smear – catching and preventing cervical cancer’s continued growth – deserves an annual test.

 

This routine, painless examination performed by Dr Goldstein checks the changes in the cells of the cervix and is the best test for identifying abnormal, cancerous and pre-cancerous cells. The number of cases of invasive cervical cancer in this country has fallen dramatically over the last sixty years mainly because of the pap smear. This painless test is completed during the patient’s routine pelvic exam.

 

If the pap smear results are abnormal, that doesn’t mean the patient should jump to conclusions and conclude that they have cancer. An abnormal pap smear doesn’t mean it will necessarily lead to cancer. It simply means there has been a change in the cervical cells. The reason for the change in cervical cells can be infection, inflammation, changes in the menstrual cycle, or in some cases pre-cancerous or cancerous cells.

 

To check for cancerous or pre-cancerous cells, there are a number of available tests to identify the abnormality after your case has been examined thoroughly.

 

Dr Goldstein, a gynecologist in Manhattan points to some of the tests that can be performed:

 

Colposcopy: A colposcope is used to see the vaginal and cervical cells in detail and any precancerous changes of, or cancerous tissue in the cervix. A colposcope is a special lighted microscope that magnifies the tissue lining the cervix and vagina. Any abnormalities that appear can be biopsied and sent to the lab to be studied under a microscope and tested for cancerous or pre-cancerous cells.

 

Endocervical curettage: A small spoon-shaped tool (curette) collects a sample of cells from the endocervical canal. This procedure is done in an outpatient setting or a hospital. The patient is given medicine not to feel pain, and the medical provider gently scrapes a layer of tissue from the cervical canal and sent to the lab to test for any problems such as cancerous or precancerous cells in the cervix.

 

If this additional testing determines that treatment of the abnormal cells is needed, Dr Goldstein may recommend one of the following options:

 

Cryotherapy: Destroys abnormal tissue through freezing. A cold chemical is applied to the area with abnormal cells in the cervix to freeze them and then remove them.

Laser therapy: Destroys or removes abnormal cells with the use of a narrow beam of intense light

Conization: A cone-shaped piece of tissue is removed with a knife, laser or LEEP technique.

If you have been told you have an abnormal pap smear, don’t jump to conclusions. As stated earlier, an abnormal pap smear doesn’t automatically mean you have cancer or pre cancer of the cervix. All it means is that there is a change in cervical cells. This  can be due to inflammation, changes in the menstrual cycle, or infection as well.

 

If you are in the New York City area, a consultation with Dr Steven R. Goldstein, an  obgyn in Manhattan may be in order.

 

MENOPAUSE AND WEIGHT GAIN

 

Dr Steven R. Goldstein is a Menopause Specialist in NYC He is a Certified Menopause Practitioner and immediate past President of the International Menopause Society.

 

Many women reach menopause and battle with weight gain. It’s a well-researched fact that a woman’s metabolism slows down 2 percent a year in middle age. One patient remarked “These days I look at food and gain weight”. She’s not far off. Do the math, and it’s clear why women who don’t eat any more or exercise any less thatn they did at forty-five may be ten pounds heavier at fifty-five.

 

Another patient remarks that she’s been walking half hour a day for the last five years, but sadly it no longer does much for her weight. She didn’t like hearing this, but she had to be told the truth  that at her age she may have to do an hour a day, and that’s just for her to keep what she has.

 

Added to this easy gain, hard loss reality is the fact that a woman’s weight is going to shift to different places as she grows older, and the shift is more obvious in thinner women. One menopausal woman remarked “I spent my twenties and thirties complaining about the cellulite in my thighs. It dawned on me the other day that my thighs haven’t looked this good in years. But I have this little growing pot belly. And it feels like my breasts are getting fat”. It isn’t her imagination. Nature distributed your fat where it determined it was most needed for procreation. When estrogen production stops and menopause enters the picture, the pear-shaped woman often turns into the apple shaped woman, much to her chagrin.

 

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.” 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.

 

Dr Goldstein, a leading menopause specialist in NYC goes on to state:    

Those women who do choose to go on estrogen in the form of hormone replacement therapy at the time of menopause will, in fact, drive down FSH levels. 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 Hormone Replacement Therapy.

 

To cope with the symptoms of Menopause, and for health maintenance in post menopausal women, Dr Goldstein, a a Hormone Specialist in NYC, and co author of the book “The Estrogen Alternative” uses hormone replacement therapy (HRT), particularly Selective Estrogen Receptor Modulators (SERMs). Hormone Replacement Therapy is not for everyone. A decision to use it requires a comprehensive medical and gynecological exam and a discussion with a specialist like Dr Goldstein to understand the symptoms of menopause the patient is experiencing.

 

If you are a woman experiencing the symptoms of menopause or interested in the use of hormone replacement therapy (HRT) for health maintenance such as bone health, heart health and more, a consultation with Dr Steven R. Goldstein,  a Menopause Doctor in NYC, may be in order.