<?xml version="1.0" encoding="UTF-8"?><rss version="2.0" xmlns:content="http://purl.org/rss/1.0/modules/content/" xmlns:wfw="http://wellformedweb.org/CommentAPI/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:atom="http://www.w3.org/2005/Atom" xmlns:sy="http://purl.org/rss/1.0/modules/syndication/" xmlns:slash="http://purl.org/rss/1.0/modules/slash/" > <channel> <title>NYC Gynecologist Blog | Steven R. Goldstein MD</title> <atom:link href="https://www.goldsteinmd.com/author/admin/feed/" rel="self" type="application/rss+xml" /> <link>https://www.goldsteinmd.com/author/admin/</link> <description></description> <lastBuildDate>Thu, 27 Feb 2025 23:22:08 +0000</lastBuildDate> <language>en-US</language> <sy:updatePeriod> hourly </sy:updatePeriod> <sy:updateFrequency> 1 </sy:updateFrequency> <image> <url>https://www.goldsteinmd.com/wp-content/uploads/2017/12/cropped-header-logo-2-1-32x32.png</url> <title>NYC Gynecologist Blog | Steven R. Goldstein MD</title> <link>https://www.goldsteinmd.com/author/admin/</link> <width>32</width> <height>32</height> </image> <item> <title>THE MYTHS AND REALITIES ABOUT IUDs</title> <link>https://www.goldsteinmd.com/blog/myths-and-realities-about-iuds</link> <comments>https://www.goldsteinmd.com/blog/myths-and-realities-about-iuds#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Tue, 25 Feb 2025 19:57:52 +0000</pubDate> <category><![CDATA[Uncategorized]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/blog/</guid> <description><![CDATA[<p>Dr Steven R. Goldstein, a NYC Gyn writes the following about IUDs I have spoken to many of my patients about my opinions about IUDs. Intrauterine devices, which is what IUD stands for, have been around for several thousand years. The first IUDs were actually stones put into the uteri of camels when nomads were … <a href="https://www.goldsteinmd.com/blog/myths-and-realities-about-iuds" class="more-link">Continue reading<span class="screen-reader-text"> "THE MYTHS AND REALITIES ABOUT IUDs"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/myths-and-realities-about-iuds">THE MYTHS AND REALITIES ABOUT IUDs</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>Dr Steven R. Goldstein, a <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">NYC Gyn</a> writes the following about IUDs</p> <p>I have spoken to many of my patients about my opinions about IUDs. Intrauterine devices, which is what IUD stands for, have been around for several thousand years. The first IUDs were actually stones put into the uteri of camels when nomads were crossing the desert in order to keep a camel from getting pregnant. These devices are not inducing an abortion. Apparently, in a survey of almost a thousand physicians in the United States, 17% believed an IUD was an abortifacient, which it is not.</p> <p>There has been a huge push towards an increase in use of IUDs, especially in adolescents and young women. This comes under a category know as LARC (long-acting reversible contraception). The American College of Obstetrics and Gynecology as well as the American Academy of Pediatrics have endorsed the use of these devices very liberally. In many respects, this is somewhat paternalistic. Forty percent of the pregnancies in this country are unintended. Many of those will have an unintended baby.</p> <p> </p> <p><img fetchpriority="high" decoding="async" class="aligncenter wp-image-10624" src="https://www.goldsteinmd.com/wp-content/uploads/2015/07/Top-NYC-Gynecologist-for-long-acting-reversible-contraception-300x169.jpg" alt="" width="357" height="201" srcset="https://www.goldsteinmd.com/wp-content/uploads/2015/07/Top-NYC-Gynecologist-for-long-acting-reversible-contraception-300x169.jpg 300w, https://www.goldsteinmd.com/wp-content/uploads/2015/07/Top-NYC-Gynecologist-for-long-acting-reversible-contraception-768x432.jpg 768w, https://www.goldsteinmd.com/wp-content/uploads/2015/07/Top-NYC-Gynecologist-for-long-acting-reversible-contraception.jpg 1000w" sizes="(max-width: 357px) 85vw, 357px" /></p> <h2><strong>The Risks associated with Intrauterine Devices</strong></h2> <p>The IUD is definitely associated with an increased risk of pelvic inflammatory disease and subsequent tubal damage and diminution in fertility. Although this is not huge, it is real. However, from a public health point of view, if you prevent a large number of unintended births with a relatively small number of patients with tubal damage and compromised fertility, that is considered a public health victory especially if you are the Secretary of Health and Human Services. Not so for the patient who has compromised fertility.</p> <p>When I trained, I was taught that the ideal candidate for an IUD would be someone who had had a child (the uterus grows some with childbearing) and is in a stable monogamous relationship. Most (but not all) single, young women will practice “serial monogamy.” It is unlikely that the boyfriend of the college sophomore is the man she will marry, although perhaps, sometimes it is. If one were to contract an STI (sexually transmitted infection) from a partner, the IUD can serve as a wick to help spread it up into the fallopian tubes and cause damage to one’s fertility.</p> <h2><strong>Hormonal Intrauterine Devices</strong></h2> <p>Hormonal IUDs, of which there are many different sizes as well as duration of use, contain the progestogen levonorgestrel. The hormone is delivered in a time-released fashion and will diminish over time. The progestin thickens cervical mucus which acts as a barrier to reduce sperms’ access thus preventing fertilization. It thins the endometrial lining. It does not inhibit ovulation on a regular basis. Nor does it affect erratic production of estrogen in perimenopausal women. It is often touted as being “local,” although some of the progestin is, in fact, absorbed.</p> <p>There is a recent Danish study that looked at almost 80,000 women who used hormonal IUDs. There was a small but real increase in the incidence of breast cancer underscoring the concept that some of this progestin is absorbed into the blood stream. Some patients with progestin IUDs do report progestin-type side effects (breast tenderness, bloating, acne) although this is not common and fairly rare, but real, especially if it happens to you.</p> <p>The copper IUD, approved for up to ten years, does not release any hormones. It causes some inflammatory response in the uterus which is toxic to sperm and thus prevents pregnancy that way.</p> <p>Dr Steven R. Goldstein is a <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">Gynecologist in NYC</a> with offices on the East Side of Manhattan. He is considered one of the <a href="https://www.castleconnolly.com/top-doctors/steven-r-goldstein-obstetrics-gynecology-81cc043015" target="_blank" rel="noopener">top gynecologists</a> in NYC. If you have an IUD and are experiencing hormonal issues, then perhaps a consultation is in order.</p> <p> </p> <p>The post <a href="https://www.goldsteinmd.com/blog/myths-and-realities-about-iuds">THE MYTHS AND REALITIES ABOUT IUDs</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/myths-and-realities-about-iuds/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Menopause, Perimenopause is having a moment</title> <link>https://www.goldsteinmd.com/blog/menopause-perimenopause-is-having-a-moment</link> <comments>https://www.goldsteinmd.com/blog/menopause-perimenopause-is-having-a-moment#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Thu, 23 Jan 2025 16:34:34 +0000</pubDate> <category><![CDATA[Uncategorized]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/blog/</guid> <description><![CDATA[<p>Thirteen years ago, when I was president of NAMS (what was the North American Menopause Society, recently renamed The Menopause Society), if I were at a cocktail party speaking to a few women who found out I was a gynecologist, and I mentioned that I was president of the Menopause Society… It cleared the room. … <a href="https://www.goldsteinmd.com/blog/menopause-perimenopause-is-having-a-moment" class="more-link">Continue reading<span class="screen-reader-text"> "Menopause, Perimenopause is having a moment"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/menopause-perimenopause-is-having-a-moment">Menopause, Perimenopause is having a moment</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>Thirteen years ago, when I was president of NAMS (what was the North American Menopause Society, recently renamed The Menopause Society), if I were at a cocktail party speaking to a few women who found out I was a gynecologist, and I mentioned that I was president of the Menopause Society… It cleared the room. Menopause was in the closet and women did not want to think about it or talk about it.</p> <p>This could not be more different today. Think about the fact that when the Women’s Health Initiative broke in July, 2002, with tremendous negative publicity about hormone replacement therapy, the average woman who is becoming menopausal today was not yet 30 years old. The interest in menopause and perimenopause today is extremely rewarding to someone like myself who has spent an entire career taking care of, doing research in, and teaching about, midlife women’s health; first in developing the use of vaginal sonograms, and more recently as a key opinion leader in the perimenopause and menopause space, with a particular interest in abnormal uterine bleeding, bone health, and hormones.</p> <p><strong>What does a male gynecologist know?</strong></p> <p>There is a tremendous advantage in my opinion to being a male gynecologist. This may seem counterintuitive to most women who would like to believe that a female practitioner would be more understanding, and empathetic of what they might be going through. However, it can be extremely inappropriate, even dangerous if a healthcare provider interjects their own experience and places some of that experience onto the patient sitting opposite them in a consultation room.</p> <p>I will never have a menstrual cramp, I will never have a labor pain, I will never have a hot flash. I have seen the entire range and spectrum of these by listening and observing intelligent, articulate patients for more than 3 decades. I have no personal experience of my own to even subconsciously put onto a patient. Perimenopausal and menopausal medicine need to be practiced one patient at a time. The lack of qualified experts in this field have caused so many women to turn to online resources and physician influencers. Often these people offer advice that seems to be universal.</p> <p>Recently, one such OBGYN with over 2 million followers, who, by the way, employs 20 people to keep her social media running, strongly advised women to take natural progesterone because “it is great for sleep.” Yes, this is true for many, many women. However, there are also many women who, upon taking natural progesterone before bed, feel zombie like the entire next day, and do not tolerate it. In addition, there are many women who are progesterone intolerant in general and have mood swings, breast, tenderness, water retention, bloating, and even headaches as a result of even small amounts of progesterone.</p> <p>The important take-home message is “it is not one size fits all”!! Responsible expert care requires individual assessment of a patient’s history, her family history, her medications, her level of physical activity, and there is a synthesis which also involves shared decision-making to come up with a plan that is individualized for that particular person. A number of sites have sprung up where you can have a telehealth visit with a nurse practitioner who can prescribe hormones over the internet. It is a very sad state of affairs that many people in our country have been unable to find a healthcare provider knowledgeable enough or caring enough to take the time to allow for an individualized care plan. My patients realize that I operate my healthcare for them one person at a time on an individual basis.</p> <p>If any of this information is helpful, perhaps to friends, family or others please feel free to share it.</p> <p>Dr Steven R. Goldstein is a <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">Menopause Specialist in NYC</a>, and a <a href="https://www.goldsteinmd.com/services/gynecologist-perimenopause-specialist/" target="_blank" rel="noopener">Perimenopause Specialist in NYC</a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/menopause-perimenopause-is-having-a-moment">Menopause, Perimenopause is having a moment</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/menopause-perimenopause-is-having-a-moment/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>NOT ALL TRANSVAGINAL ULTRASOUNDS ARE EQUAL</title> <link>https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal</link> <comments>https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Wed, 15 Jan 2025 23:55:14 +0000</pubDate> <category><![CDATA[Abnormal Bleeding]]></category> <category><![CDATA[Ultrasounds]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/blog/</guid> <description><![CDATA[<p>Dr Steven R. Goldstein Gynecologist in NYC Most of my patients are aware that I use vaginal sonograms as part of the overall evaluation of gynecologic care and maintaining gynecologic health. However, increasingly I have become aware that there are many women who are now demanding a vaginal sonogram of their healthcare provider. More and … <a href="https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal" class="more-link">Continue reading<span class="screen-reader-text"> "NOT ALL TRANSVAGINAL ULTRASOUNDS ARE EQUAL"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal">NOT ALL TRANSVAGINAL ULTRASOUNDS ARE EQUAL</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>Dr Steven R. Goldstein<br /> <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">Gynecologist in NYC</a></p> <p>Most of my patients are aware that I use vaginal sonograms as part of the overall evaluation of gynecologic care and maintaining gynecologic health. However, increasingly I have become aware that there are many women who are now demanding a vaginal sonogram of their healthcare provider. More and more educated, intelligent women have come to realize that the traditional bimanual examination, with two fingers in the vagina and a hand on the lower abdomen for palpation, is extremely ineffective at detecting early changes that might, indeed, be ominous, if not lethal. Thus, many women are asking for periodic vaginal sonograms.</p> <p>Most of the time such procedures are then referred to radiology for performance. A technician (preferred term “sonographer”), then performs the vaginal sonogram. They may take 50, 60, 70 or more still images of various anatomic structures, label them, and even write an initial report. Later, a radiologist will come by and “read” the images and finalize “the report.” Unfortunately, in some instances, the physician will merely sign off on what the sonographer has written. More competent radiologists will read the images themselves and only use the sonographer’s impression as a springboard. However, this is still now being read off of static images. This loses much of the advantage of vaginal sonograms.</p> <p>I have championed the concept of “dynamic ultrasound”. This is one in which the patient is examined with the probe to see if there is any pain, to see if the pelvic organs have normal mobility, and that there is no scar tissue or adhesions. There is much more to a <a href="https://www.goldsteinmd.com/services/transvaginal-ultrasounds-and-sonohysterograms/" target="_blank" rel="noopener">vaginal sonogram</a> than simply the anatomy. For instance, sometimes an ovary will look normal, but not be in its normal anatomic location because of some scar tissue either from previous surgery or infection. Such patients may or may not have pain. Some such patients who desire fertility may have compromised fertility that would go otherwise unrecognized and simply delay their ultimate diagnosis and treatment.</p> <p>Only in the US and Australia are most vaginal sonograms performed by technicians. I perform the examination myself routinely. Sometimes I am asked if a copy of the study can be sent elsewhere. I reply that the study was actually going on in my head while I was performing the examination and, while a sample of representative still images are kept for measurements for the chart, these do not constitute the actual study. That is performed in real time by me.</p> <p>Vaginal sonograms are operator dependent and equipment dependent. It is not like having a blood test where, if the machine is calibrated, the result will be standard regardless of where it is done. Too many patients will say “I had a vaginal sonogram” thinking it is as standard and reliable as if they had a blood test. In my writing and teaching I am trying to spread the word to those who perform vaginal sonograms, be they physicians or technicians, that it needs to be done in such a dynamic fashion with movement of the probe, and the other hand on the lower abdomen. Then it really becomes an examination with ultrasound not simply an ultrasound examination.</p> <p>The post <a href="https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal">NOT ALL TRANSVAGINAL ULTRASOUNDS ARE EQUAL</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>PUBLIC LACK OF AWARENESS CONCERNING BLEEDING AFTER MENOPAUSE</title> <link>https://www.goldsteinmd.com/blog/specialist-for-bleeding-after-menopause</link> <comments>https://www.goldsteinmd.com/blog/specialist-for-bleeding-after-menopause#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Sat, 04 Jan 2025 18:39:50 +0000</pubDate> <category><![CDATA[Uncategorized]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/blog/</guid> <description><![CDATA[<p>  PUBLIC LACK OF AWARENESS CONCERNING BLEEDING AFTER MENOPAUSE From Dr. Steven R. Goldstein, Menopause Specialist in NYC A recent study published in the journal Menopause, entitled “Public Awareness and Provider Counseling Regarding Postmenopausal Bleeding as a Symptom of Endometrial Cancer” came to my attention. It of course refers to bleeding after menopause. I was … <a href="https://www.goldsteinmd.com/blog/specialist-for-bleeding-after-menopause" class="more-link">Continue reading<span class="screen-reader-text"> "PUBLIC LACK OF AWARENESS CONCERNING BLEEDING AFTER MENOPAUSE"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/specialist-for-bleeding-after-menopause">PUBLIC LACK OF AWARENESS CONCERNING BLEEDING AFTER MENOPAUSE</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p> </p> <p>PUBLIC LACK OF AWARENESS CONCERNING BLEEDING AFTER MENOPAUSE<br /> From Dr. Steven R. Goldstein, <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">Menopause Specialist in NYC</a></p> <p>A recent study published in the journal Menopause, entitled “<a href="https://pubmed.ncbi.nlm.nih.gov/39078668/" target="_blank" rel="noopener">Public Awareness and Provider Counseling Regarding Postmenopausal Bleeding as a Symptom of Endometrial Cancer</a>” came to my attention. It of course refers to bleeding after menopause. I was shocked by the findings, and although they represented a wider cross-section of women than typically find their way to my office, still, the numbers presented show that there is a sad lack of understanding about what is acceptable and not acceptable in our menopausal patients.</p> <p>In a survey of 648 women,</p> <ul> <li>37% of them did not identify bleeding in menopause as a symptom potentially of endometrial cancer.</li> <li>Less than half of the respondents to the survey reported that their healthcare provider had counseled them on postmenopausal bleeding.</li> <li>Incredibly, 41% reported that they would not tell their provider if they had postmenopausal bleeding after only one episode.</li> </ul> <p>Even our third-year medical students, at least in obstetrics and gynecology, are taught that any postmenopausal bleeding, that includes staining, spotting, and, in my opinion, even a brownish discharge is “uterine cancer until proven otherwise.”</p> <p>Fortunately, only about 5% of such patients will actually have a malignancy, but such a finding mandates further evaluation. Fortunately, this can almost always be accomplished with a transvaginal sonogram and saline infusion sonogram, when necessary, rather than surgical D&C, hysteroscopy, or even hysterectomy.</p> <p>I would like to think that all my patients are aware of this and would promptly report to me any bleeding that they had in menopause. However, obviously, the knowledge among physicians and healthcare providers in general is woefully lacking. The authors of this study conclude that there is a need for increased recognition of women about any postmenopausal bleeding, as well as counseling by providers to their patients. Educational interventions to raise public and provider awareness of endometrial cancer risks and symptoms clearly need to be increased.</p> <p>As usual, feel free to share this information with anyone in your family, circle of friends, or relatives for whom it might be appropriate.</p> <p>Dr Goldstein is a Certified Menopause Practitioner, a past President of the North American Menopause Society (now Menopause Society), and a past President of the International Menopause Society. If you are a post menopausal woman, and you have bleeding, then a consultation with Dr Goldstein, a <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">Menopause Specialist in NYC</a> may be appropriate.</p> <p>The post <a href="https://www.goldsteinmd.com/blog/specialist-for-bleeding-after-menopause">PUBLIC LACK OF AWARENESS CONCERNING BLEEDING AFTER MENOPAUSE</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/specialist-for-bleeding-after-menopause/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Low Dose Birth Control Pills</title> <link>https://www.goldsteinmd.com/blog/low-dose-birth-control-pills</link> <comments>https://www.goldsteinmd.com/blog/low-dose-birth-control-pills#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Sun, 18 Feb 2024 00:10:18 +0000</pubDate> <category><![CDATA[Uncategorized]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=6552</guid> <description><![CDATA[<p>Misconceptions About Low Dose Birth Control Pills From Dr Steven R. Goldstein, NYC Gyn There are many misconceptions about Low Dose Birth Control Pills. When Dr. Goldstein was a medical student, pills came in 80 and 50 microgram strengths of estrogen. By the time he was a resident, they were 50 and 35 micrograms. Most … <a href="https://www.goldsteinmd.com/blog/low-dose-birth-control-pills" class="more-link">Continue reading<span class="screen-reader-text"> "Low Dose Birth Control Pills"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/low-dose-birth-control-pills">Low Dose Birth Control Pills</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<h2>Misconceptions About Low Dose Birth Control Pills</h2> <p>From Dr Steven R. Goldstein, <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">NYC Gyn</a></p> <p>There are many misconceptions about Low Dose Birth Control Pills. When Dr. Goldstein was a medical student, pills came in 80 and 50 microgram strengths of estrogen. By the time he was a resident, they were 50 and 35 micrograms. Most of his career, they have been 35, 30, 25 and 20 micrograms. Now they make a 10 microgram. However, the lowest doses are not always the best choice for women under thirty.</p> <p>Often a patient’s mother will come in with her teenage daughter and ask for birth control pills. Routinely, they often say, “I want the lowest dose pill.” When asked why, it appears they assume this it is the safest. Actually, these lowest dose pills are too low for young women.</p> <p>What is it not explained or understood is that in pre or perimenopausal women, birth control pills act to turn off ovarian function, and thus substitute a low-dose of estrogen and progesterone all month long. Thus, the hormone in the pill is not on top of what a woman makes, but becomes instead of what she makes. This is one reason why the lowest dose pills are inappropriate for women under 30, especially regarding their bone health. Bone is a dynamic organ, and bone mass increases greatly until about age 30-35 and then falls slowly until menopause when there is a sharp decline. Young women on the lowest dose pills will see less bone growth at a time when it is growing geometrically than the growth with their own natural cycle. Thus, for women under 30, average-dose birth control pills are more appropriate than the lowest doses.</p> <p>Bone is a hormonally sensitive organ. There is good evidence that women even on 20 microgram estrogen pills will have less bone growth through age thirty than those who are getting their own cyclic menses.</p> <p>Another major misconception about birth control pills is that they will increase the risk of cancer, mainly breast cancer. Nothing could be further from the truth. 24 years ago, the author, Malcolm Gladwell wrote an article in the New Yorker magazine entitled “John Rocks Error”. John Rock was one of the inventors of birth control pills, and part of the thesis is that they should have brought these out as cancer reducing agents. This is related to the fact that modern women are having too many cycles. As higher order primates, nature thought women would have 8 children and have to nurse them all for 15 months, there being no bottles or formula in nature.</p> <p>At most then, women would have perhaps 250 menstrual cycles in their lifetime as opposed to modern women who are often approaching 500 cycles. This explains one of the reasons why ovarian, uterine and even breast cancers are on the rise in modern industrialized nations. Women are cycling too much! It is actually closer to natural to suppress the ovarian cycle with birth control pills than to have women ovulate month after month after month without having children.</p> <p>In that article 24 years ago, Gladwell, a non-physician wrote, ”A woman who takes the Pill for ten years cuts her ovarian-cancer risk by around seventy per cent and her endometrial-cancer risk by around sixty per cent.”</p> <p>However, I believe you deserve data that is evidence-based and more recent than 24 years ago. In 2021, a study of over a quarter million women in the United Kingdom, based on their national registry, compared never-users of birth control pills to users of birth control pills. They found that in the women who used pills there was a 20% reduction in breast cancer, a 43% reduction in ovarian cancer, and a 57% reduction in uterine cancer all of which were highly statistically significant.</p> <p>The longer women took pills the greater the reduction. The misconception about cancer and birth control pills is an inappropriate extrapolation from the Women’s Health Initiative, where use of hormone replacement therapy (HRT) in that study did increase a woman’s risk of breast cancer. HRT usually consists of estrogen with progesterone as does birth control pills. Thus, it is understandable why women about to take birth control pills might look at the pill and then look at their breast and wonder why would she put this in her body.</p> <p> </p> <h2>Who can low dose birth control pills help?</h2> <p>However, low dose birth control pills are excellent choices for perimenopausal women, especially if there are small fibroids or excessive bleeding. The reason for this is because the pill suppresses a woman’s own ovarian function. Thus, the hormone in the pill is not on top of what a woman makes, actually it is instead of what she makes.</p> <p>Thus, the lowest dose pills actually deliver less total effective circulating hormone than a woman’s own cycle. This is desirable in perimenopausal women, especially, as mentioned, if they have excessive bleeding or fibroids but is too low for women who are still growing their bone mass until age 30 or 35. If you are late thirties to late forties and suspect you have Perimenopause, then see a <a href="https://www.goldsteinmd.com/services/gynecologist-perimenopause-specialist/" target="_blank" rel="noopener">Perimenopause Specialist in NYC</a>. </p> <p> </p> <h2>What about “natural” birth control?</h2> <p>Finally, a word about “natural.” Sometimes when Dr. Goldstein suggests birth control pills, patients will claim they are not “natural.” What did nature expect for women? As a higher order primate, left to nature, women would have eight children, probably two to three miscarriages, and have to nurse all the children for twelve to fifteen months, as there are no bottles or formula in nature. Thus, women would have probably approximately 250 menstrual cycles.</p> <p>Modern women living in industrialized nations could have approximately forty years of reproductive life (age 11-51) with 13 cycles in each year and end up with as many as 500 menstrual cycles. It is therefore actually closer to natural to use birth control pills and not ovulate monthly without having children.</p> <p>Dr. Goldstein is not suggesting that women have eight children and nurse them for twelve to fifteen months but do understand, what is “natural” and what we have socialized into.</p> <p> </p> <h3>About Dr Steven R. Goldstein</h3> <p>Dr Steven R. Goldstein is a top <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">NYC Gyn</a> in private practice in New York City for over 25 years. He is a Professor of Obstetrics and Gynecology at New York University School of Medicine, a past President of the International Menopause Society, Certified Menopause Practitioner, and more. You can read more about him <a href="https://www.goldsteinmd.com/about/" target="_blank" rel="noopener">here</a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/low-dose-birth-control-pills">Low Dose Birth Control Pills</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/low-dose-birth-control-pills/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Specialist for Premature Ovarian Failure and Premature Ovarian Insufficency</title> <link>https://www.goldsteinmd.com/blog/specialist-for-premature-ovarian-failure-and-premature-ovarian-insufficency</link> <comments>https://www.goldsteinmd.com/blog/specialist-for-premature-ovarian-failure-and-premature-ovarian-insufficency#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Thu, 15 Feb 2024 14:42:53 +0000</pubDate> <category><![CDATA[Uncategorized]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=6546</guid> <description><![CDATA[<p>Dr Steven R. Goldstein is a Menopause Specialist in NYC and one of the nation’s leading gynecologists. In private practice for over 25 years, Dr Goldstein has treated many patients with early menopause, and is a specialist for Premature Ovarian Failure and Premature Ovarian Insufficiency. A co- author of the book “The Estrogen Alternative”, he … <a href="https://www.goldsteinmd.com/blog/specialist-for-premature-ovarian-failure-and-premature-ovarian-insufficency" class="more-link">Continue reading<span class="screen-reader-text"> "Specialist for Premature Ovarian Failure and Premature Ovarian Insufficency"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/specialist-for-premature-ovarian-failure-and-premature-ovarian-insufficency">Specialist for Premature Ovarian Failure and Premature Ovarian Insufficency</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>Dr Steven R. Goldstein is a <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/">Menopause Specialist in NYC</a> and one of the nation’s leading gynecologists. In private practice for over 25 years, Dr Goldstein has treated many patients with early menopause, and is a specialist for Premature Ovarian Failure and Premature Ovarian Insufficiency. A co- author of the book “The Estrogen Alternative”, he is the first <a href="https://www.goldsteinmd.com/services/female-hormone-replacement-therapy-nyc/">hormone specialist in NYC</a> to write about Selective Estrogen Receptor Modulators (SERMs) for the relief of menopausal symptoms which are also associated with POF and POI. </p> <p> </p> <p><img decoding="async" class="aligncenter wp-image-6547" src="https://www.goldsteinmd.com/wp-content/uploads/2024/02/Gynecologist-in-NYC-for-Premature-Ovarian-Failure-300x169.png" alt="Premature Ovarian Failure Premature Ovarian Insufficiency" width="428" height="241" srcset="https://www.goldsteinmd.com/wp-content/uploads/2024/02/Gynecologist-in-NYC-for-Premature-Ovarian-Failure-300x169.png 300w, https://www.goldsteinmd.com/wp-content/uploads/2024/02/Gynecologist-in-NYC-for-Premature-Ovarian-Failure-768x432.png 768w, https://www.goldsteinmd.com/wp-content/uploads/2024/02/Gynecologist-in-NYC-for-Premature-Ovarian-Failure.png 800w" sizes="(max-width: 428px) 85vw, 428px" /></p> <p> </p> <p>Experienced in both Menopause and Hormone Replacement Therapy (HRT), Dr Goldstein is uniquely qualified to help women suffering with Premature Ovarian Failure (POF) and Primary Ovarian Insufficiency (POI)</p> <p> </p> <h2><u>What is Menopause?</u></h2> <p>Menopause is defined as having no more ovarian function due to a depletion of eggs. The average age of natural menopause in the United States is 51.4. However, there is a great deal of range around that number for different people. In my own practice, the oldest patient I have had who was still making her own ovarian estrogen was three weeks before her fifty-ninth birthday. When a patient has a full hysterectomy, she becomes surgically menopausal at the time of the removal of her ovaries.</p> <p> </p> <h2><u>What is Early Menopause?</u></h2> <p>If natural menopause takes place prior to age forty-five, it is considered “early menopause”.</p> <p>Obviously, early menopause, especially if it is before a woman has finished her desired childbearing, can be emotionally and psychologically devastating. Dealing with those aspects as well as educating a patient about what her childbearing options may still be going forward is an important part of healthcare for such individuals.</p> <p> </p> <h2><u>What is Premature Ovarian Failure (POF) / Premature Ovarian Insufficiency (POI)?</u></h2> <p>If natural menopause occurs prior to age forty, this is what defines premature ovarian failure (POF) or more recently labeled premature ovarian insufficiency (POI).</p> <p> </p> <h2><u>What can you do about Premature Ovarian Failure (POF) / Premature Ovarian Insufficiency (POI)?</u></h2> <p>As a <a href="https://www.goldsteinmd.com/services/female-hormone-replacement-therapy-nyc/">Hormone Specialist in NYC</a>, Dr. Goldstein says that Hormone replacement therapy (HRT) in such individuals, unless absolutely contraindicated by a personal history of breast cancer or a previous history of a blood clot (for instance in the legs or the lungs), is almost mandatory. Anything one has heard about the pros and cons of hormone replacement therapy was information gathered from women who went through typical menopause in their early fifties.</p> <p>When someone goes through premature ovarian insufficiency (or early menopause prior to age 40), giving them hormonal support until they reach the average age (roughly fifty-one) is essential for their overall health. Furthermore, the doses of hormone that such patients require is often considerably greater than that required by a typical fifty-one-year-old who may be experiencing hot flashes, night sweats, and vaginal dryness resulting in painful sexual intimacy.</p> <p>It is often also necessary to do a further workup for patients who do suffer premature ovarian insufficiency (early menopause prior to age 40). Often, these patients have antithyroid antibodies and sometimes an autoimmune process. In addition, they may have an abnormal number of DNA “copies” in one of their X chromosomes which may be relevant, especially if they have had children.</p> <p>Women of a similar age who are still having regular cyclic menses are making a large amount of estrogen and progesterone naturally of their own, and so replacing similar amounts of estrogen and progesterone in patients with premature ovarian insufficiency is merely bringing them up to the level that their peer group is still making and what they would have made if they had not gone into premature menopause.</p> <p> </p> <h2><u>Early Menopause prior to age 40 requires individualized therapy</u></h2> <p>Thus, one can see that Premature Ovarian Insufficiency (POI) or early menopause prior to age 40 is a relatively unique subset of general menopause. It requires special testing, and individualized and unique therapy as well. Unfortunately, many healthcare providers are not aware of the unique nature of POI and simply treat such patients the same way they would treat an average fifty-one-year-old going through natural menopause.</p> <p>Dr Steven R. Goldstein is <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/">Menopause Specialist in NYC</a>. He is a past President of the International Menopause Society, a past President of the North American Menopause Society and a Certified Menopause Practitioner. As part of his expertise in this and menopause in general, Dr. Goldstein routinely consults and treats patients with POI or early menopause. He is specialist for Premature Ovarian Failure and Primary Ovarian Insufficiency (POI). If you feel this is a possibility in your case, consultation would be more than appropriate. Click the schedule appointment below and we will contact you.</p> <p>The post <a href="https://www.goldsteinmd.com/blog/specialist-for-premature-ovarian-failure-and-premature-ovarian-insufficency">Specialist for Premature Ovarian Failure and Premature Ovarian Insufficency</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/specialist-for-premature-ovarian-failure-and-premature-ovarian-insufficency/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Could it be Endometriosis?</title> <link>https://www.goldsteinmd.com/blog/endometriosis-specialist-nyc</link> <comments>https://www.goldsteinmd.com/blog/endometriosis-specialist-nyc#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Wed, 07 Feb 2024 00:07:57 +0000</pubDate> <category><![CDATA[Uncategorized]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=6533</guid> <description><![CDATA[<p>Dr Steven R. Goldstein, Gynecologist for Endometriosis in NYC What is Endometriosis? Dr Steven R. Goldstein is a NYC Gynecologist and specialist for Endometriosis in NYC. Endometriosis is an all too common gynecologic condition where the glands that lie inside the uterine cavity can come to lie outside the uterus in the pelvis. When the … <a href="https://www.goldsteinmd.com/blog/endometriosis-specialist-nyc" class="more-link">Continue reading<span class="screen-reader-text"> "Could it be Endometriosis?"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/endometriosis-specialist-nyc">Could it be Endometriosis?</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<h2>Dr Steven R. Goldstein, Gynecologist for Endometriosis in NYC</h2> <hr /> <h2>What is Endometriosis?</h2> <p>Dr Steven R. Goldstein is a <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">NYC Gynecologist</a> and specialist for Endometriosis in NYC. Endometriosis is an all too common gynecologic condition where the glands that lie inside the uterine cavity can come to lie outside the uterus in the pelvis. When the endometrial glands bleed (that is a period) these glands located outside the uterus bleed as well. This can cause some scar tissue. If there is a collection of this blood within the ovary, it is referred to as an endometrioma (or sometimes called a “chocolate cyst”).</p> <p>Endometriosis can also take the form of small deep implants of endometrial tissue in many different places in the body, including the wall of the bladder, the anterior abdominal wall, the bowel wall and the uterosacral ligaments, as well as other pelvic sites. Rarely endometriosis can occur in sites such as the lung, potentially causing hemoptysis.</p> <p> </p> <h2>What are the Symptoms of Endometriosis?</h2> <p>The exact cause of endometriosis is unknown and there are multiple theories. Endometriosis does not always show symptoms. There appears to be a higher incidence of endometriosis in women who are diagnosed with infertility and pelvic pain. Symptoms of Endometriosis include pelvic pain, painful periods, heavy bleeding during periods, or bleeding between periods.</p> <p><img decoding="async" class="aligncenter wp-image-6536" src="https://www.goldsteinmd.com/wp-content/uploads/2024/02/Endometriosis-Specialist-in-NYC-300x169.png" alt="Endometriosis Specialist NYC" width="430" height="242" srcset="https://www.goldsteinmd.com/wp-content/uploads/2024/02/Endometriosis-Specialist-in-NYC-300x169.png 300w, https://www.goldsteinmd.com/wp-content/uploads/2024/02/Endometriosis-Specialist-in-NYC.png 640w" sizes="(max-width: 430px) 85vw, 430px" /></p> <p> </p> <h2>Painless Diagnosis of Endometriosis by NYC Endometriosis Specialist</h2> <p>Increasingly, <strong>transvaginal ultrasound</strong> can make a very strong presumptive diagnosis of endometriosis without any surgical laparoscopy which, until recently, was the gold standard for making a definitive diagnosis. An endometrioma of the ovary has a classic appearance and, when present, can confirm the absolute diagnosis of endometriosis.</p> <p>However, there are times where there is no obvious endometrioma, but the presence of scar tissue can result in structures becoming adherent to each other and be a source of pain. Such abnormal mobility can be judged by transvaginal ultrasound but only if it is done dynamically. Unfortunately, this is not generally practiced here in the United States where a technician instead takes dozens of still two-dimensional images which are later read by the radiologist.</p> <p> </p> <h2>What is a dynamic Transvaginal Ultrasound for Endometriosis?</h2> <p>Dr. Goldstein, an Endometriosis Specialist NYC, as well as most European doctors, performs his own ultrasound, and movement of structures at the time of the exam can often give a strong clue to adhesions associated with endometriosis, as well as eliciting pain with the probe and the abdominal examining hand which can also be indicative of a high likelihood of endometriosis.</p> <p>Dr. Goldstein, a leading <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">NYC Gyn</a> has helped to author a paper entitled, “An evidence-based approach to assessing surgical versus clinical diagnosis of symptomatic endometriosis.”</p> <p> </p> <h2>What can you do about Endometriosis in NYC?</h2> <p>If you suffer from pelvic pain and think there is a suspicion of any endometriosis, a dynamic ultrasound performed by an expert sonologist like Dr. Goldstein can be extremely helpful in making the diagnosis without surgery, and then beginning medical intervention for treatment. Schedule an appointment with Dr. Steven R. Goldstein, a top <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">NYC Gyn</a> for an evaluation.</p> <p>The post <a href="https://www.goldsteinmd.com/blog/endometriosis-specialist-nyc">Could it be Endometriosis?</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/endometriosis-specialist-nyc/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Dr Goldstein receives the Ian Donald Gold Medal Award from the International Society of Ultrasound in Obstetrics and Gynecology</title> <link>https://www.goldsteinmd.com/blog/dr-goldstein-receives-the-ian-donald-gold-medal-award</link> <comments>https://www.goldsteinmd.com/blog/dr-goldstein-receives-the-ian-donald-gold-medal-award#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Wed, 25 Oct 2023 21:09:24 +0000</pubDate> <category><![CDATA[Uncategorized]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=6184</guid> <description><![CDATA[<p>Steven R. Goldstein MD, Professor of Obstetrics and Gynecology, New York University Grossman School of Medicine, receives the Ian Donald Gold Medal Award at the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). This is the highest honor this society awards and is given annually to an individual “who has changed the way ultrasound … <a href="https://www.goldsteinmd.com/blog/dr-goldstein-receives-the-ian-donald-gold-medal-award" class="more-link">Continue reading<span class="screen-reader-text"> "Dr Goldstein receives the Ian Donald Gold Medal Award from the International Society of Ultrasound in Obstetrics and Gynecology"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/dr-goldstein-receives-the-ian-donald-gold-medal-award">Dr Goldstein receives the Ian Donald Gold Medal Award from the International Society of Ultrasound in Obstetrics and Gynecology</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p><span class="xyt-core-attributed-string" style="font-family: times new roman, times, serif; font-size: 14pt;"><span style="color: #494949;">Steven R. Goldstein MD, Professor of Obstetrics and Gynecology, New York University Grossman School of Medicine, receives the Ian Donald Gold Medal Award at the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). This is the highest honor this society awards and is given annually to an individual “</span><span style="color: #494949;">who has changed the way ultrasound is practiced through research or innovation.” Over the 33 years since this society began only once before was this award given to someone like Dr Goldstein who only does ultrasound in Gynecology rather than Obstetrics.</span></span></p> <p>See Videos below</p> <p><a href="https://1drv.ms/v/s!AojJ8ozhcb7igyxvfu2klbMYVdP2?e=jdsVLF" target="_blank" rel="noopener">Ian Donald Gold Medal Award 2023 Video Prof. Steven Goldstein.mp4</a></p> <p><a href="https://1drv.ms/v/s!AojJ8ozhcb7igysSE0-v4iMWn_2L?e=1X6ebR" target="_blank" rel="noopener">Interview Ian Donald Gold Medal Winner 2023 Prof. Steven Goldstein.mp4</a></p> <p> </p> <p> </p> <p> </p> <p>The post <a href="https://www.goldsteinmd.com/blog/dr-goldstein-receives-the-ian-donald-gold-medal-award">Dr Goldstein receives the Ian Donald Gold Medal Award from the International Society of Ultrasound in Obstetrics and Gynecology</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/dr-goldstein-receives-the-ian-donald-gold-medal-award/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Perimenopausal Bleeding or Spotting</title> <link>https://www.goldsteinmd.com/blog/perimenopausal-bleeding-or-spotting</link> <comments>https://www.goldsteinmd.com/blog/perimenopausal-bleeding-or-spotting#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Tue, 01 Aug 2023 22:02:47 +0000</pubDate> <category><![CDATA[Menopause/Perimenopause]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=5939</guid> <description><![CDATA[<p>  Dr Steven R. Goldstein is one of the world’s top experts on the science of Perimenopause, one of America’s leading Gynecologists and a tenured Professor at New York . He is a nationally recognized Menopause expert and a tenured Professor of Obstetrics and Gynecology, New York University School of Medicine. A Perimenopause Specialist in … <a href="https://www.goldsteinmd.com/blog/perimenopausal-bleeding-or-spotting" class="more-link">Continue reading<span class="screen-reader-text"> "Perimenopausal Bleeding or Spotting"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/perimenopausal-bleeding-or-spotting">Perimenopausal Bleeding or Spotting</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p><img loading="lazy" decoding="async" class="aligncenter wp-image-5948" src="https://www.goldsteinmd.com/wp-content/uploads/2023/08/Perimenopausal-Bleeding-or-Spotting.png" alt="Perimenopausal Bleeding or Spotting" width="590" height="304" srcset="https://www.goldsteinmd.com/wp-content/uploads/2023/08/Perimenopausal-Bleeding-or-Spotting.png 1000w, https://www.goldsteinmd.com/wp-content/uploads/2023/08/Perimenopausal-Bleeding-or-Spotting-300x155.png 300w, https://www.goldsteinmd.com/wp-content/uploads/2023/08/Perimenopausal-Bleeding-or-Spotting-768x396.png 768w" sizes="auto, (max-width: 590px) 85vw, 590px" /></p> <p> </p> <p>Dr Steven R. Goldstein is one of the world’s top experts on the science of Perimenopause, one of America’s leading Gynecologists and a tenured Professor at New York . He is a nationally recognized Menopause expert and a tenured Professor of Obstetrics and Gynecology, New York University School of Medicine. A <a href="https://www.goldsteinmd.com/services/gynecologist-perimenopause-specialist/">Perimenopause Specialist in NYC</a>, Dr Goldstein offers some helpful information on the topic of Perimenopause, specifically bleeding and spotting.</p> <p>Much is said about Menopause, but less about Perimenopause and the related perimenopausal bleeding or spotting. Women have lots of questions about Perimenopause, particularly regarding the menstrual cycle, bleeding or spotting during this stage.</p> <p> </p> <h2 style="text-align: left;"><strong><u>What is Perimenopause?</u></strong></h2> <p>Perimenopause is the transition into menopause when a woman’s body begins to slow the production of hormones. Women most often experience perimenopause signs and symptoms in their early 40s, but for some it can begin in their 30s. This transition time can last anywhere from 4-7 years. </p> <p> </p> <h2 style="text-align: left;"><strong><u>What are the symptoms of Perimenopause?</u></strong></h2> <p>The symptoms of Perimenopause are occasional hot flashes, sleep problems, vaginal dryness, mood changes, inability to concentrate, free floating anxiety and <strong>Irregular periods. </p> <p></strong></p> <p> </p> <h2><strong><u>Why is there irregular periods or spotting during perimenopause?</u></strong></h2> <p>Dr Steven R. Goldstein, a <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">Menopause Specialist in NYC</a> and co author of the book “Could it be… Perimenopause?”outlines the following about Perimenopausal bleeding or spotting. Think of perimenopause as the mirror image of adolescence. Adolescence is the coming on to the reproductive years while perimenopause is the coming off of the reproductive years.</p> <p>In both of these timeframes, regular ovulatory cycles are less likely. To patients, all the blood that comes out of their vagina is their “period,” whereas to me as a clinician, a “menses” is a bleed preceded two weeks before by ovulation. If one does not ovulate but is making estrogen, when and how much one bleeds is related to the stability of the estrogen levels without progesterone. When there is fluctuation, it destabilizes the uterine lining, and it can be shed, causing bleeding.</p> <p>The hallmark of cycles with ovulation is their predictability, regularity, and cyclicity. The hallmark of cycles without ovulation is being potentially “all over the map.” They can be heavy, they can be light, they can be continuous or intermittent. As they are in perimenopause. The hallmark is the inconsistency, whereas pre-menopausal ovulatory cycles are characterized by predictability, consistency, and regularity.</p> <p>In a large study conducted by us more than twenty years ago, 79% of women over the age of thirty-five who had any irregularity to their bleeding cycle had no anatomic reason such as polyps, fibroids, pre-cancers, and even occasional cancers. Thus, these 79% had irregular bleeding or spotting due to “hormone imbalance,” what doctors tell patients when they are not ovulating and thus not making progesterone on a regular basis.</p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.goldsteinmd.com/services/gynecologist-perimenopause-specialist/" target="_blank" rel="noopener"><strong> <img loading="lazy" decoding="async" class="aligncenter wp-image-5940" src="https://www.goldsteinmd.com/wp-content/uploads/2023/08/Perimenopause-usually-misdiagnosed-1024x1024.png" alt="" width="349" height="349" srcset="https://www.goldsteinmd.com/wp-content/uploads/2023/08/Perimenopause-usually-misdiagnosed-1024x1024.png 1024w, https://www.goldsteinmd.com/wp-content/uploads/2023/08/Perimenopause-usually-misdiagnosed-300x300.png 300w, https://www.goldsteinmd.com/wp-content/uploads/2023/08/Perimenopause-usually-misdiagnosed-150x150.png 150w, https://www.goldsteinmd.com/wp-content/uploads/2023/08/Perimenopause-usually-misdiagnosed-768x768.png 768w, https://www.goldsteinmd.com/wp-content/uploads/2023/08/Perimenopause-usually-misdiagnosed.png 1080w" sizes="auto, (max-width: 349px) 85vw, 349px" /></strong></a></p> <p> </p> <p> </p> <h2><strong><u>What can be done about irregular or abnormal bleeding or spotting?</u></strong></h2> <p>The guidelines state that any women over forty who is having any irregular, abnormal bleeding or staining or spotting needs to have her uterine lining (endometrium) evaluated to rule out structural, anatomic reasons for the bleeding.</p> <p>Whereas, years ago the primary diagnostic procedure was a D&C (dilitation and curettage also known as “scraping”) today we use transvaginal ultrasound and, when necessary, saline infusion into the uterine cavity to better delineate the presence or absence of any anatomic abnormality. If the bleeding is “hormone imbalance,” then such patients can be reassured and almost always treated hormonally.</p> <p>If the bleeding is from some structural abnormality (polyps, fibroids, pre-cancers, or even potential cancers) then either endometrial biopsy if the process involves the entire uterine cavity, or D&C hysteroscopic visualization under anesthesia, if the process involves only a portion of the uterine cavity mainly because in those instances, a blind biopsy may miss the area of interest.</p> <p>Dr Steven R. Goldstein is a past President of the <a href="https://www.imsociety.org/" target="_blank" rel="noopener">International Menopause Society</a>, past President of the North American Menopause Society, a Certified Menopause Practitioner and one of the nation’s top doctors in gynecology. He is also the co-author of the book “Could it be….Perimenopause?” If you think you are experiencing perimenopause or have irregular bleeding, you may schedule a consultation with Dr Goldstein at <a href="https://www.goldsteinmd.com/contact/" target="_blank" rel="noopener">this link</a>.</p> <p>You can read more about Dr Goldstein at <a href="https://www.goldsteinmd.com/about/" target="_blank" rel="noopener">this page</a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/perimenopausal-bleeding-or-spotting">Perimenopausal Bleeding or Spotting</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/perimenopausal-bleeding-or-spotting/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Important information about antibiotic resistance</title> <link>https://www.goldsteinmd.com/blog/5759-2</link> <comments>https://www.goldsteinmd.com/blog/5759-2#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Tue, 11 Apr 2023 16:37:37 +0000</pubDate> <category><![CDATA[Uncategorized]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=5759</guid> <description><![CDATA[<p>The following is from Dr Steven R. Goldstein, an expert NYC gyn, to his current patients. Please note that the following information is not a substitute for in office diagnosis and treatment. It is meant for informational or educational purposes only. Most of you are aware that I usually only send email blasts when something … <a href="https://www.goldsteinmd.com/blog/5759-2" class="more-link">Continue reading<span class="screen-reader-text"> "Important information about antibiotic resistance"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/5759-2">Important information about antibiotic resistance</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>The following is from Dr Steven R. Goldstein, an expert <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">NYC gyn</a>, to his current patients. Please note that the following information is not a substitute for in office diagnosis and treatment. It is meant for informational or educational purposes only.</p> <p>Most of you are aware that I usually only send email blasts when something has appeared in the news or print media that I think would be of important interest to you and worth sharing. </p> <p>Approximately two weeks ago, there was an article in the Science Section of the New York Times speaking about drug resistance (actually, in a gastrointestinal situation), which “has scientists worried.” Obviously, I don’t primarily treat gastrointestinal infections (diarrhea, irritable bowel) but many of you often do and should call me when you think you have a urinary tract infection. What I am going to explain now I have related to a handful of you face-to-face in the office. I think, however, this is worthy of wider distribution. </p> <p>When penicillin first came out in the 1940’s, it killed almost all bacteria. Today, it kills very few bacteria. This is because many bacteria have become resistant to its use. Antibiotic resistance is a natural occurrence caused by mutations in bacteria’s genes. However, inappropriate overuse of antibiotics accelerates the emergence and spread of antibiotic resistant bacteria. When a patient does have symptoms of a urinary tract infection (burning with urination, frequent urination, feeling like one has to go and can’t, suprapubic pain, and sometimes even bloody urine) increasingly, many healthcare providers, especially those at “urgent care,” will do a dipstick of the urine and if it contains a substance called leukocyte esterase, they presume a bacterial infection and will give a broad spectrum antibiotic that should kill anything that might be present. I finally had happen something that I had predicted for more than a decade. In the not so distant past, I have had two patients who had confirmed urinary tract infections based on a culture and sensitivity test. Such a test not only identifies the actual bacteria and number of colonies present, but also will give a long list of various antibiotics and whether this particular bacteria is susceptible or resistant to each of these antibiotics. These two patients had confirmed urinary tract infections that were resistant to virtually every oral medication that we normally give. Their bacteria was sensitive to medications that would be intramuscular or intravenous. I had to call these patients and tell them that I treat urinary tract infection almost as a courtesy, and that I was not about to give a big shot in the buttocks or hang an IV of a drug that I have no experience with (since they were resistant to all the usual oral medications) and that they would have to go to urology to be treated for their urinary tract infection. Clearly, it is the overuse of antibiotics that has resulted in the rapidly emerging resistance to common oral medications.</p> <p>The preferred way to handle suspected urinary tract infection would include a urinalysis and formal urine culture with sensitivities. While this takes forty-eight hours for a result, there are medications (like Uristat, or Pyridium) which are actually urinary anesthetics. They are so effective at masking the symptoms of urinary tract infection that when I was a resident at Bellevue, we did not utilize such medications because in such patients their symptoms were so masked that they felt they were cured and did not do any follow up. If a patient starts such a urinary anesthetic, it is essential to simultaneously run a urine culture. If the culture is negative, then the diagnosis is “sterile trigonitis.” In these cases, the trigone of the bladder becomes inflamed. “-Itis” represents inflammation of and not true infection. Such a situation can be treated with one week of one of these urinary anesthetics and an antibiotic is not necessary. If such a culture and sensitivity shows bacteria being present, then I like to choose the least broad spectrum antibiotic for that particular bacterial strain. </p> <p>Obviously, we live in the real world, and if someone calls me on a Friday afternoon about to leave on vacation for a week with symptoms of a urinary tract infection, I may be forced to give an antibiotic because we do not have the luxury of obtaining a culture and waiting forty-eight hours. Hopefully, most of you understand the logistics of what I am trying to explain.</p> <p>If you think you have a urinary tract infection, please contact the office. We can arrange for medication to relieve your symptoms (these urinary anesthetics) and order an appropriate urinalysis and urine culture and sensitivity, assuming we have adequate time for results. This will be appropriate for you and help prevent development of resistant organisms “down the road.”</p> <p>Dr Steven R. Goldstein is a leading <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">Gynecologist in NYC</a>. If you are not a current patient, but suspect you have a urinary tract infection you may schedule a consultation for an examination.</p> <p>The post <a href="https://www.goldsteinmd.com/blog/5759-2">Important information about antibiotic resistance</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/5759-2/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> </channel> </rss>