<?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>Menopause/Perimenopause Archives - goldsteinmd</title> <atom:link href="https://www.goldsteinmd.com/category/menopauseperimenopause/feed/" rel="self" type="application/rss+xml" /> <link>https://www.goldsteinmd.com/category/menopauseperimenopause/</link> <description></description> <lastBuildDate>Thu, 23 Jan 2025 00:08:33 +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>Menopause/Perimenopause Archives - goldsteinmd</title> <link>https://www.goldsteinmd.com/category/menopauseperimenopause/</link> <width>32</width> <height>32</height> </image> <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 fetchpriority="high" 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="(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 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="(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>The Burden of Osteoporosis, Poor Bone Health, and Fragility Fractures – Dr Steven R. Goldstein</title> <link>https://www.goldsteinmd.com/blog/osteoporosis-poor-bone-health-and-fragility-fractures</link> <comments>https://www.goldsteinmd.com/blog/osteoporosis-poor-bone-health-and-fragility-fractures#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Wed, 21 Dec 2022 21:40:39 +0000</pubDate> <category><![CDATA[Breast Health]]></category> <category><![CDATA[Bone Health]]></category> <category><![CDATA[Menopause/Perimenopause]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=5493</guid> <description><![CDATA[<p>Bone Health is more than just Osteoporosis In my office almost all women are cognizant of breast health, have a great fear of breast cancer, and for the most part are attuned to the importance of competent periodic breast imaging… the key to earliest detection. The goal is not to have a better bone density … <a href="https://www.goldsteinmd.com/blog/osteoporosis-poor-bone-health-and-fragility-fractures" class="more-link">Continue reading<span class="screen-reader-text"> "The Burden of Osteoporosis, Poor Bone Health, and Fragility Fractures – Dr Steven R. Goldstein"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/osteoporosis-poor-bone-health-and-fragility-fractures">The Burden of Osteoporosis, Poor Bone Health, and Fragility Fractures – Dr Steven R. Goldstein</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<h1><strong>Bone Health is more than just Osteoporosis<br /> </strong></h1> <p>In my office almost all women are cognizant of breast health, have a great fear of breast cancer, and for the most part are attuned to the importance of competent periodic breast imaging… the key to earliest detection.</p> <p>The goal is not to have a better bone density score on a Dexa test at age 82, the goal is to not break a hip at age 82</p> <p><a href="https://www.goldsteinmd.com/conditions/osteoporosis-specialist-nyc-menopause-bone-loss/" target="_blank" rel="noopener">Bone health IS more than just osteoporosis</a>. My hope is to get these same patients to be just as concerned about their bone health as they are concerned about their breast health, so I compiled some statistics which I hope will help you to understand how important bone health, osteoporosis and fragility fractures are to you as you pursue HEALTHY aging!</p> <p> </p> <p> </p> <h2><img decoding="async" class="aligncenter wp-image-5647" src="https://www.goldsteinmd.com/wp-content/uploads/2022/12/MenopauseBoneLoss_1080x1080Artboard-1-1024x1024.png" alt="" width="482" height="482" srcset="https://www.goldsteinmd.com/wp-content/uploads/2022/12/MenopauseBoneLoss_1080x1080Artboard-1-1024x1024.png 1024w, https://www.goldsteinmd.com/wp-content/uploads/2022/12/MenopauseBoneLoss_1080x1080Artboard-1-300x300.png 300w, https://www.goldsteinmd.com/wp-content/uploads/2022/12/MenopauseBoneLoss_1080x1080Artboard-1-150x150.png 150w, https://www.goldsteinmd.com/wp-content/uploads/2022/12/MenopauseBoneLoss_1080x1080Artboard-1-768x768.png 768w, https://www.goldsteinmd.com/wp-content/uploads/2022/12/MenopauseBoneLoss_1080x1080Artboard-1.png 1080w" sizes="(max-width: 482px) 85vw, 482px" /></h2> <h2>Why pay attention to bone health, osteoporosis and fragility fractures?</h2> <p>First, worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every three seconds.<a href="#_edn1" name="_ednref1">[i]</a></p> <p>Second, it is estimated that osteoporosis effects 200 million women worldwide. One-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and, actually two-thirds of women aged 90 carry this diagnosis.<a href="#_edn2" name="_ednref2">[ii]</a></p> <p>Third, worldwide, one in three women after the age 50 will experience an osteoporotic fracture.<a href="#_edn3" name="_ednref3">[iii]</a></p> <p>Fourth, at <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">menopause</a>, the removal of estrogen has much greater effects in women than men of similar age. The female-to-male ratio of osteoporotic fractures is approximately 1.6, such that 80% of forearm fractures, 75% of humerus fractures, 70% of hip fractures, and 58% of spine fractures occur in women.<a href="#_edn4" name="_ednref4">[iv]</a></p> <p>Fifth, A prior fracture is associated with an 86% increased risk of any subsequent fracture.<a href="#_edn5" name="_ednref5">[v]</a></p> <p>Sixth, Fragility fractures are a leading cause of chronic disease morbidity. For instance, in Europe, fragility fractures are the fourth leading cause, after ischemic heart disease, dementia, and lung cancer; however, they surpass chronic obstructive pulmonary disease and ischemic stroke.<a href="#_edn6" name="_ednref6">[vi]</a></p> <p>Seventh, After sustaining a hip fracture, 10-20% of formerly community-dwelling patients require long-term nursing care.<a href="#_edn7" name="_ednref7">[vii]</a></p> <p>Overall, hip fractures cause the most morbidity, and reported mortality rates are up to 20-24% in the first year after a hip fracture.<a href="#_edn8" name="_ednref8">[viii]</a></p> <p>Loss of function and independence among survivors is profound, with 40% unable to walk independently, and 60% require assistance a year later.<a href="#_edn9" name="_ednref9">[ix]</a></p> <h2> </h2> <h2><strong>Is monitoring bone health just as important as the early detection of breast cancer?<br /> </strong></h2> <p>In localized breast cancer where there is no sign that the cancer has spread outside the breast, the 5-year survival in the US is 99%!</p> <p>(American Cancer Society. Survival Rates for Breast Cancer. Available at: <a href="https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html">https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html</a> )</p> <p>Even regional breast cancer, defined as spread outside the breast to nearby structures or lymph nodes, has an 86% five-year survival.</p> <p>(American Cancer Society. Survival Rates for Breast Cancer. Available at: <a href="https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html">https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html</a> )</p> <p>In developed countries where women have access to periodic competent breast screening by imaging techniques, for many the diagnosis of localized breast cancer and the psychological ramifications may actually exceed the physical manifestations.</p> <p style="text-align: center;"><strong>You only have to contrast the statistics above vis a vis breast cancer versus the statistics cited about the incidence, morbidity and even mortality associated with osteoporosis and fragility fractures (ESPECIALLY of the hip) to see the importance of <a href="https://www.goldsteinmd.com/conditions/osteoporosis-specialist-nyc-menopause-bone-loss/" target="_blank" rel="noopener">bone health and osteoporosis</a></strong></p> <p> </p> <h2>Promoting Bone Health</h2> <p>There are several things you can do to improve your bone health.</p> <p>Be sure you are getting enough calcium in your diet and that you supplement with Vitamin D. Here is an article from Dr. Goldstein with more information on calcium and vitamin D. Click <a href="https://www.goldsteinmd.com/calcium-vitamin-d/">HERE</a></p> <p>Be sure to exercise. Walking is a good exercise, especially when you practice “mindful walking”, which includes being aware of your steps and that the surface is safe. Be aware of black ice and use non-skid rugs in the bathroom. Ensure that your eyesight is good and there is sufficient illumination. It is also essential to maintain muscle strength which can be done, depending on your condition and advice from your doctor, by using light weights. You want to avoid sarcopenia which is “muscle wasting,” and atrophy of your muscles.</p> <p>Balance exercises are also recommended. For more information on this, check out this article from the <a href="https://www.heart.org/en/healthy-living/fitness/fitness-basics/balance-exercise">American Heart Association</a><u>.</u></p> <p>As usual if you have any questions, schedule 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> </p> <p> </p> <p>Footnotes:</p> <p><a href="#_ednref1" name="_edn1">[i]</a> Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis Int. 2006;17:1726–1733.</p> <p><a href="#_ednref2" name="_edn2">[ii]</a> Kanis, JA, Odén A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis Int. 2012;23:2239–2256.</p> <p><a href="#_ednref3" name="_edn3">[iii]</a> Adult Official Positions of the ISCD as updated in 2019. www.iscd.org. Last accessed July 2021</p> <p><a href="#_ednref4" name="_edn4">[iv]</a> Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis Int. 2006;17:1726–1733.</p> <p><a href="#_ednref5" name="_edn5">[v]</a> Kanis JA, Johansson H, Harvey NC, et al. A brief history of FRAX. Arch Osteoporos. 2018;13(1):118</p> <p><a href="#_ednref6" name="_edn6">[vi]</a> Kanis JA, Johansson H, Strom O, et al. The National Osteoporosis Guideline Group. Case finding for the management of osteoporosis with FRAX<sup>®</sup> – assessment and intervention thresholds for the UK. Osteoporos Int. 2008;19:1395–1408.</p> <p><a href="#_ednref7" name="_edn7">[vii]</a> Bone HG, Wagman RG, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol. 2017;5:513–523.</p> <p><a href="#_ednref8" name="_edn8">[viii]</a> Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: The health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006;61:1059–1064.</p> <p><a href="#_ednref9" name="_edn9">[ix]</a> Anker SD, Morley JE, von Haehling S, et al. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle. 2026;7(5):512–514.</p> <p>The post <a href="https://www.goldsteinmd.com/blog/osteoporosis-poor-bone-health-and-fragility-fractures">The Burden of Osteoporosis, Poor Bone Health, and Fragility Fractures – Dr Steven R. Goldstein</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/osteoporosis-poor-bone-health-and-fragility-fractures/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Update from World Congress of the International Menopause Society</title> <link>https://www.goldsteinmd.com/blog/update-from-world-congress-of-the-international-menopause-society</link> <comments>https://www.goldsteinmd.com/blog/update-from-world-congress-of-the-international-menopause-society#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Thu, 03 Nov 2022 19:15:27 +0000</pubDate> <category><![CDATA[Bone Health]]></category> <category><![CDATA[Menopause/Perimenopause]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=5438</guid> <description><![CDATA[<p>To my patients, I am writing this email blast from Lisbon, Portugal where the 18th World Congress of the International Menopause Society has just concluded. As many of you know, I have been the president of this society for the last two years and this meeting was the culmination of that term. There were over … <a href="https://www.goldsteinmd.com/blog/update-from-world-congress-of-the-international-menopause-society" class="more-link">Continue reading<span class="screen-reader-text"> "Update from World Congress of the International Menopause Society"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/update-from-world-congress-of-the-international-menopause-society">Update from World Congress of the International Menopause Society</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>To my patients,</p> <p>I am writing this email blast from Lisbon, Portugal where the 18th World Congress of the <a href="https://www.imsociety.org/" target="_blank" rel="noopener">International Menopause Society</a> has just concluded. As many of you know, I have been the president of this society for the last two years and this meeting was the culmination of that term. There were over 1,700 healthcare providers from 76 countries, 183 invited speakers with dozens of scientific sessions, debates, “meet the expert” sessions, and over 200 oral or poster communications. I was honored to deliver the Presidential Lecture. I highlighted the history of the role of vaginal ultrasound in menopausal and perimenopausal patients of which I was the first to suggest its utility, for instance, in measuring the lining of the uterus in patients with abnormal bleeding, sonohysterograms, that is putting fluid into the uterus to see the lining better, and using ultrasound and color Doppler blood flow to allow us to leave benign ovarian cysts alone without surgery, just to name a few. I also delivered a “meet the expert” session on SERMs (selective estrogen receptor modulators) something I have spoken to many of you about.</p> <p>The presentations involved all aspects of midlife women’s health before, during, and after <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/">menopause</a>. There are important new areas a few of which I share here: Duavee, the combination of estrogen and a SERM will be shipping again January 1. Although the FDA is allowed to take up to six months to reapprove it, all efforts are being made to expedite this. Secondly, the role of <a href="https://www.goldsteinmd.com/conditions/osteoporosis-specialist-nyc-menopause-bone-loss/">muscle and bone health</a> – preventing the muscle wasting of sarcopenia, something I have talked to so many of you about, has finally made its way into these scientific sessions; and, finally, a new drug to treat hot flashes known as an NK3 receptor antagonist is likely to gain approval in February. While this will not offer the benefits of HRT to bone or vagina, it is an important addition especially for breast cancer survivors and patients who have experienced blood clots and cannot take estrogen regardless of the severity of their hot flashes or night sweats.</p> <p>Hearing all the science from all over the globe was stimulating and exciting. Also exhausting, especially as the president with all the ceremonious responsibilities that went along with it. I learned being asked to pose for a “selfie” is the 2022 equivalent of being asked for an autograph! I am ready to use all that I know as well as all that I learned to benefit all of you.</p> <p>Yours in Health,</p> <p>Dr Goldstein</p> <p> </p> <p>The post <a href="https://www.goldsteinmd.com/blog/update-from-world-congress-of-the-international-menopause-society">Update from World Congress of the International Menopause Society</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/update-from-world-congress-of-the-international-menopause-society/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Commentary on a NY Times article on Menopause</title> <link>https://www.goldsteinmd.com/blog/commentary-on-a-ny-times-article-on-menopause</link> <comments>https://www.goldsteinmd.com/blog/commentary-on-a-ny-times-article-on-menopause#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Tue, 08 Oct 2019 14:26:59 +0000</pubDate> <category><![CDATA[Menopause/Perimenopause]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=2718</guid> <description><![CDATA[<p>To my patients, In a recent Sunday New York Times there was an article entitled, “Why do we dread menopause” by a professor named Susan Mattern from the University of Georgia. In the article “why do we dread menopause” she highlights that if you Google search “menopause and…” you come up with a whole assortment … <a href="https://www.goldsteinmd.com/blog/commentary-on-a-ny-times-article-on-menopause" class="more-link">Continue reading<span class="screen-reader-text"> "Commentary on a NY Times article on Menopause"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/commentary-on-a-ny-times-article-on-menopause">Commentary on a NY Times article on Menopause</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[ <p>To my patients,</p> <p>In a recent Sunday New York Times there was an article entitled, “<a href="https://www.nytimes.com/2019/09/12/opinion/sunday/menopause-symptoms.html" target="_blank" rel="noopener">Why do we dread menopause</a>” by a professor named Susan Mattern from the University of Georgia.</p> <p>In the article “why do we dread menopause” she highlights that if you Google search “menopause and…” you come up with a whole assortment of very negative symptoms like weight gain, depression, hair loss, etc. She goes on to state that such a bleak view of menopause is unique to only modern cultures. She goes into great length about the history of how menopause was defined in ancient times and has come to be known as a medical issue only in relatively more modern times. She describes the importance of women after their reproductive life to the family unit, often allowing care of younger children as a grandparent so that the parent will be free to occupy other important roles in the extended as well as nuclear family unit.</p> <figure id="attachment_5555" aria-describedby="caption-attachment-5555" style="width: 269px" class="wp-caption aligncenter"><img loading="lazy" decoding="async" class="size-medium wp-image-5555" src="https://www.goldsteinmd.com/wp-content/uploads/2023/01/Menopause-Specialist-in-NYC-269x300.png" alt="Menopause Specialist in NYC for symptoms of menopause" width="269" height="300" srcset="https://www.goldsteinmd.com/wp-content/uploads/2023/01/Menopause-Specialist-in-NYC-269x300.png 269w, https://www.goldsteinmd.com/wp-content/uploads/2023/01/Menopause-Specialist-in-NYC.png 530w" sizes="auto, (max-width: 269px) 85vw, 269px" /><figcaption id="caption-attachment-5555" class="wp-caption-text">Menopause Specialist in NYC can help you cope with the symptoms of menopause</figcaption></figure> <p>I could not agree more with such an assessment and hope that all of you realize that I value women in their post reproductive state and the contributions they make to their families, to our communities and society in general.</p> <p>At the same time, these days many people seem to be obsessed with the concept of anti-aging. Anti-aging doctors have been giving bio identical hormones and other non-tested, non-approved substances as patients search for an antidote to aging. Ponce de Leon left Spain more than 600 years ago in search of the fountain of youth. People are still looking. The key, in my opinion, is healthy aging not anti-aging.</p> <p>My problem with this excellent article in Sunday’s New York Times is that it does not acknowledge the very real medical issues that accompany estrogen deprivation after there is no more ovarian function (the medical definition of menopause). Other higher order primates live a very short time after they stop reproducing. My patients will spend more than 40% of their lives in a post reproductive state.</p> <p>There are very real consequences medically of the lack of estrogen production that <a href="https://www.goldsteinmd.com/menopausal-changes-that-dont-have-to-be/">menopause</a> brings. Loss of bone mass occurs quite rapidly, and osteoporotic fractures are a significant medical issue as the population ages more and more. A 50-year-old woman who does not already have cancer or heart disease has a life expectancy of 91. If a woman suffers a hip fracture her chances of being dead within the next year are 20–30% and she has a 25% chance of never living independently again.</p> <p>There are also serious changes in the vagina as a result of a lack of estrogen. A change in the normal bacteria causes diminished production of lactic acid and thus the pH will change dramatically, as does the cell count. This leads to dryness and lack of normal lubrication which, in patients who are sexually active, can result in severe discomfort. Almost all of you are aware of the symptoms of <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/">hot flashes and night sweats</a>, the most common of the menopausal transition. Fortunately, for the majority of women, these will ameliorate by 4–5 years, although some women will have these indefinitely. In addition, lack of estrogen can result in joint pains.</p> <p>After the Women’s Health Initiative published its findings in 2002 showing that estrogen plus progesterone therapy caused an increase in <a href="https://www.goldsteinmd.com/regarding-an-article-in-the-ny-times-on-reducing-breast-cancer-threat/">breast cancer</a> and heart disease, 50% of women stopped their hormones immediately but 25% went back on. The most common reason for resuming was hot flashes and night sweats as you would think. The second most common reason was joint pains. Furthermore, menopause, with its lack of estrogen, on average causes an increase of 15 -20% in total cholesterol and LDL cholesterol (the bad cholesterol). In addition, estrogen helps promote lean body mass and after menopause women tend to accumulate more fat centrally (that old “midriff bulge”).</p> <p>I am not trying to medicalize menopause. However, we cannot ignore the effects of estrogen deprivation on a variety of organ systems especially as women are living longer and longer. There are new approaches to replacing estrogen without the use of progesterone. As evidenced by the Women’s Health Initiative, it is the addition of progesterone in order to protect the uterus that seems to be the culprit in causing most of the negative findings. These new approaches are, in my opinion, much safer than what we’ve done for the past half century. They involve combining the estrogen Premarin with a different category of drug than progesterone. That category is SERM (selective estrogen receptor modulator). There are a number of SERMs already on the market for breast cancer prevention and prevention and treatment of osteoporosis. </p> <p>In summary, yes menopause can and should be a time of healthy aging and continued productivity and personal satisfaction indefinitely. The pros and cons of replacing estrogen need to be individualized and discussed on a case by case basis. </p> <p>If you or anyone you know would benefit from this knowledge, please share this with them. </p> <p>Dr Steven R. Goldstein is a Past President of the International Menopause Society, past President of the North American Menopause Society, a Certified Menopause Practitioner and a <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/">Menopause Specialist in NYC</a> .</p> <p>The post <a href="https://www.goldsteinmd.com/blog/commentary-on-a-ny-times-article-on-menopause">Commentary on a NY Times article on Menopause</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/commentary-on-a-ny-times-article-on-menopause/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Menopausal changes that don’t have to be</title> <link>https://www.goldsteinmd.com/blog/menopausal-changes-that-dont-have-to-be</link> <comments>https://www.goldsteinmd.com/blog/menopausal-changes-that-dont-have-to-be#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Wed, 12 Sep 2018 13:58:57 +0000</pubDate> <category><![CDATA[Menopause/Perimenopause]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=2525</guid> <description><![CDATA[<p>Menopausal changes that don’t have to be In last Tuesday’s 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 … <a href="https://www.goldsteinmd.com/blog/menopausal-changes-that-dont-have-to-be" class="more-link">Continue reading<span class="screen-reader-text"> "Menopausal changes that don’t have to be"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/menopausal-changes-that-dont-have-to-be">Menopausal changes that don’t have to be</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p><strong>Menopausal changes that don’t have to be</strong></p> <p>In last Tuesday’s Science Times there was an article entitled, “Menopausal vagina monologues.” It was an excellent article talking about the fact that without any estrogen in<a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/"> menopause</a> 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.</p> <p>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.</p> <p>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 <u>not absorbed</u> 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 <a href="http://r20.rs6.net/tn.jsp?f=001V-wSkKKM7xKIN_9BU02oY8IZlZKyIVvlICyilgXYP39hHuZhkJCNCOMgoRFsShcG3fkvXYCgGWyL8bN_7gSEOM_4g_8GHkxmIRm7qD1lVqtoYPX-lELFrb3AivthmfR-dC18zUGw3ZKPMi0I9m0fXO4A8O33pB-WCWOE5BN80Gc1QldmuLCUHxX6gVkeTEyyeESmPZHmvguh1SmXqXlkWQ==&c=AA6k4hqfEtxYsD67ARVAWv64sBWIkC4SgxlwrDP6xTcD-qyd9GTX7g==&ch=TznC6YA0n9-KWCDMIGLqJA9ILsrhJoh7vCI_atvsRtpwpCwC_bKrog==">(link to editorial)</a> and petition the FDA to modify that label and its unnecessary frightening warnings. They have not budged.</p> <p>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.</p> <p>If you or anyone you know suffers from painful intercourse of <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/">menopause</a> due to vaginal dryness and atrophy, please share this information with them.</p> <p>I remain yours in health</p> <p>Dr. Goldstein</p> <p> </p> <p>The post <a href="https://www.goldsteinmd.com/blog/menopausal-changes-that-dont-have-to-be">Menopausal changes that don’t have to be</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/menopausal-changes-that-dont-have-to-be/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Still More News About Maintaining Bone Health</title> <link>https://www.goldsteinmd.com/blog/still-more-news-about-maintaining-bone-health</link> <comments>https://www.goldsteinmd.com/blog/still-more-news-about-maintaining-bone-health#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Tue, 13 Feb 2018 15:47:33 +0000</pubDate> <category><![CDATA[Menopause/Perimenopause]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=2240</guid> <description><![CDATA[<p>Maintaining Bone Health In today’s New York Times Science Section, there is an excellent article by Jane Brody entitled, “Fear of Drugs’ Hazards may Put Bones at Risk.” She reiterates a problem that I have seen evolving in clinical practice over the last several years. As the reimbursement for performing bone density tests had gotten … <a href="https://www.goldsteinmd.com/blog/still-more-news-about-maintaining-bone-health" class="more-link">Continue reading<span class="screen-reader-text"> "Still More News About Maintaining Bone Health"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/still-more-news-about-maintaining-bone-health">Still More News About Maintaining Bone Health</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p><strong>Maintaining Bone Health</strong></p> <p>In today’s New York Times Science Section, there is an excellent article by Jane Brody entitled, “Fear of Drugs’ Hazards may Put Bones at Risk.” She reiterates a problem that I have seen evolving in clinical practice over the last several years. As the reimbursement for performing bone density tests had gotten so low that many facilities (including ours) could not stay open without losing money, the number of bone density tests being ordered nationwide has declined sharply.</p> <p>In addition, the category of medications for preventing and treating osteoporosis known as bisphosphonates, of which the most well known is Fosamax, have come under scrutiny for a very small incidence of some untoward, rare complications that have been overly publicized. These include one called osteonecrosis of the jaw that has put fear into patients as well as dentists. It virtually never happens except for people who have received intravenous bisphosphonate or who are immunocompromised or have a malignancy. In addition, even rarer, are the atypical fractures of the femur that can occur. Both of these complications pale compared to the number of hip fractures that are prevented in women who do take bone health drugs when they are clinically indicated.</p> <p>The data in Ms. Brody’s article talks about the fact that there was a steady decline in hip fracture in women over the age of 65 from 2002 until 2012. However, in approximately 2012, that reduction abruptly ended and has not continued as one would hope.</p> <p>It is said that a 50-year-old woman who does not already have cancer or heart disease, has a life expectancy of 91. As women are living longer and longer, issues of maintaining bone health become extremely important. A woman who does suffer a hip fracture has a 20-30% chance of being dead within one year. In addition, about 50% of patients who fracture their hip are not able to ambulate without assistance and 25% may end up in long-term care facilities. Each year, there are more osteoporotic fractures (hip and spine) than all of the heart attacks, strokes, breast cancers, and gynecologic cancers COMBINED.</p> <p>As many of you know, I have been extremely interested in <a href="https://www.goldsteinmd.com/conditions/osteoporosis-specialist-nyc-menopause-bone-loss/">bone health</a>. I write the annual “Update on Bone Health and Osteoporosis,” for OBG Management Journal, of which, I am on the Editorial Board. I am constantly talking to my patients about bone density testing, if indicated, as well as fall prevention (balance exercises, non-skid rugs in the bathroom, nothing between your bed and bathroom in the middle of the night to trip on, etc.). In addition, adequate calcium in your diet (as opposed to supplements) and a supplement of vitamin D are also extremely important.</p> <p>Next time you are in, if you have any concerns about maintaining bone health or related issues, let’s have a conversation.</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 was the Co-Directory of Bone Densitometry and Body Composition at NYU Langone Medical Center from 1997 to 2016</p> <p>The post <a href="https://www.goldsteinmd.com/blog/still-more-news-about-maintaining-bone-health">Still More News About Maintaining Bone Health</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/still-more-news-about-maintaining-bone-health/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Researchers track an unlikely culprit in weight gain</title> <link>https://www.goldsteinmd.com/blog/researchers-track-an-unlikely-culprit-in-weight-gain</link> <comments>https://www.goldsteinmd.com/blog/researchers-track-an-unlikely-culprit-in-weight-gain#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Wed, 09 Aug 2017 17:03:21 +0000</pubDate> <category><![CDATA[Menopause/Perimenopause]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=2214</guid> <description><![CDATA[<p>In yesterday’s 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 … <a href="https://www.goldsteinmd.com/blog/researchers-track-an-unlikely-culprit-in-weight-gain" class="more-link">Continue reading<span class="screen-reader-text"> "Researchers track an unlikely culprit in weight gain"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/researchers-track-an-unlikely-culprit-in-weight-gain">Researchers track an unlikely culprit in weight gain</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>In yesterday’s 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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>Fortunately, many of you have heard me speak of a new paradigm for delivering HRT (hormone replacement therapy) 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.”</p> <p>Dr Steven R. Goldstein is a past President of the International Menopause Society and a Certified Menopause Practitioner. As a <a href="https://www.goldsteinmd.com/services/female-hormone-replacement-therapy-nyc/" target="_blank" rel="noopener">HRT specialist NYC</a> he has helped thousands of women cope with the symptoms of Menopause </p> <p>The post <a href="https://www.goldsteinmd.com/blog/researchers-track-an-unlikely-culprit-in-weight-gain">Researchers track an unlikely culprit in weight gain</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/researchers-track-an-unlikely-culprit-in-weight-gain/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Calcium and Atherosclerosis</title> <link>https://www.goldsteinmd.com/blog/calcium-and-atherosclerosis</link> <comments>https://www.goldsteinmd.com/blog/calcium-and-atherosclerosis#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Thu, 05 Jan 2017 16:17:16 +0000</pubDate> <category><![CDATA[Menopause/Perimenopause]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=2194</guid> <description><![CDATA[<p>This is the current issue of the journal OBG Management and, as you can see, the cover story is by Dr. Goldstein. It is an update in bone health specifically addressing calcium supplements and their role in cardiovascular disease. In 2001 a National Institutes of Health (NIH) consensus panel on osteoporosis concluded that calcium intake … <a href="https://www.goldsteinmd.com/blog/calcium-and-atherosclerosis" class="more-link">Continue reading<span class="screen-reader-text"> "Calcium and Atherosclerosis"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/calcium-and-atherosclerosis">Calcium and Atherosclerosis</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>This is the current issue of the journal OBG Management and, as you can see, the cover story is by Dr. Goldstein. It is an update in bone health specifically addressing calcium supplements and their role in cardiovascular disease.</p> <p>In 2001 a National Institutes of Health (NIH) consensus panel on osteoporosis concluded that calcium intake is indeed crucial to maintain bone mass and should be maintained at 1,000-1,500 mg/day in older adults. That panel felt that the majority of older adults were not meeting recommended intake from dietary sources and, therefore, recommended calcium supplements. It is well known that calcium supplements are one of the most commonly used dietary supplements in America. Various surveys have shown that they are used by the majority of older women in the United States.</p> <p>More recently, however, large, randomized placebo-controlled trials (the gold standard of clinical research) involving calcium supplements have demonstrated some concerns about their safety as well as their efficiency in possible fracture prevention. Several studies over the last few years have suggested that calcium supplements can increase the risk of kidney stones as well as cardiovascular events in healthy older women. It is important to note that not all research has shown these detrimental effects of calcium supplementation but none of them has shown a positive benefit.</p> <p>Thus, many of you are aware and I have spoken to many of my patients as well, about the importance of trying to obtain adequate calcium (I recommend 1,200 mg/day) from dietary sources. I have attached a list of foods and the amount of calcium contained within those various foods. </p> <p><a href="http://files.constantcontact.com/07e149ec501/6ab97ea4-10f5-43b6-b5d3-f36bf7ba5c43.pdf" target="_blank" rel="noopener">FOODS AND THEIR CALCIUM CONTENT</a></p> <p>My other problem with calcium supplements is that</p> <p>1) they are often extremely constipating</p> <p>2) they do not deliver the amount of elemental calcium listed on the label. For instance, calcium supplements have elemental calcium that is bound to a negative ion (the medical term for this is “salt”). Thus, calcium oxalate in Oscal or calcium citrate in Citrical have the calcium bound to oxalate or the calcium bound to citrate. When it dissolves into your blood stream, the amount of elemental calcium is, at best, forty percent of what is on the label. Thus, a 500 mg Oscal will give you, at best, 200 mg of elemental calcium.</p> <p>This cover story article that I have written for OBG Management entitled, “Calcium and Atherosclerosis?” reviews several more recent studies that indicated that women who took calcium supplementation had higher calcium artery calcification (CAC scores) on CT scan. This is a surrogate marker that is felt to represent risk for heart disease. Women on calcium supplementation also manifested higher small increases in blood pressure compared to women who obtained their calcium from diet alone.</p> <p>Most recently the United States Preventative Services Taskforce recommended against calcium supplements for the primary prevention of fractures in postmenopausal women (unless they were institutionalized). I realize that when contradictory information comes out many patients lose faith in the medical establishment, in general. This is indeed unfortunate. Realize that changes that are then promulgated in the media are often the result of an increase in our understanding of the science.</p> <p>Indulge me for a moment and understand the evolution of lipids (better known as cholesterol). In 1959 when my father had his first heart attack, they barely understood the importance of saturated fats and cholesterol as a molecule. This was three years before even the President’s Council on Physical Fitness was developed. In those days, heart attack victims were told to, “not eat red meat and substitute blue fish,” as well as not to exercise for fear of, “stressing their heart.” The understanding about cholesterol then divided into HDL (the good) and LDL (the bad) came along next. For quite some time it was felt that the higher your good cholesterol the better. Later, people often looked at the ratio between good and bad cholesterol. More recently, the science has indicated that the most important factor is how low is your bad cholesterol. It cannot be too low from a risk point of view. Such changes in opinion are simply the function of more scientific knowledge and a better understanding of physiology.</p> <p>Thus, do not be disheartened that in 2001, women were told to take calcium supplements and now in 2017, we are telling women to get their calcium from their diet and not from supplementation. It is simply better knowledge. And while we’re at it, don’t forget you need 1,000-2,000 IU/day of vitamin D. I advise that as a supplement since most vitamin D comes from sunlight and we have ruined the ozone layer and if you do go out in the sun, you will be wearing SPF for protection against skin cancers.</p> <p>Dr Steven R. Goldstein<br /> <a href="https://www.goldsteinmd.com/conditions/osteoporosis-specialist-nyc-menopause-bone-loss/" target="_blank" rel="noopener">Osteoporosis Specialist NYC</a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/calcium-and-atherosclerosis">Calcium and Atherosclerosis</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/calcium-and-atherosclerosis/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Dr. Goldstein receives Prestigious Clarkson Award</title> <link>https://www.goldsteinmd.com/blog/dr-goldstein-receives-prestigious-clarkson-award</link> <comments>https://www.goldsteinmd.com/blog/dr-goldstein-receives-prestigious-clarkson-award#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Fri, 26 Aug 2016 19:27:50 +0000</pubDate> <category><![CDATA[Menopause/Perimenopause]]></category> <category><![CDATA[clarion award]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1864</guid> <description><![CDATA[<p>Dr. Steven R. Goldstein, Menopause Specialist NYC, is the recipient of the North American Menopause Society’s 2016 Thomas B. Clarkson Award. The award is for life time achievement in menopause research and is mainly related to his work in transvaginal ultrasound and SERMs (the estrogen alternative). Click on the link below to view the Society’s … <a href="https://www.goldsteinmd.com/blog/dr-goldstein-receives-prestigious-clarkson-award" class="more-link">Continue reading<span class="screen-reader-text"> "Dr. Goldstein receives Prestigious Clarkson Award"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/dr-goldstein-receives-prestigious-clarkson-award">Dr. Goldstein receives Prestigious Clarkson Award</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>Dr. Steven R. Goldstein, <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">Menopause Specialist NYC</a>, is the recipient of the North American Menopause Society’s 2016 Thomas B. Clarkson Award. The award is for life time achievement in menopause research and is mainly related to his work in transvaginal ultrasound and SERMs (the estrogen alternative). Click on the link below to view the Society’s announcement of their awards.</p> <p><a class="common-btn" href="https://www.menopause.org/annual-meetings/2016-meeting/award-scholarship-recipients" target="_blank" rel="noopener">NAMS Prestigious Thomas B Clarkson Award</a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/dr-goldstein-receives-prestigious-clarkson-award">Dr. Goldstein receives Prestigious Clarkson Award</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-prestigious-clarkson-award/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Improving Sexual Comfort in Menopausal Patients</title> <link>https://www.goldsteinmd.com/blog/improving-sexual-comfort-in-menopausal-patients</link> <comments>https://www.goldsteinmd.com/blog/improving-sexual-comfort-in-menopausal-patients#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Tue, 23 Apr 2013 18:31:48 +0000</pubDate> <category><![CDATA[Menopause/Perimenopause]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1713</guid> <description><![CDATA[<p>03/05/2013 This past week there has been a lot of news emanating from the FDA that concerns menopausal and perimenopausal women. I would like to share some of this with you. A week ago the FDA, without using an Advisory Panel of outside experts, approved Ophena (generic name Ospemifene) for “treatment of moderate to severe … <a href="https://www.goldsteinmd.com/blog/improving-sexual-comfort-in-menopausal-patients" class="more-link">Continue reading<span class="screen-reader-text"> "Improving Sexual Comfort in Menopausal Patients"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/improving-sexual-comfort-in-menopausal-patients">Improving Sexual Comfort in Menopausal Patients</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p style="text-align: right;"><span style="color: #000000;"><strong>03/05/2013</strong></span></p> <p><span style="color: #000000;"><strong>This past week there has been a lot of news emanating from the FDA that concerns <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/">menopausal and perimenopausal</a> women. I would like to share some of this with you.</strong></span></p> <p><span style="color: #000000;"><strong>A week ago the FDA, without using an Advisory Panel of outside experts, approved Ophena (generic name Ospemifene) for “treatment of moderate to severe dyspareunia (medical term for painful intercourse) a symptom of vulvar and vaginal atrophy due to menopause (the vaginal changes seen with no more estrogen production)”. This is extremely important for women. Previously there had been no FDA approved non estrogen agent whether local or systemic for such an indication. Ophena is a SERM (selective estrogen receptor modulator). Other SERMs for other applications include Evista (for osteoporosis and breast cancer prevention) and Tamoxifen (for breast cancer patients and breast cancer prevention). The FDA decided to include language in the boxed warming for Ophena in which they state “in the endometrium (uterine lining) Ophena has estrogenic effects. There is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogen”. I am somewhat disappointed and almost shocked at this statement. I was involved in the studies of uterine safety for a number of SERM compounds. This drug is similar to raloxifene, which has been proven to be extremely safe in the uterus. The FDA has labeled this drug like estrogen which by itself can be a problem in the uterine lining. This is not appropriate nor is it borne out by the data for Ophena. I’ve been asked to write an editorial for the journal <span style="text-decoration: underline;">Menopause</span> and have explained this with scientific backup and appropriate references.</strong></span></p> <p><span style="color: #000000;"><strong>Furthermore the labeling for Ophena states that it has “not been adequately studied with breast cancer therefore should not be used in women with known or suspected breast cancer or with a history of breast cancer”. This borders on unbelievable. While I agree with the first part of that statement, that there are not yet adequate studies, every SERM adequately studied thus far has a <span style="text-decoration: underline;">reduced</span> breast cancer risk, and <span style="text-decoration: underline;">none</span> of the others have suggested <span style="text-decoration: underline;">any </span>harm in the breast. As a clinician there is a large unmet need for an agent to treat painful intercourse due to vaginal dryness and atrophy in women who cannot, should not, or will not use estrogen products; and this is exactly those with a history of breast cancer or at high risk for breast cancer. In my opinion this is the ideal group for such a new agent as Ophena. Based on class labeling a statement about not using it in such patients is in my opinion unfair and not appropriate.</strong></span></p> <p><span style="color: #000000;"><strong>OTHER NEWS</strong></span></p> <p><span style="color: #000000;"><strong>Yesterday, an advisory panel of the FDA recommended against approval of two non-hormonal drugs specifically designed to treat vasomotor symptoms (hot flashes, night sweats). Both of these have been around in other forms for quite some time and many of my patients use them, especially gabapentin (also known as Neurontin). One of the reasons they advised against approval was apparently because they claim the medications are already available (although its use is “off label”). The new form was a sustained release version, instead of needing to take up to 3 to 4 doses per day. This underscores the conundrum of our current system. Some physicians, like myself, who follow the scientific literature closely, are aware of its utility. For some of my patients this medication has been a Godsend. However, most physicians do not follow the scientific literature so closely. They rely on marketing and publicity to inform them of new developments. Without FDA approval, and “on label” marketing, most physicians are not aware of the existence of this application for gabapentin. The other drug not approved is a lower dose of Paxil, the antidepressant. The use of ½ strength antidepressants for hot flashes has been tested and became popular initially in breast cancer patients on tamoxifen who obviously cannot take estrogen for hot flashes or night sweats. Once again, however, most physicians are not aware of this and only with FDA approval would publicity and marketing be possible.</strong></span></p> <p><span style="color: #000000;"><strong>I am disappointed by much of the above posture of the FDA. As always I will stay on top of scientific developments in an attempt to deliver world class gynecologic care based on science not politics.</strong></span></p> <p>The post <a href="https://www.goldsteinmd.com/blog/improving-sexual-comfort-in-menopausal-patients">Improving Sexual Comfort in Menopausal Patients</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/improving-sexual-comfort-in-menopausal-patients/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> </channel> </rss>