Social Icons:
Doctor Steven R. Goldstein MD is considered a top perimenopause specialist in New York and across the nation. He has extensive experience working with menopausal and perimenopausal women. He has authored two books on Perimenopause and Menopause, one of them titled “Could it be…..Perimenopause?”. A Certified Menopause Practitioner, Dr. Goldstein is also a Past President of the International Menopause Society and a past President of the North American Menopause Society (NAMS).
You may have been told that taking hormone replacement therapy (HRT) is a cure all for Perimenopause.
Simply giving traditional hormone replacement therapy such as estrogen patches and progesterone pills, or progesterone IUDs (as many nurse practitioners, physician assistants, women’s health internists who are new to this field are doing) may relieve hot flashes and night sweats, but can often exacerbate abnormalities in bleeding and does nothing for other perimenopausal symptoms such as brain fog, inability to concentrate, free floating anxiety, mood changes, memory issues, sleep problems, etc.
Schedule a consultation with Dr Steven R. Goldstein, an expert on the science of Perimenopause, for an examination, evaluation and proper treatment if you have Perimenopause.
The only thing predictable about Perimenopause is that it is unpredictable. And confusing. Perimenopause is one of the least understood, most misdiagnosed, and most confounding stages in a woman’s life. The perimenopausal process is highly individualized , with great variation from woman to woman. Perimenopause is about a distinct stage with symptoms and realities of its own that responds to specialized health care strategies. Which is why you need to see an expert and not rely on virtual consultations and their prescriptions. Perimenopause is not “one size fits all”.
Dr Goldstein is one of the world’s top experts on the science of Perimenopause and has helped thousands of women deal with it in over 35 years of practice.
Dr Goldstein has compiled a list of questions that patients have asked over the years regarding Perimenopause. This will be helpful to you as you seek to learn more about this stage of life.
Perimenopause is the transition into menopause when a woman’s body begins to slow the production of hormones.
If you are a woman in your late thirties or forties and are experiencing irregular periods, occasional hot flashes, mood swings, free floating anxiety, memory lapses, inability to concentrate, and sleep disturbances to list a few, it is not all in your head and you are not alone. You may be experiencing Perimenopause.
Unlike menopause which can be strictly defined and proven with laboratory tests, perimenopause has more fluctuation and is actually defined as “irregularly irregular” hormone levels. Perimenopause describes the changes that can occur in a woman long before actual menopause. It is not necessarily diagnosed with laboratory tests due to fluctuating hormonal levels which vary greatly from woman to woman.
Some of the symptoms of Perimenopause are:
Yes, Perimenopause can cause irregular periods or spotting. This is because in Perimenopause, regular ovulation and cycles are less likely. When a woman doesn’t ovulate, no progesterone is produced.
Why does this matter? It does because cycles when women do not ovulate are characterized by variable amounts of estrogen production without progesterone to balance it. This “imbalance” isn’t dangerous (although it can be in the case of unopposed estrogen for very long periods of time, which is unusual), but it is the basis of a host of symptoms that appear to be totally unrelated to the woman’s menstrual cycle – occasional hot flashes, sleep problems, free floating anxiety, memory lapses and “foggy memory”, inability to concentrate, feeling depressed at times, worsening PMS, and so on.
Secondly, this condition of estrogen without progesterone to balance it (which occurs during Perimenopause) can result in these other symptoms as well such as Salt and Fluid retention, Low blood sugar levels, blood clotting, fibroid tumor enhancement, altered thyroid hormone function (leading to weight gain or feelings of exhaustion), increased production of body fat, feelings of sluggishness and low energy.
To be clear, the above symptoms can be due to many factors, but the fact that it can be due to Perimenopause and hormonal factors is unfortunately not considered as much as it should be.
You can read more about spotting and bleeding during perimonopause in this blog article by Dr Goldstein – Perimenopausal bleeding or Spotting.
Yes. There are other symptoms also, many of which women will never associate with their menstrual cycle. Women may experience symptoms such as hunger that can’t be assuaged, days when she is not hopeful, optimistic or grounded, feelings of depression, lack of concentration, racing thoughts, anxiety, and more.As a Perimenopause Specialist in NYC, Dr. Goldstein has seen women visit internists, mental health professionals, neurologists, etc. for an answer to their symptoms only to find no answer until they wound up in his office for their exam..
It is essential to understand we are not talking about “early menopause”, which is why current books available on menopause don’t help and often confuse, depress or frighten younger women. Early menopause means that you stop menstruating completely for a period of at least twelve months, and that this occurs before the age of forty-five.
If you are a woman in your late thirties or forties and you are experiencing symptoms like those above you need to know that this is very likely not all in your head. There probably is something physical happening here. These symptoms may be related to destabilizing estrogen levels and a decrease in ovulation and you are entering into a stage known as Perimenopause, which begins about a decade before the onset of actual menopause.
Dr. Goldstein, a top rated Perimenopause Specialist in New York believes in offering individualized patient care. He will personally evaluate you from the beginning of your visit to the end. Please set aside at least an hour for your visit as you will not be rushed.
Transvaginal Ultrasounds to examine the endometrium (lining of the uterus or womb) are a must. The uterine lining is a biomarker for what is going on with the ovaries and must be evaluated prior to any treatment for perimenopause, menopause or post menopause. It tells a story. Dr Goldstein personally performs all Transvaginal ultrasounds. He is a pioneer in the field and one of the world’s best operators.
After your examination, dressed and seated in the office, Dr Goldstein will go over all your findings and possible treatment options if you have Perimenopause. It is important that an individualized treatment plan is developed from a process of shared decision making between you and Dr Goldstein.
Treating women in perimenopause with traditional HRT is a suboptimal approach by practitioners who do not understand the basic pathophysiology. The key to treatment, if there are no contraindications, is suppression of erratic ovarian function and substitution of a low amount of estrogen and progesterone all month long. This not only controls bleeding but will ameliorate any psychosocial symptoms that are hormonally related to perimenopause.
appointment request