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 Sue:
What got you interested in perimenopause?
How much of your practice is dedicated to perimenopausal/menopausal women?
 Dr. Goldstein
I became interested in perimenopause as a result of my expertise in
ultrasound. I have been a pioneer in transvaginal
gynecologic ultrasound, having lectured to approximately one out of three
OB/GYN's in this country. In working out an algorithm to approach abnormal uterine bleeding
with transvaginal ultrasound and sonohysterography (a technique where a tablespoon of
sterile saline is instilled into the uterus through a plastic spaghetti–like
catheter), I published a paper in July 1997 on 433 perimenopausal women with any degree of
abnormal uterine bleeding. Seventy–nine percent of the time the bleeding was hormonal
and not from any anatomic cause such as polyps, fibroids, or pre–cancers.
When I listened to those patients, the floodgate of the
symptoms we have previously discussed was obvious. In addition when many of these
patients with "hormonal imbalance" where treated with ultra low dose birth
control pills the amount of improvement in many of these patients was significant.
Thus I stumbled onto this observation in the early 1990's and began to look for it.
Because women's health research has been notoriously
underserved and it was not until 1991 the Woman's Health Caucus got Congress to spend $600
million for the Woman's Health Initiative did this
begin to change. However, the Woman's Health Initiative will study mostly breast
cancer, heart disease, and osteoporosis as they should. No one ever died from a mood
swing. Thus I wrote this book Could it be... Perimenopause? because this
information needed to be brought directly to the consumer public. At this point more
than 80% of my practice is dedicated to perimenopausal/menopausal women.
Sue:
Can you contrast and delineate the uses for standard pelvic ultrasound versus
transvaginal ultrasound? Do you feel there should be a standardized schedule for transvaginal ultrasound for
ovarian cancer surveillance akin to the mammography schedule for breast cancer
surveillance?
Dr. Goldstein
Currently virtually all standard pelvic ultrasound is being done with the transvaginal probe.
We may do a quick scout look with the abdominal transducer just to get a feel for
any large masses but the beauty of the vaginal probe is that the high frequency and the
close proximity of the structures give us a degree of image magnification that is almost
like doing an ultrasound through a low power microscope. In my office ultrasound
with a vaginal probe is part of a standard exam. New equipment being introduced almost as we
speak will be to the ultrasound machine what the laptop is to the computer. Such
high quality portable hand–held devices will finally enable ultrasound to become part
of the standard exam in gynecology. After all the structures that one is trying to
palpate are in fact anatomic and objective. As more physicians are comfortable with
scanning in the pelvis and equipment becomes high quality, small, and operator friendly,
there is no doubt in my mind that students in the future will look at us and say,
"you used to feel without looking? How could you possibly know what the
patients had?"
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 Save a Life - Yours!
The role of fertility drugs & ovarian cancer.
by Sue Spataro, RN, BSN
Liz Tilberis, in her book No Time To Die, chronicles her 6 year battle
with ovarian cancer.  As
the editor of the fashion magazine Harper's Bazaar her book received much recognition; as
one of the few books about ovarian cancer it stands out. She illustrates the possible
connection between fertility drugs the increased chance of ovarian cancer. Her life could
have possibly been saved with the early use of a screening test that is ALREADY available
in most doctors offices but that most doctors will not tell you about and most insurance
companies will not pay for.
Find out more and save a life - YOURS!
 newly revised
for 2000!
Could It
Be...Perimenopause?
by Steven R.
Goldstein, Laurie
Ashner
 
 see the interview with Dr Goldstein
In clear, supportive prose, Goldstein offers no-baloney advice. "Today's
perimenopausal women has neither the time nor the patience to go through four to fifteen
years of symptoms without relief," he says. He fully delineates the roles of various
hormones, how to determine if you're in perimenopause or not, as well as how to treat the
various symptoms to gain control over your life.
The Estrogen Alternative:
What Every Woman Needs to Know About Hormone Replacement Therapy and Serms, the New
Estrogen Substitutes
click here to find out more
by Steven R. Goldstein, Laurie Ashner
 Most women know the benefits of
estrogen replacement after menopause: It reduces the risk of osteoporosis, heart disease,
even Alzheimer's disease. Many are still reluctant to take it, because it increases the
incidence of breast and uterine cancer. Find out more.
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