Enlightening Interview with the doctor that coined the term/ concept “peri-menopause” — Dr. Steven R. Goldstein

• Key-note speaker at the American College of Obstetricians and Gynecologists (ACOG) 62nd Annual Clinical Meeting in Chicago, IL April 2014 –
• Past President of North American Menopause Society
• Introduced the concept of “peri-menopause”
• Introduced the vaginal ultra-sound
• Set the standards for evaluation of the endometrium in aging women

A personal “chat” between Dr. Lindsey Berkson and Dr. Steven R. Goldstein – “Where medicine, especially FEMALE medicine, is headed.”
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I got lucky.

I got a call out of the blue. I was kindly asked me if I would like to interview Dr. Steven R. Goldstein, a professor of obstetrics and gynecology at New York University Langone Medical Center in New York City and the immediate past president of NAMS (North American Menopause Society) and write about it on my blog for you my readers.

I couldn’t turn that down.

Estrogen. My first question to Dr. Goldstein was what were his thoughts about how estrogen has been unjustly vilified. Dr. Goldstein agreed and said, “The estrogen-only arm of the WHI (Women’s Health Initiative, that study that got so many women and doctors frightened about estrogen) showed almost none of the harms that were seen with the estrogen-and-progesterone (synthetic progestin) arm.”

“However, that arm of WHI got very little attention”, he said, “and many younger women who could benefit from estrogen replacement therapy may not be getting it!”

That’s from the top, ladies. Listen.

Women missing out on HRT? “You need to look at an individual’s family history and personal history, and make the most intelligent decision about their menopause treatments,” he said. “There is no question that in general the harm that a lot of people associate with hormone replacement therapy is unfounded and overstated,” Goldstein said.

Bio-identical snake oil. There Dr. Goldstein and I parted ways, but just for a few minutes. He was much less supportive of so-called “bioidentical” hormonal therapies, which are made by compounding pharmacies and typically come from plant sources such as soy. “This is snake oil,” Goldstein said, adding that, in his opinion, most bioidenticals do not have the proper ingredients in the correct amount.

Dr. Goldstein has 7 books out. His specialty is peri-menopause. Dr. Goldstein was the first physician to identify this period of time before menopause. And, Dr. Goldstein revolutionized the use of the vaginal ultra sound in gynecologic practice.

It was a pleasure to hear Dr. Goldstein’s passionate feelings about practice and the old one-on-one of patient and doctor. How refreshing to hear that Dr. G does NOT use electronic records nor have a PA ask the initial questions. He is one of the last “hands on” docs and says that by the time he gets the answers to his questions, he has a real idea of what is going on with this woman in front of him. He calls himself a dinosaur. He believes, like I do, in the power of a thorough “intake”. And he laments, again like me, that medicine is moving toward more and more of a systems approach in which doctors no longer really “listen” to patients. Dr. Goldstein’s mentor always believed in his patients and passed this precious legacy on.

Dr. Goldstein has an impressive resume, including being Past President of The American institute of US Medicine, so he is at the pulse of medicine. Being surprisingly candid, which I greatly appreciated, Dr. G said, “I do not see an answer. I am pessimistic about medicine. Unless we create better algorithms (step-by-step approach to looking at answers for health issues), right now medicine is “one–size- fits-all” and that makes no sense what so ever but that’s what patients get.”

If a postmenopausal woman has bleeding, Dr. Goldstein has set the standards of how to evaluate her. His guidelines are supposed to help figure out accurately if she is bleeding due to a serious health issue, a hormonal issue, or what. He is the expert of the modern evaluation of the lining of the uterus, the endometrium.

But he is frustrated by how women are treated and he only sees it getting worse. Yes, ladies, we have all felt this, but here we are hearing it from the “top”, who is as frustrated as we are.

“If docs use data, age, weight, BMI, number of children, history of hypertension, diabetes, echo imaging and we treat the patient and not the algorithms, then the woman might save her uterus rather than have a hysterectomy she might not need,” shared Dr. G.

Dr. Goldstein feels he is losing the battle of “real medicine” and in 10 years all of the old Dr. Welby type true individual care will fade away, unless,” he says, “we construct better algorithms.”

Is that it? Or do we need more time, caring and sound science that is not run by patent medicine?

As you ladies well know, I am especially interested in 2-MEO (2-methoxyestradiol), the final metabolite of estrogen. It has the name estrogen in it because it came from the parent compound estrogen, but it is really is an anti-estrogen rinsing estrogen out of tissues so it doesn’t adversely bio-accumulate. It is an anti-proliferative and in this way would protect many of us against our endometrium’s’ growing “out of control” as well as being an anti-carcinogen. I am all about prevention, so why not take HRT with an anti-proliferative and get into less trouble down the road. So I have been adding this to my HRT for years. You all know I am a DES daughter and had breast cancer 20 years ago, and have been on HRT for 16 years and 2-MEO for 5 years. I am a proponent of this being added to the HRT of some women, to protect against possible issues down the road. It’s one of the reasons, in my mind, that the estrogen-only arm of the WHI was protective.

I asked Dr. G about his thoughts on this and he kindly said, “Next call, I’ll ask and learn from you.”

What a sweetheart of a smart, caring doc!

It was a pleasure to hear from one of the mover’s and shakers in women’s health, and listen to how his sees the path of female medicine unfolding. But his perspective of the horizon ahead unfortunately confirms all of our fears.

This conversation with Dr. Goldstein reminded me to remind you; no one will ever care about your health as much as you (and perhaps Dr. G). Develop a team of experts around you, ask, read, and live wisely to prevent as much disease as you can.