Steven R Goldstein MD is a NYC Obstetrician and Gynecologist, author, professor at NYU and inventor of the Goldstein Catheter.

There are many misconceptions about 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. 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. 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. They 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. 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.

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. 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. 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. 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.

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Menopause and Perimenopause

Menopause Menopausal women often have many questions, ranging from the signs and symptoms, treatment options and emotional support. Dr. Steven R. Goldstein, a widely renowned menopause expert, works closely with many women to educate them on the changes happening in their bodies, identify possible ...

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Abnormal Uterine Bleeding

Abnormal Uterine Bleeding Many women experience what they perceive as abnormal uterine bleeding at least once in their lives. Women in their 20s and early 30s often have unusual bleeding due to a hormonal imbalance. Abnormal uterine bleeding becomes more common as women near menopause. However, con...

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Gynecologic Ultrasounds

The Use of Ultrasounds to Diagnose Thick Uterine Lining, Abnormal Uterine Bleeding and Ovarian Cysts Ultrasound is an important tool to determine if surgery is truly necessary for women who have been diagnosed with a thick uterine lining (post-menopausal), abnormal uterine bleeding (pre and post-m...

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Pap Smear Screening

Pap Smear A Pap smear (or Pap test), is a routine exam that checks for changes in the cells of the cervix. Pap smears are the best tool to identify abnormal, pre-cancerous or cancerous cells and provide immediate and effective treatment. We now understand that abnormal cervical cells are related t...

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Cancer Screenings

Gynecological Cancer Screenings Dr. Goldstein provides several different types of gynecological cancer screenings to his patients, including ovarian and cervical cancer. Ovarian Cancer Ovarian cancer is the fifth most common cancer among women, according to the U.S. Library of National Medicine. ...

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