Dr. Goldstein receives Prestigious Clarkson Award

Dr. Goldstein 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.

NAMS Prestigious Thomas B Clarkson Award


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Comment on front-page article entitled “Birth Control Via App Gains Quiet Foothold”

In yesterday’s New York Times there was a front-page article entitled “Birth Control Via App Gains Quiet Foothold”. I am compelled to comment.

I acknowledge that the problem of unintended pregnancy in this country is huge. It is estimated that as many as 50% of births are “unintended”, or I guess that means “unplanned.” Fortunately, that is not even close to true in my practice.
You see, guidelines are created as health policy and are intended for populations. I prefer healthcare that is individualized, one patient at a time, utilizing all factors such as previous personal history, family history, and my experience and knowledge to try to do what is best for that particular woman.

Birth control pills are an excellent example. Taking into account generics and varying doses and formulations, there must be close to 100 brands of birth control pills. When I choose a particular pill for my patient, I take into account optimal dosage, type of progesterone in it, typical side effects that I want to avoid (weight gain, breast tenderness, mood changes, inadequate bone growth in women under 30) as well as factors I want to correct (existing acne, menstrual irregularities, perimenopausal symptoms like mood swings memory changes, sleep disturbances, free-floating anxiety, etc.). When a pharmacist or a healthcare provider “prescribes” pills via an app, yes they will suppress ovulation and prevent pregnancy but they will not get the fine-tuning of minimizing side effects and maximizing the non-contraceptive benefits that I strive for.

As I’ve told so many of you, birth-control pills are actually cancer reducing agents. By suppressing ovulation there is good science that for every year you take birth control pills you reduce your risk of ovarian cancer 10%. The pill works by suppressing ovulation so the hormone in the pill is not on top of what you actually make it becomes instead of what you actually make. Thus it will actually lower hormone levels in perimenopausal women. Conversely, the lowest doses are too low for adolescents who are still growing their bone mass until age 30-35.

In addition, suppressing ovulation is closer to “natural” than allowing one to ovulate 13 lunar months in a calendar year. The reason ovarian, uterine, and even breast cancer are on the rise in modern industrialized nations is because women are having too many menstrual cycles.

Often, patients state that birth control pills are not “natural”
So what is natural? Left to nature, women would have eight children and have to nurse them all for 12 to 15 months (there are no bottles or formula in nature). Along the way they would probably have three miscarriages. So most women who have two children and nurse them for 3 to 6 months end up with 500 or so menstrual cycles. Nature expected that you would have no more than perhaps 250 cycles. Thus suppressing the cycle with birth control pills is closer to “natural” then simply ovulating month after month after month.

I hope this is helpful to you or someone close to you with whom you can share it.

I remain yours in health,
Steven R. Goldstein M.D.

I remain yours in health,

Dr. Goldstein


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Comment on New York Times article entitled “Bone drugs shunned for fear of side effects”

A recent New York Times article entitled “Bone drugs shunned for fear of side effects”, is an excellent article written by the well known medical writer Gina Kolata. This is important information for all of my patients whether they are already at the age where bone loss and risk of osteoporotic fracture is present or, if considerably younger, concerns about bone health for themselves or their loved ones should be still on their minds going forward.

By way of background statistics: more women in the United States will suffer and a serious fracture of hip or spine than all of the heart attacks, strokes, breast cancers, and gynecologic cancers COMBINED.Truly a staggering statistic!

Bone health and the risk of fracture from loss of bone after menopause is an important personal as well as a public health issue. It is said that a 50-year-old woman who doesn’t already have cancer or heart disease has a life expectancy of 91!! In the past when women didn’t live as long as they do now bone health and the concerns for us to prevent fracture were not as great in generations years ago. Thus maintaining bone health throughout one’s lifetime is crucial. It begins with what I call FAMS ( Flexibility Agility Mobility and Strength). There should be a lifelong adequate calcium ingestion ( preferably in one’s diet, rather than supplements) but also supplementation of 1000 to 2000 IU’s of Vitamin D per day. At the appropriate interval after menopause baseline Bone Density testing (DEXA scan) should be performed. Finally, it is tragic that so many women who WOULD benefit from drug therapy to reduce the risk of fracture shy away from appropriate therapy because of fear of very VERY rare side effects including the osteonecrosis of the jaw( abbreviated ONJ) and these atypical fractures of the femur which are exceedingly rare. As this article points out you only need to treat 50 people to prevent one osteoporotic fracture while fewer than one in 10,000 women on medication would be expected to have either the problem in the jaw (ONJ) or an atypical fractures. Women who do sustain a hip fracture have a 25% chance of not surviving one more year and a 20% chance of ending up in assisted-living. Another staggering statistic!
Obviously decisions about whether or not medications are appropriate, and if so, which are the best medications for any individual patient, must be made on a case-by-case basis. As I’ve told so many of you: guidelines are created for populations medicine should be practiced one patient at a time. If you have any concerns about your bone health or one of your relative’s bone health, feel free to contact our office. I would be happy to discuss this with you further.

Yours in health,
Dr Goldstein

I remain yours in health,

Dr. Goldstein


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