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