Low Dose Birth Control Pills

Misconceptions About Low Dose Birth Control Pills

From Dr Steven R. Goldstein, NYC Gyn

There are many misconceptions about Low Dose 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.

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.

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.

Who can low dose birth control pills help?

However, low dose birth control pills 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.

What about “natural” birth control?

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.

About Dr Steven R. Goldstein

Dr Steven R. Goldstein is a top NYC Gyn in private practice in New York City for over 25 years. He is a Professor of Obstetrics and Gynecology at New York University School of Medicine, a past President of the International Menopause Society, Certified Menopause Practitioner, and more. You can read more about him here