Steven R Goldstein, MD

07/24/2026

Vitamin D is discussed frequently, and for good reason. ☀️

If you’re supplementing, vitamin D3 is typically recommended. When we check blood levels, the sweet spot is usually between 30 and 50 in the units your lab uses. For most people, around 2,000 IU per day is enough to get there.

Vitamin D is essential because it helps your body use calcium properly to support bone health. Calcium and vitamin D alone don’t build bone, and they’re not treatments for osteoporosis, but without enough of them, even osteoporosis medications don’t work as well.

I once heard a lecture showing that nearly half of women on osteoporosis medications had insufficient vitamin D levels—not a deficiency, but still insufficient. That matters.

Vitamin D deficiency causes rickets in children and osteomalacia in adults, but insufficiency is different and much more common.

That’s why I generally recommend that all women be on vitamin D supplementation as part of their overall bone health plan.

As always, talk with your doctor about what’s right for you.

02/15/2026

02/12/2026

Birth control pills ≠ the scary headlines you remember 💊

A lot of the fear comes from the Women’s Health Initiative, but that studied menopausal women adding hormones ON TOP of decades of hormones, not perimenopausal women whose ovaries are being gently turned OFF by low-dose pills.

Today’s pills are ultra-low dose (20–35 mcg) — often LESS hormone than your body naturally makes 🤯

And here’s the part people don’t talk about:
We’re biologically built for ~250 lifetime cycles...modern women experience ~500.
More cycles = more exposure to estrogen = higher risk for certain cancers.

Long-term pill use has been shown to:
✔️ ↓ ovarian cancer risk
✔️ ↓ uterine cancer risk
✔️ help with perimenopause symptoms
✔️ regulate hormones safely (when medically appropriate)

Sometimes medicine isn’t “unnatural,” it’s correcting a modern mismatch 🧠

02/06/2026

There’s been a lot of buzz about progesterone being “great for sleep.” Yes, natural progesterone can make some women sleepy, but that’s not the whole story. For others, it does nothing. And for many, it causes fatigue, mood swings, irritability, breast tenderness, and even acne. Around 10% can’t tolerate it at all. Progesterone absolutely has medical uses, and when you need it, we prescribe it at night, but it should not be used as a sleep aid. Women deserve the whole picture, not half the story.

02/06/2026

Vitamin D is discussed frequently, and for good reason. ☀️

If you’re supplementing, vitamin D3 is typically recommended. When we check blood levels, the sweet spot is usually between 30 and 50 in the units your lab uses. For most people, around 2,000 IU per day is enough to get there.

Vitamin D is essential because it helps your body use calcium properly to support bone health. Calcium and vitamin D alone don’t build bone, and they’re not treatments for osteoporosis, but without enough of them, even osteoporosis medications don’t work as well.

I once heard a lecture that showed nearly half of women taking osteoporosis medications had insufficient vitamin D levels—not a deficiency, but still insufficient. That matters.

Vitamin D deficiency causes rickets in children and osteomalacia in adults, but insufficiency is different and much more common.

That’s why I generally recommend that all women be on vitamin D supplementation as part of their overall bone health plan.

As always, talk with your doctor about what’s right for you.

01/28/2026

Let’s talk about side effects.

Patients often ask me, “What are the side effects of this medication?” And my answer is usually this: the most common side effect is the reason you’re taking it.

If I prescribe medication for severe osteoporosis, the most common side effect is fewer fractures. If I prescribe menopausal hormone therapy for night sweats that wake you up three times a night, the most common side effect is sleeping through the night.

Too often, we focus on very small percentages listed on drug labels. Many of those appear simply because they occurred slightly more often than placebo, sometimes in just over 2% of people.

That’s why you’ll see labels listing things like weight gain and weight loss, increased hair and decreased hair.

It’s important to understand risks, but it’s just as important to remember the intended benefit. The main side effect is usually the help you were looking for.

01/13/2026

Most people think of a fracture as a short-term problem. But as we get older, it can affect much more than just the bone.

There’s a surprising statistic: after a hip fracture, about 1 in 5 women don’t make it through the following year, often because of loss of mobility, independence, or medical complications, not the fracture itself.

That’s why bone health matters so much.

Strong bones support independence, movement, and quality of life as we age, and that’s something worth protecting.

,h

01/03/2026

📸 Let’s talk about the hidden downside of modern imaging.

Today’s MRIs, ultrasounds, and scans are so sensitive that they often find things we were never meant to see, what I call “incidental-omas.”

These are incidental, benign findings discovered when we weren’t even looking for a problem.

👉 1 in 8 menopausal women has a uterine polyp that never causes symptoms and the risk of cancer is less than 1 in 1,000.
👉 1 in 7 menopausal women has a simple ovarian cyst, benign and not precancerous.

Yet the complication rate from removing these can be as high as 4%, making the treatment riskier than the finding.

Imaging saves lives, but it can also lead to unnecessary anxiety, testing, and even surgery if we don’t put results in context. 🧠🩺