Tiniest Birth-control Pill Dose Is Best

December 28, 1987|By Allan Bruckheim, M.D.

Q-I would like to be sure and I know there are many kinds of birth-control pills on the market. What are the best choices?

A-Birth-control pills, or oral contraceptives, have been around for more than 25 years, and they are still the most effective nonpermanent form of birth control.

Oral contraceptives have changed. The pills first marketed in 1960 had large doses of estrogen and progestin, whereas those made now have far lower doses and still are effective.

The best choice for birth-control pills, or any other medicine, is the smallest dose that does the job.

Most brands of oral contraceptives now contain 30 to 35 micrograms of estrogen. Some women have breakthrough bleeding at this low dose and may need to be switched to brands with 50 micrograms of estrogen. This still is a far lower amount of estrogen than was once used.

Some types of oral contraceptives use slightly different amounts of estrogen and progestin over the course of the cycle, to mimic the normal rise and fall of hormones in the body.

The most serious health risks of taking the pill are cardiovascular, meaning an increased risk of heart attack, stroke and blood clots. However, this risk is significant only for women older than 40 or those who smoke.

For most women, the health risks of a possible unwanted pregnancy outweigh the risks of contraception.

The pill can cause nuisance side effects such as acne, weight gain and headaches, but these are minimized with newer low-dose versions.

There are actually several benefits to taking oral contraceptives. They appear to prevent formation of ovarian cysts, and there is evidence that they protect against endometrial and ovarian cancer.

But please remember, each of us is unique, and what may be right for your neighbor may not be the best for you. In this case it really is smart to get the personalized advice of your own physician.

Q-What is a ``boxer`s fracture``? Is it easily treated?

A-A ``boxer`s fracture`` is cracked knuckles, a common side effect of fist fighting, and frequently is called this even when caused by other circumstances.

There are several options for treating such a fracture, and the final decision on how to treat it depends on the severity of the injury, how important the hand`s function is to the patient and how often the patient expects to be using the hand as a weapon.

For instance, if the patient`s hands are used at work or in hobbies, he or she may opt for more aggressive treatment.

And if the patient is a regular fistfighter, then the possibility of reinjury must be considered before advising extensive and delicate surgical repair.

The choices for treatment of boxer`s fracture mainly revolve around whether to operate or treat more conservatively with protective splinting.

More time is lost from work when surgery is chosen because recovery is slower. There is some controversy over whether the functional and cosmetic improvements gained in surgery are worth the delayed recovery it involves.

The best results in treating boxer`s fracture occur when the extent of the injury is fully evaluated, considering how the hand is used in

occupational and leisurely pursuits and how important cosmetic results are.

Based on this information, the patient can decide, with the physician, on the best course of action.
