Diethylstilbestrol (DES) is a synthetic form of estrogen, first developed in 1938. It was once widely prescribed as a hormonal therapy. However, its use has been discontinued due to serious health consequences observed in individuals exposed to it.
The Drug’s Purpose and History
Diethylstilbestrol was initially prescribed to pregnant women between the late 1930s and early 1970s. It was believed to prevent complications such as miscarriage and premature birth. Millions of Americans were exposed to DES during this period.
Despite its widespread use, studies in the 1950s showed DES was not effective in preventing these pregnancy issues. Concerns about its safety grew, leading the U.S. Food and Drug Administration (FDA) to advise against its use in pregnant women in 1971. This led to a decline in its prescription for pregnancy-related indications, though it continued to be used for other purposes like treating certain cancers.
Impact on DES Daughters
Women whose mothers took DES during pregnancy, known as DES Daughters, face specific health challenges. One of the most serious is an increased risk of clear cell adenocarcinoma (CCA) of the vagina and cervix, a rare cancer. DES Daughters have approximately 40 times the risk of developing CCA compared to unexposed women.
Beyond cancer, DES Daughters may experience various reproductive tract abnormalities. These can include a T-shaped uterus, cervical hoods, or vaginal adenosis. Such structural differences can contribute to fertility issues and adverse pregnancy outcomes, such as preterm birth or ectopic pregnancy. There is also a potential increased risk for breast cancer in this population.
Impact on DES Sons
Men whose mothers were prescribed DES during pregnancy, known as DES Sons, can experience adverse health effects. These impacts primarily involve abnormalities of the reproductive tract. Common findings include epididymal cysts, which are benign sacs that can form on the epididymis.
Other reported abnormalities in DES Sons include undescended testicles (cryptorchidism) and hypoplastic testes (smaller than normal testicles). While less conclusive than the risks for DES Daughters, studies have explored potential links to fertility issues or certain cancers, such as testicular cancer. The overall health risks for DES Sons are generally considered less severe than those for DES Daughters.
Impact on DES Mothers
Women who were prescribed DES during their pregnancies, known as DES Mothers, also face potential health considerations. The primary concern for this group is a slightly increased risk of breast cancer. Research indicates a modest elevation in breast cancer incidence among DES Mothers.
While some other health issues have been reported in DES Mothers, their prevalence is less clear or less consistently linked to DES exposure. The increased risk of breast cancer remains the most significant long-term health effect for women who took the medication.
Current Considerations for Affected Individuals
Individuals who suspect they may have been exposed to DES should prioritize understanding their family medical history. It is important to inform healthcare providers about any known or suspected DES exposure, as this information can guide appropriate medical care and monitoring.
For DES Daughters, regular screenings are important. This includes annual pelvic exams and Pap tests, sometimes with specific techniques to visualize the cervix and vagina more thoroughly. Awareness of symptoms like unusual bleeding or discharge is advised, prompting immediate medical attention if they occur. DES Sons and Mothers should also discuss any concerns with their doctors.