Introduction
Diethylstilbestrol (DES) is a man-made form of the female hormone estrogen. It is the most potent estrogenic compound that is more powerful than natural estrogen. DES is known to be an endocrine-disrupting chemical. It interferes with the endocrine system to cause birth defects, cancer, and other developmental abnormalities.
What Is DES Used For?
Between 1940 and 1971, it was prescribed to pregnant women to prevent premature labor, miscarriage, postpartum breast engorgement, menstrual disorder, and pregnancy-related complications. It is also used in the common food supply with pellets implanted in poultry, beef, and swine to promote their growth. The use of DES declined after 1950 as many studies showed it was ineffective in preventing pregnancy-related complications. Even then it was used to stop lactation, treat menopause symptoms in women, and for emergency contraception.
In 1971, many studies showed the association between prenatal DES exposure and clear cell adenocarcinoma (a type of cancer of the vagina and the cervix)in women. After the prescription of the drug to pregnant women was banned by the government. But till 1978, the drug was prescribed to pregnant women in Europe.
Who May Be Exposed to DES?
It is believed around 5 to 10 million people have been exposed to DES during pregnancy:
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DES mothers - DES exposure happens in women who took DES while pregnant.
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DES daughters - If a woman's mother took DES during their pregnancy. Then the fetus gets exposed to DES while growing in the uterus.
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DES sons - If a man whose mother took DES during their pregnancy. Then the fetus gets exposed to DES while growing in the uterus.
DES exposure happens to children in the uterus when their mothers take DES. But, the brothers or sisters from pregnancies during which the mother did not take the DES were not exposed.
What Are the Health Issues That Affect the People Exposed to DES in the Uterus?
People who are exposed to DES in the uterus have many health-related problems that include:
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Clear Cell Adenocarcinoma - Daughters of women who took DES, have more risk of developing clear cell adenocarcinoma of the vagina or cervix than women who were not exposed to DES in the womb. However, this is a rare type of cancer; approximately 1 in 1,000 DES daughters get this type of cancer.
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Breast Cancer - After age 40, DES daughters may have approximately twice the risk of breast cancer as women who are not exposed to DES of the same age and with breast cancer women who are not exposed to DES of the same age and with.
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Pancreatic Cancer - A recent study found that DES daughters had more risk of pancreatic cancer than women in the general population.
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Cervical Precancer - Researches show that DES daughters were twice more likely to have high-grade changes in the cell of the cervix than females not exposed to DES in the uterus.
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Testicle and Prostate Cancer - Males exposed to DES in the uterus have been at risk of testicles and prostate cancers. There is no evidence for the reason why DES exposure increases the risk of prostate cancer and testicular cancer.
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Cardiovascular Diseases - People exposed to DES have an increased risk of hypertension, coronary artery disease, high cholesterol, and heart attack but not stroke. DES daughters have stronger associations between prenatal DES exposure and heart attack and coronary artery disease than DES sons.
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Autoimmune Condition - People exposed to DES in the uterus may have problems with the immune system. But many researchers show that DES daughters do not have a high risk of autoimmune diseases.
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Pancreatic Disorder - Research found an increased risk of pancreatic disorders and inflammation of the pancreas in both DES sons and DES daughters compared with unexposed females and males.
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Depression - One study found a 40 % higher risk of depression in DES daughters have increased risk of depression than in unexposed women has been found by some studies. But the risk of depression is not seen in DES-exposed men.
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Early Menopause - DES daughters have more risk of early menopause than unexposed women. Around three percent of DES-exposed women have experienced early menopause.
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Psychosexual Characteristics - Prenatal exposure to DES may influence certain sexual and psychological characteristics of adult women and men.
What Health Problems Can Affect Women Who Took DES During Pregnancy?
Women who were exposed to DES while pregnant are DES mothers. DES exposure has a high risk of developing certain diseases, such as breast cancer. DES mother requires special healthcare that should include
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Monthly breast self-examination.
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Annual mammography (breast x-ray).
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Annual gynecological check-up.
What Should Women Who Used DES During Pregnancy Do?
If a woman has taken DES while pregnant, if possible, she should try to find out the dosage, how it was used, and when it was used. She should also inform her children who were exposed during pregnancy. DES-exposed mothers should follow a regular breast cancer detection check-up, as the doctor recommends If any new breast lumps or breast changes should be immediately informed to a doctor. They should also have regular pelvic examinations and medical check-ups.
What Should a DES Daughter Do?
Women exposed to DES before birth should be aware of the health effects of DES and inform their health care. These individuals have been advised to have a medical examination annually to check for adverse health effects of DES, which may include clear cell adenocarcinoma and abnormal cervical cells. The medical examination may include a pelvic examination, that checks for any abnormalities in the vulva, vagina, ovaries, uterus, cervix, and rectum. A PAP test will also collect cells from the vagina and the cervix. If any abnormalities are detected then a colposcopy (examination of the cervix with magnification) will be recommended. A routine breast cancer screening is also recommended for women who are over 45 years.
What Should a DES Exposed Son Do?
DES should be examined periodically even though the risk of testicular cancer development among DES sons is not clear. Many males have unusually small or undescended testicles, cysts on the testicles, and lowered sperm count. Testicular cancer is often diagnosed in young men, with less than nine percent over age 55. A DES-exposed male should examine their testicles for lumps every month.
Conclusion -
Diethylbestrol (DES) is a synthetic hormone that prevents premature labor, abortion, and other pregnancy-related complications during early periods. It is banned later on due to its adverse effects like cancer, heart problems, etc. But women who took DES and their children exposed to DES in the uterus had many health-related issues. So they are recommended to have regular medical check-ups to avoid complications.
