Dosage of Stilbestrol

KARL JOHN KARNAKY, M.D.
AJOG, Volume 60, Issue 5, November 1950

Correspondence

Dr. 0. TV. Smith in an article published in the November 1948, issue of the JOURNAL, gave her experiences with stilbestrol used for the prevention and treatment of some of the complications of pregnancy. She stated,

“We have been concerned about the theoretical dangers of stilbestrol overdosage.”

In discussing the 10 cases of failure in the series of habitual abortions, she states that,

“9 were on too low a dosage, of whom 3 aborted and 13 were on too high n dosage, 7 of whom aborted.”

While the number of cases reported is substantial and while the writer has no dispute as to too low a dosage of stilbestrol being a cause of failure, he begs to differ from Smith in her viewpoint in regard to so-called unphysiologic dosage. It has been found that the larger the dose, the more certain the patient would carry the baby to term and deliver a normal child.

What is the required dosage of stilbestrol ?
The writer has been interested in the correct reply to this question ever since he observed that stilbestrol is of value for threatened and habitual abortion and premature labor, somewhat over ten years ago. No definite dosage schedule is followed because the dosage varies with each individual, therefore no weekly increase is necessary. The amount required for the treatment of threatened abortion is that amount which stops cramps, low back pains, spotting, bleeding, and/or pain and keeps these symptoms from returning. Most patients require 25 to 50 mg. every morning. Even though I have found no dosage schedule, the following is the amount that has been required in most cases to control the various types of threatened abortion. However we do not hesitate to give much larger doses if required to control the symptoms.

In threatened abortions, mild cases (patient with spotting, mild cramping, and low back pains for 4 to 12 hours) :
One hundred mg. of micronized stilbestrol are given every 16 minutes until symptoms are relieved and then 25 mg. three times daily for one week. Twentyfive mg. are given every morning until the eighth month. If pain, cramps, or bleeding recur. repeat above.

In moderately severe threatened abortion (cramps, low back pains, spotting and bleeding for 12 to 24 hours before treatment) :
Give 250 t,o 500 mg. of micronized stilbestrol in oil intramuscularly in the gluteal region, using a large spinal needle. Two hundred mg. of micronized stilbestrol are given orally every 15 minutes until all symptoms are controlled. 129 mg. tablet is given four times daily for two weeks, one tablet three times daily for 2 weeks, two daily in the morning for one week, and one daily thereafter until the eighth month. Every 3 t,o 7 days 250 to 500 mg. in oil intramuscularly are given for 2 to 4 times. Emergency dose of 50 to 200 mg. (two to eight 25 mg. tablets of micronized stilbestrol) is given immrtliately if symptoms or signs recur and treatment above is repeated. Find daily morning dose necessary to keep patient from aborting.

Severe type of threatened abortion (cramping, low back pains, bleeding, and pain 2 to 4 or more days before treatment) :
Give 250 to 1,000 mg. by mouth every 15 minutes until pain, cramps, and bleeding stop, followed by 250 to 500 mg. intramuscularly about every tihird day for 2 to 4 weeks, 100 mg. four times a day for two weeks, 25 mg. four times daily for 2 months, then one 25 mg. tablet daily until the eighth month. In 64 consecutive private cases of threatened abortion of all types, 45, or 70 per cent, caarried to term and delivered normal infants.

Habitual abortion :
Twenty-five mg. of micronized stilbestrol are given upon rising and as soon as the patient has missed 3 to 7 days of menstruation and if her basal temperature indicates pregnancy. If the patient develops no signs or symptoms in 3l/r months, % of a 25 mg. tablet is given every morning. If the patient ever threatens to abort she is treated as a threatened abortion case as described above. Stilbestrol was given in this manner to 4 habitual abortion patients who had lost 24 babies (an average of 6 each). None aborted in this very small series.

Premature labor :
It has been shown in our clinic that 200 mg. or more of micronized stilbestrol daily are required to keep the patient from losing her baby in a premature labor case. As soon as a premature labor starts, eight 25 mg. micronized stilbestrol tablets are given stat. and four every 15 minutes until all symptoms and signs disappear, plus 10 c.c. of stilbestrol in oil intramuscularly, which is repeated daily or every other day if signs 01 symptoms are not controlled. Then 300 to 400 mg. are given daily for one week and thereafter 200 mg. daily until the eighth month. If signs and symptoms of premature labor recur? the treatment is repeated. If history of premature labor is given, 25 mg. of micronized stilbestrol are given as soon as pregnancy is diagnosed and this dosage is continued until the eighth month. Emergency treatment is given if necessary.

In successfully treated sterility cases :
All sterility patients who subsequently become pregnant are given 6.25 mg. of micronized stilbcstrol as soon as pregnancy is diagnosed by basal body temperature, amenorrhea, frog test, or the Aschheim-Zondek test. If a ,patient, ever threatens to abort she is treated for threatened abortion as previously described. It has been observed that before stilbestrol administration 27 out of every 100 such patieuts aborted but since stilbestrol is given 14 out of 100 abort.

Again I would like to emphasize that, in my opinion, no specific dosage schedule can be set up for stilbestrol in abortion cases, the dosage varies with each and every individual. Find the dose that holds the pregnancy and keep up this dose. No weekly or monthly increase has been necessary.

Sources

DES DIETHYLSTILBESTROL RESOURCES

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