DES usage as a post-ovulatory pill

The Stilbestrol Story, Albrecht W. Schmitt, M.D., 1974

Abstract

Finally, a few comments should be made concerning DES-related problems. First, the morning-after pill, which should better be called the post-ovulatory pill, needs to be mentioned. As we know, there are a great number of practitioners and clinics who use DES for the prevention of pregnancies in girls who come to the office or clinic after sexual exposure, specifically rape or incest. DES should not do any harm to these patients as the drug is given at a time when the duct systems of the genital organs are not yet being formed. With this fact in mind, there should be no objection to the use of DES in such emergencies. However, considering the potential teratogenic effect of DES, it should be advised against the routine use of DES as a morning-after pill, as expressed in a pamphlet recently distributed by Eli Lilly and Company, the only manufacturer of DES, according to the current PDR.

Another point of importance is the feeding of cattle and sheep with DES. The FDA banned stilbestrol for this purpose in 1972 because small amounts of DES had been found in the livers of DES-fed livestock. This ban is, of course, difficult to enforce but all possible ways should be used to prevent meat from DES-fed or implanted animals from reaching the food markets.

The final point concerns the question of whether a patient with a history of DES-exposure in utero should be permitted to take the birth control pill. The author goes along with Herbst that there is no evidence that the pill has ever changed adenosis into clear cell carcinoma. However, on the basis of our knowledge, that clear cell carcinoma develops mostly after puberty when the ovaries produce an increased amount of endogenous estrogen, patients with DES history should be advised against the pill; and an alternate means of contraception should be used.

Sources

  • Read the full paper (free access) : The Stilbestrol Story, Dept. of Obstetrics & Gynecology. The Medical College of Pennsylvania., doi/pdf/10.1177/019262337400200201, June 1974.
  • Image credit avert.
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