Tag: morning-after pill

Diethylstilbestrol as Post-Coital Contraceptive

1976 Abstract

The administration of large doses of estrogen to women shortly after unprotected, isolated coitus is followed by an extremely low incidence of pregnancy, suggesting an effect of the estrogen in preventing some aspect of early gestation. Controlled studies have not.been carried out, but there would seem to be little doubt of the efficacy of DES while lesser data on EE and other estrogens are suggestive.

The mode-of-action of the estrogens is not well established. Edgren cited the similarity between this human use and the tubal effects in animals (low dose acceleration of egg transport and high dose inhibition, tubal lock, in some species). In contradistinction, Dr. Hertz insisted that the anti-fertility effect in humans resulted from biochemical changes in the endometrium that precluded nidation. The review of Blye mentions both possibilities, as well as others.

The possible danger of this type of therapy, at least with respect to cancer, was disposed of rapidly by the panel. The postcoital use of estrogens, and particularly DES, is high-dose, short term therapy, quite different from the high-dose, long-term approach usually associated with carcinogenesis. Therefore, danger to the woman taking an estrogen correctly would seem minimal. Further, danger for the fetus seems of little significance, even if DES is conclusively proved to be carcinogenic. If pregnancy is prevented, no danger can exist; however, later abortion should be recommended in the event of an unsuccessful termination.

Sources

• Are Oral Contraceptives and Diethylstilbestrol (DES) Involved in Sex-Linked Cancer?, Steroid Hormone Action and Cancer, PDF, 5.48 MB, 1976.
• Image credit medium.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

American journal of obstetrics and gynecology

Abstract

The development of oral contraceptives (OCs) is briefly discussed.

From reviewing the literature it was seen that the 1st “OC” was the harmless, nontoxic, safe, and very inexpensive synthetic estrogen diethylstilbestrol, or stilbestrol, which is still the best OC in 1975.

This OC is still prescribed because a toxic dose, even up to 300,000 mg yearly, has never been encountered. The regimen consists of 3-5 mg daily for 26 nights with 3-5 nights shipped, plus a potent B-complex vitamin (Livitamin) 2-3 times daily.

This OC is unique in that ovulation and menstrual flow can be inhibited for 60-120 days. The patient can miss from 7-14 days before ovulation occurs, after 1 course of this OC. This regimen provides a harmless, nontoxic, and 100% effective OC.

Sources

• Development of the oral contraceptives, International family planning digest, NCBI PubMed, PMID: 12307393, 1975 Sep.
• Image credit cannabishempexpo.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

Copper IUD, inserted after coitus averts pregnancy and provides continuing contraceptive protection

1975 Study Abstract

No pregnancies have been reported for 97 women treated postcoitally with the copper-T IUD. This method avoids the use of massive doses of estrogen with its associated side effects and provides continuing contraception.

The T-Cu has been found to be easy to insert in nulliparous women, with most patients being high school and college students.

Rape victims were 7% of the total. About half were treated within 24 hours of unprotected coitus. In 2 cases delay was 65 days. The majority of those seeking help did so during the fertile phase of the cycle. Sperm were found in the cervical mucus or vaginal secretions of 18 of the women. It has been estimated that a single unprotected intercourse at random throughout the cycle has a 2-4% risk of pregnancy. It was pointed out by a critic of the method that if a gonorrheal infection or pelvic inflammatory disease were present, serious complications might result. Also, serious infection might result if the patient was already pregnant from prior exposure.

Others reported results of their experiences with diethylstilbestrol (DES) as an emergency method. There were 3 failures in a reported group of 124 patients. Of these 2 had had more than 1 unprotected exposure and 1 had not taken the full 5-day course of therapy. In the total group of 124 patients, 50% had nausea and vomiting. Anxiety and depression were frequently present at a 2-week follow-up among DES patients. Only 15% refused offers of further contraception; 60% chose the pill or IUD. Of the 124 women in the DES group, 22 had had previous abortions and 4 subsequently returned for another course of DES therapy.

Sources

• Copper IUD, inserted after coitus averts pregnancy and provides continuing contraceptive protection, International family planning digest, NCBI PubMed, PMID: 12307393, 1975 Sept.
• Image credit pharmhealth.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

DES in the Treatment of Rape Victims

Prevention of Pregnancy, 1975

Post-coital prevention of pregnancy should be attempted in victims of childbearing age who are likely to be fertile, who are at a vulnerable time in their menstrual cycle, and who do not have contraceptive protection. Diethylstilbestrol, 25 mg orally twice daily for five days is prescribed. Because nausea is a frequent side effect, an antiemetic is of benefit prophylactically.

Abstract

The patient was also given a prescription for diethylstilbestrol (DES) to prevent pregnancy. It is an interesting historical note that this medication, experimentally effective in preventing pregnancy in laboratory animals, received its first human trial among rape victims. Kuchera2 administered DES within 72 hours of unprotected intercourse in 1,000 women at the University of Michigan Health Center. There were no pregnancies. This case illustrates the importance of disseminating health information to the public. This patient would never have come to our Emergency Room had she not been aware of the efficacy of DES.

MS. HILASKI

What are the side effects of DES and are we worried about subsequent vaginal adenocarcinoma in the victim’s female offspring should the victim become pregnant?

DR. KAUFMAN

First, the term “morning after pill” is a misnomer. Actually you must take 25 mg twice daily for five days. In light of the frequent nausea, some women do not complete the course and thus do have an increased risk of pregnancy. Nausea can be treated with an antiemetic such as prochlorperazine (Compazine®). Your point about vaginal adenocarcinoma in female offspring is well taken. While recent work has linked DES with higher than expected rates of vaginal adenocarcinoma in female offspring of the recipients of the drug, its actual occurrence is rare.3 Nevertheless, we customarily advise the victim that if she takes DES and becomes pregnant an abortion is indicated. DES is withheld if a menstrual history suggests the possibility of pregnancy prior to the assault, or if the victim is uncertain if she would have an abortion.

Sources

• Total health needs of the rape victim, The Journal of family practice, jfp-archived-issues, 1975 June.
• Image credit mirror.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

1975 Study Abstract

A case report is presented of the failure of diethylstilbestrol to prevent an ectopic pregnancy.

A 29-year-old physician’s wife, gravida 4, para 2, abortuses 2, received 25 mg diethylstilbestrol twice daily for 5 days beginning on Day 14 of the menstrual cycle after condom accident during intercourse the prior night. Withdrawal bleeding did not occur. The patient’s menstrual period before the condom accident had begun on August 25, 1971.

In mid-October she returned to the doctor feeling pregnant. The pregnancy test was positive on October 18, 1971, and physical examination revealed a soft uterus of about 7 weeks’ gestation.

Because of the fear of congenital defects in the fetus from diethylstilbestrol, suction curettage was carried out on October 27, 1971.

On October 31, 1971, the patient experienced great pain in the lower left quadrant. Her abdomen was tender and distended, and pelvic examination revealed a bulging cul-de-sac from which culdocentesis revealed nonclotting blood. Laparotomy revealed a ruptured tubal pregnancy on the left side. A left salpingectomy was carried out which pathologically confirmed a tubal pregnancy.

The question of whether diethylstilbestrol prevents implantation in the uterus but not in extrauterine sites is examined. A report by Morris is noted in which the only 3 pregnancies which followed diethylstilbestrol failure were ectopic. It is recommended that others with similar cases report them in order to better understand what occurs.

Sources

• Ectopic pregnancy after postcoital diethylstilbestrol, American journal of obstetrics and gynecology, PMID: 1115139, 1975 Jan.
• Image credit Asdrubal luna.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

The Population Planning Department School of Public Health University of Michigan

Summary

This paper represents an updating of a study done at the University of Michigan Health Service from the fall of 1967 through April, 1971.

Of the 1410 women of child bearing age who received the morning-after pill, diethylstilbestrol, 1298 have received follow-up, or a total of 92.1%.

Of the 1217 patients who met the criteria of having had one unprotected or inadequately protected sexual exposure since the last normal menstrual period, who came in for therapy within 72 hours of the fact, and completed the course of 25 mg of DES twice daily for five days, there were no pregnancies, or 100% effectiveness.

One would have to conclude, with a follow-up of 90%+ that this therapy is highly efficacious.

Sources

• Postcoital contraception with diethylstilbestrol – updated, contraceptionjournal, doi.org/10.1016/0010-7824(74)90131-0, July 1974.
• Image credit sekalainen.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

Diethylstilbestrol usage as an effective postcoital contraceptive has been lauded

Abstract, 1974

During the past 5 years much emphasis has been placed on the development of an effective postcoital contraceptive (an intraceptive, or “morning-after” pill). Much of the impetus toward this goal has come from college health services and from rape cases. The idea is not new. In 1926, Smith and Parkes and Bellerby demonstrated that administration of estrogen could inhibit pregnancy in laboratory animals. The mechanism of this action was considered to be either a change (increase or decrease) in tubal transport or an effect on the endometrium. Within a few months after the synthesis of DES, Parkes et al. reported a similar DES effect in rabbits. Interestingly, in 1969 Dodds remarked that the possible human implications of this work had not occurred to them in 1939, and so development of oral contraceptives had been delayed many years.

It was the mid 1960’s before DES was again studied actively as a postcoital agent. Primarily through the work of Morris and van Wagenen in primates, DES was shown to be very effective. Kuchera reported the first large series in humans, noting no pregnancies among 1,000 exposures, wherein 20 to 40 pregnancies would have been expected. Morris commented in February 1972 that of “several thousand” midcycle exposures treated with DES, only three failures were known.

The results of these trials prompted the FDA to approve DES for use as a postcoital antifertility agent. The present dosage recommended is 25 mg twice daily for 5 days, beginning within 72 hours of exposure. Because failure can occur (though it is unlikely), the patient must be warned of the possibility of a late effect-Le., development of genital adenocarcinoma-in female offspring. And if pregnancy does ensue, therapeutic abortion should be considered.

The mechanism by which DES prevents pregnancy in humans is not clear. Large doses of most estrogens prevent pregnancy. Ethinyl estradiol has been studied extensively in this regard and is effective. But since a small amount of estrogen is known to be necessary for implantation in most species, including man, small doses of estrogens may promote rather than prevent gestation. Various antiestrogenic drugs also have been shown to prevent pregnancy in some species, but the “results are various and not confirmed in humans. A recent study has confirmed the suspected decrease of plasma progesterone in women receiving DES postovulation and has suggested that this may be the primary reason for inhibition ofimplantation. Endometrial biopsies do not show a persistent proliferative phase; rather, secretory endometrium appears early and persists unchanged throughout the luteal phase. Another postulated explanation of the inhibition of implantation is that the decrease of progesterone causes a change in the concentration of carbonic anhydrase in the endometrium.

Sources

• Diethylstilbestrol Usage: Its Interesting Past, Important Present, and Questionable Future, Medical Clinics of North America, sciencedirect, July 1974.
• Image credit caseygueren.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

New Zealand Medical Journal, 1974 Apr 26

Abstract

Interception or prevention of implantation by high doses of estrogen given after a single midcycle exposure is recommended as an emergency method.

Therapy should be related to the time of ovulation rather than to the sexual act.

Possible modes of action include retarded endometrial hyperplasia, impairment of progesterone release from the corpus luteum, and enhanced spontaneous tubal and myometrial activity.

Suitable interception doses are 50 mg/day stilbestrol for 5 days or 5 mg/days ethinyl estradiol for 5 days.

80 cases treated with 50 mg stilbestrol are reviewed. Nausea was a common complaint %50%). 1 ectopic pregnancy occurred.

Sources

• Oestrogen interception: the morning-after pill, New Zealand Medical Journal, popline, 1974 Apr 26.
• Image credit engadget.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

Possibility of postconception control of fertility using medicamentous nidation inhibitors

1973 Study Abstract

Clinical aspects of postconception fertility control are reviewed. Estrogens (ethinyl estradiol and diethylstilbestrol) have been used for this purpose. In addition to their undesirable side effects, they must be administered within a strictly defined time period.

Several progestagens have been used as postcoital contraceptives, but they too are effective only when administered a few days after ovulation.

A number of nonsteroidal substances appear promising, as inhibitors of implantation and as abortifacient agents.

Prostaglandins also appear promising because of similar properties. Oral administration is not feasible, but vaginal administration is an attractive possibility. But the high incidence of side effects and somewhat unreliable effects are problems. The mechanisms of action of all these substances have not been explained.

Sources

• Possibility of postconception control of fertility using medicamentous nidation inhibitors, Zentralblatt fur Gynakologie, PMID: 4131008, 1973 Dec.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

On the mechanism of the contraceptive action of oestrogens administered after ovulation

1973 Study Abstract

The antifertility effects of estrogens in animals has long been known, but it was not until 1966 that the effects of estrogen in man became known as well.

The estrogen effects during the time of the transport of the egg through the fallopian tubes to the uterine cavity was studied. 50 mg of diethylstilbestrol (DES) was administered daily during the 5-day postovulatory period.

The results were

• a shortening of the cycle,
• a lowering of plasmic progesterone,
• and a decrease in the secretion of pregnanediol.
• The development of the endometrium stopped.

These results indicate that DES, when given at this time, shortens the function of yellow corpuscles and affects the further development of the endometrium. Either of these mechanisms could explain the contraceptive effects of the estrogen.

Sources

• On the mechanism of the contraceptive action of oestrogens administered after ovulation , Ceskoslovenska gynekologie, PMID: 4765140, 1973 Sep.
• Image credit The Roaming Platypus.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.