chapter  7
28 Pages

Uterine Abnormalities Resulting from DES Exposure

The administration of DES . . . did not reduce the incidence of abortion, prematurity or postmaturity. — W. J. Dieckmann, 1953

Although the majority of mullerian anomalies are congenital in nature, a unique group of anatomic abnormalities of the male and female reproductive tracts are secondary to in utero exposure to diethylstilbestrol (DES). The history of DES presents an interesting study in the application of basic science to clinical care and what is known in contemporary parlance as “evidence-based medicine”. Interest in nonsteroidal estrogens in the 1920s and 1930s focused on developing orally active preparations.1 In 1933 DES was synthesized by E. C. Dodds in Middlesex, London.2 There was considerable clinical interest in DES because of its unique effectiveness when administered orally.3,4 Intensive laboratory and clinical studies investigating its potential role in a variety of clinical settings were carried out shortly thereafter.5 DES was the most widely researched of the synthetic estrogens and found clinical applications in gynecology, endocrinology, and oncology. Early investigations through the late 1930s and early 1940s demonstrated a marked improvement in the relief of menopausal symptoms in dosages varying from 0.2 to 0.5 mg per day.6