Furostilbestrol

Diethylstilbestrol (DES), also known as stilboestrol or furostilbestrol, is a synthetic nonsteroidal estrogen that was first synthesized in 1938. It was prescribed from the 1940s through the early 1970s to prevent miscarriage, premature labor, and related complications of pregnancy. The use of DES declined after studies in the early 1970s showed that it was associated with an increased risk of clear cell adenocarcinoma (CCA) in the daughters of women who had taken DES during pregnancy, a condition known as DES syndrome.

Medical Uses

Originally, DES was used to support pregnancy in women with a history of recurrent miscarriage, preterm labor, and other pregnancy-related complications. It was believed to act as a form of hormone replacement therapy by supplementing estrogen levels, which are crucial for maintaining pregnancy.

Adverse Effects

The adverse effects of DES exposure are significant and have led to changes in medical practice. DES daughters, or females exposed to DES in utero, have an increased risk of developing clear cell adenocarcinoma of the vagina and cervix, as well as fertility problems and pregnancy complications. DES sons, or males exposed to DES in utero, may experience genital abnormalities and fertility issues, although the risks are less well defined than for DES daughters.

Mechanism of Action

DES functions as an estrogen agonist. It binds to estrogen receptors in the body, mimicking the effects of natural estrogen. This action was intended to support the endometrium and maintain pregnancy, but it also led to unintended adverse effects due to its potency and the duration of exposure.

History

The history of DES use is a cautionary tale in medical science. Initially hailed as a miracle drug for preventing miscarriages, its widespread use was eventually curtailed due to the discovery of its link to cancer and other serious health issues in the children of women who took the drug during pregnancy.

Regulation and Legacy

The regulatory response to the discovery of DES's adverse effects was significant. In many countries, the use of DES during pregnancy was banned or severely restricted. The DES tragedy has had a lasting impact on drug regulation and monitoring, leading to more stringent testing requirements for drugs and greater awareness of the potential for long-term effects of pharmaceuticals.

See Also

• Estrogen
• Hormone replacement therapy
• Clear cell adenocarcinoma
• Pregnancy complications