II. Background

  1. DES is an oral synthetic nonsteroidal Estrogen
  2. DES was prescribed in pregnanc
    1. Used to improve pregnancy outcomes
    2. Later studies did not support any benefit for DES
    3. Used in U.S. 1938 to 1971
    4. Used in Europe until 1980's
  3. Now DES is only used in advanced Prostate Cancer

III. Associated conditions to DES Exposure (highly correlated)

  1. Associated with in utero exposure to DES
  2. Highest risk were patients exposed in first trimester
  3. Carcinoma
    1. Vaginal clear cell adenocarcinoma
      1. Peak onset age 17 to 22 years
      2. Possibly second peak at post-Menopause
    2. Breast Cancer (same risk as Hormone Replacement)
  4. Gynecologic tract abnormalities
    1. T-shaped Uterus
    2. Adenosis
    3. Cervical abnormalities (e.g. pseudopolyp)
  5. Risks in men exposed in utero to DES
    1. Undescended Testes
    2. Small Testes
    3. Possible Prostate Cancer risk
    4. Possible Testicular Cancer risk

IV. Surveillance of women with in utero DES Exposure history

  1. Colposcopy at first Pap Smear
    1. Repeat annually (at minimum) for abnormalities
    2. Routine Colposcopy not needed if normal
  2. Annual Pap Smear, four quadrants and pelvic exam
    1. Sample cells with brush from four vaginal quadrants
    2. Routine Pap Smear
    3. Bimanual exam
  3. Pregnancy management
    1. Discuss higher risk of Miscarriage and poor outcomes
    2. Refer to obstetrics if pregnant

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Related Studies

Cost: Medications

des (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
DESCOVY 200-25 MG TABLET $66.13 each
DESIPRAMINE 10 MG TABLET Generic $0.10 each
DESIPRAMINE 100 MG TABLET Generic $0.56 each
DESIPRAMINE 25 MG TABLET Generic $0.18 each
DESIPRAMINE 50 MG TABLET Generic $0.46 each
DESLORATADINE 5 MG TABLET Generic $0.34 each
DESMOPRESSIN 10 MCG/0.1 ML SPR Generic $7.86 per ml
DESMOPRESSIN ACETATE 0.1 MG TB Generic $0.33 each
DESMOPRESSIN ACETATE 0.2 MG TB Generic $0.42 each
DESOGESTREL-EE 0.15-0.03 MG TB Generic $0.15 each
DESOGESTR-ETH ESTRAD ETH ESTRA Generic $0.26 each
DESONIDE 0.05% CREAM Generic $0.49 per gram
DESONIDE 0.05% LOTION Generic $1.38 per ml
DESONIDE 0.05% OINTMENT Generic $0.66 per gram
DESOXIMETASONE 0.05% CREAM Generic $2.61 per gram
DESOXIMETASONE 0.05% OINTMENT Generic $3.34 per gram
DESOXIMETASONE 0.25% CREAM Generic $0.62 per gram
DESOXIMETASONE 0.25% OINTMENT Generic $0.62 per gram
DESOXIMETASONE 0.25% SPRAY Generic $1.44 per ml
DESVENLAFAXINE SUCCNT ER 100 MG Generic $0.52 each
DESVENLAFAXINE SUCCNT ER 25 MG Generic $0.52 each
DESVENLAFAXINE SUCCNT ER 50 MG Generic $0.48 each