DES: The Smith and Smith Regimen and It's Consequences

The treatment called the Smith and Smith regimen treatment was universally used by gynecologists in it's day. Never heard of it? It sparked a generation of disaster. In 1949 the New England Journal of Medicine, a gynecologic paper advocated a radical new treatment that could prevent many pregnancy complications: miscarriages, preterm births to name the two most important. The paper described a regimen that came to be known as the "Smith and Smith" regimen which advocated the use of the estrogen, DES (diethylstibesterol). The regimen had become widespread as an off label treatment, and late in 1947 the FDA had actually granted Squibb an approval for the process. Twenty-three yeas later, in 1973, Dr. Arthur Herbst at the University of Chicago, described a vaginal cancer in a young women who had been exposed to this drug while being a fetus (in utero). And there is a DES registry that has been going since the early 70s to track these rare vaginal cancers. They were the DES daughters. Not all the changes they experienced were serious. Some changes lead to non-cancerous but unique physical properties lie the "cockscomb" hood of the cervix. And Gyno Gab Gal will occasionally see this change in women who have not had any unusual hormonal exposure when they were maturing through fetal life. DES itself is a particularly unique estrogen type drug. It has had successful uses in prostate cancers, breast cancers, as a morning after pill and to stop uterine hemorrhaging. A Ying and Yang treatment of gynecology, with the bad so over shadowing the good that it passed from being famous to ignominy.


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