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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Passing Your Uterine Lining, Menstrual Period Norms

Decidual Cast Periods can be fairly easy, passing some tissue at a time, or off can come the whole lining in one piece called a decidual cast. Generally the lining of the uterus is only 6-8 mm thick at the time of the menstrual period, and it is shed gradually, a few cells at a time. The decidual cast is when the entire lining passes spontaneously. It's not uncommon, but it usually both uncomfortable, and alarming to some. But us women are designed to have some sort of periods Or Not? We have to pass tissue each month. Or Not? Are they good for us? Or Not? Do we want them? Or Not? Is this something that is individual? Or Not? It's a complex topic that I will be discussing a lot over my time in this blog. So lets start with basics: How much do we bleed and what are we loosing, and just what was this that the patient passed? And another basic: track your periods, and the Women's Health Practice site http://www.womenshealthpractice.com/media/pdf/menstrual_chart.pdf you...

Post-Endometrial Ablation Syndrome

If you have had an endometrial ablation and have developed symptoms of pelvic pain you might have post endometrial ablation syndrome. What is post-endometrial ablation syndrome? It is a constellation of symptoms due to entrapped blood or tissue within a uterus that has previously undergone an endometrial ablation. We are able to diagnose this at Women's Health Practic e but occasionally other conditions are causing similar symptoms. Other complications of endometrial ablation include pregnancy, risks from pre-existing conditions such as a polyp or fibroid, an infection of the uterus, or a pregnancy. If you have had a tubal ligation then it is possible that the condition could be post-ablation tubal sterilization syndrome. The ablation procedure is designed to destroy all lining tissue, but in fact there is no way to confirm the completeness of the ablation. It is thought that either residual or regrowth of the tissue is producing the symptoms of post-endometrial ablation syndrom...

You Have an IUD: But a Positive Pregnancy Test

Fortunately IUD pregnancy failures are rare. But if you have an IUD for contraception, and you get a positive pregnancy test, you probably ask yourself, what next? Well, make your gyno appointment promptly, this is a condition that is not typically an emergency, but it can be and it’s not handled over the phone or on a blog, or through self diagnosis! That being said, some researchers from University of Texas Southwestern Medical Center in Dallas decided to look back at over 4100 women who had IUDs and of those 42 cases who became pregnant in their institution, over about a year period of time, to help understand what these women could expect when they got to their gyno and what actually happened to their pregnancies. Accurate pregnancy diagnosis, pelvic examination, and pelvic ultrasound were the cornerstones of the evaluations. They had very specific ways they looked at their ultrasound to prove there was no pregnancy in the fallopian tube, or partially in the fallopian tube...

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