Uterine fibroids are one of the most common conditions seen by practicing gynecologists. The uterine muscle becomes enlarged and thickened in certain parts of the uterus and bleeds during the menstrual cycle. Fibroids are benign tumors in effect and while they don't spread like a cancer or cause death, can cause significant bleeding and pain. The consequence of increased bleeding from uterine fibroids is anemia or a low red blood cell count. Many patients can keep up with the increased blood loss by taking over the counter iron supplements but some cannot if the rate of blood loss is too brisk. These patients may require hospitalization for blood transfusions. Those patients who face the prospect of blood transfusions or the need to take significant amounts of pain medication often come to the attention of gynecologists and interventional radiologists who need to perform procedures to control the fibroids and the bleeding. DES has recently been found to be a risk factor for this very common problem as outlined below.
DES daughters have an increased incidence of fibroid tumors. Recently, there have been reports linking intrauterine DES exposure to the later development of uterine fibroids which can be associated with menstrual irregularities, infertility, uterine hemorrhage, pain and anemia sometimes requiring blood transfusion. Baird and Newbold from the National Institute of Environmental Health Sciences (NIEHS) studied 1323 women, aged 35-49 and determined that a higher proportion of women with a history of prenatal DES exposure reported a diagnosis of fibroids, especially large fibroids (26). The associated risk was 2.3 fold. This study correlated very well with findings noted in earlier mouse studies. Large fibroids almost invariably require treatment with gonadotropin releasing agonists like leuprolide or more invasive and painful treatments such as uterine artery embolization (artificially reducing the blood supply), myomectomy or hysterectomy.
26. Baird, D.D. and Newbold, R. Prenatal Diethylstilbestrol (DES) Exposure is Associated with Uterine Leiomyoma Development. Reproductive Toxicology. 20:81-84, 2005.