Benign Anomalies
Benign Anomalies
Adenosis and vaginal epithelial changes, present in as many as 50% of women who were exposed to DES before 18 weeks of gestation, include large transformation zones extending to the vagina, cervical collars, hypoplastic cervices, pseudopolyps, and vaginal septa. As the patient grows older, these changes diminish.
The immature squamous metaplasia noted on colposcopy can lead to overzealous treatment. Among the progeny of women exposed to DES, fewer than 10% with biopsies of these areas will have significant intraepithelial neoplasia. Women with these large transformation zones should be followed with cytologic testing, iodine staining, colposcopy, and careful palpation every 6 months to 1 year. Oral contraceptive use does not increase the risk for genital tract clear-cell adenocarcinoma.
The vaginal changes and anatomic abnormalities of the uterus and fallopian tubes, occurring in some progeny, may increase the risk of early pregnancy loss, ectopic pregnancy, and preterm delivery. Careful monitoring throughout pregnancy is indicated.
Exposure to DES may place women at a small, but statistically significant, risk for developing breast cancer. The possibility of an increased risk of cancer of the uterine corpus has been raised. Because of these increased risks, women who have been exposed to DES should be followed for life with appropriate and cost-effective screening.