DES Daughters

Unveiling the Health Challenges of DES Daughters: A Comprehensive Exploration into the Adverse Outcomes Linked to Prenatal Diethylstilbestrol Exposure

DES Daughters: Female individuals whose mothers were prescribed DES while pregnant with them. 

Much of the information reported here regarding the medical conditions of DES Daughters comes from an article published in 2011 in the New England Journal of Medicine, “Adverse Health Outcomes in Women Exposed in Utero to Diethylstilbestrol,” by Robert N. Hoover et al. A review of this important article was done by MedPage Today, an online publication for healthcare professionals. DES Daughters may find it useful to print and share it with their doctors.

Respected researchers with the National Cancer Institute (NCI) DES Follow-up Study analyzed the available data in the NEJM article. They identified twelve adverse health outcomes for women exposed to DES before birth. A layperson’s explanation of the research can be found in the VOICE Fall 2011 review of the study. 

***Unless otherwise stated, statistics regarding risk factors listed on this page come from this NCI DES Follow-up Study peer-reviewed research.***

Table adapted from Voss AM. DCEG news article: the DES follow-up study. National Cancer Institute website. Published August 1, 2012.

Clear Cell Adenocarcinoma of the Vagina and Cervix

Various types of cancers affect the vagina and cervix, but only one specific kind is associated with prenatal DES exposure. Clear cell adenocarcinoma (CCA) of the vagina/cervix is a rare cancer, even for DES Daughters. The risk is estimated to be approximately 1 in 1,000 DES Daughters.

Years ago, there was a mistaken belief that DES Daughters over age 30 were out of danger. However, a 2012 population-based analysis by researchers at the Centers for Disease Control and Prevention (CDC) suggests otherwise. It raises the specter that the incidence of this cancer has no upper age limit for DES Daughters. This information was reviewed in the VOICE Winter 2012. 

A study published in June 2022 performed an updated investigation into the risk of CCA as DES Daughters age. This group took a different approach to studying CCA than previous DES-related studies. Instead of comparing a group of known DES Daughters to women who were not exposed, these researchers, led by Mary C. White at the CDC, focused on the time periods during which the women were born. They compared CCA rates among women born between 1947 and 1971 — the “DES era” — to women born before 1947. 

The drawback of this approach is that it is impossible to be sure how many women in the 1947–1971 cohort were exposed to DES. But, in a way, that is also the study’s strength. Since so many women never learned of their DES exposure, a study like this can capture the impact of the drug’s effects even among women who never knew — and still perhaps do not know — they were DES Daughters.

The researchers extended their analysis through 2018, examining data from women up to age 69. They concluded that their findings align with prior research, suggesting that women with in utero exposure to DES continue to have an elevated risk of CCA. 

 Arthur L. Herbst, MD, Director of the University of Chicago CCA Study, who first discovered the link between prenatal DES exposure and vaginal or cervical clear cell adenocarcinoma, told DES Action: “Even in the absence of a pap smear, the DES-exposed woman should have an annual pelvic exam where her physician fully views the vagina and cervix.” Even if the pap smear is not done annually, it is important that they have annual pelvic examinations for visual screening. Additionally, he explains, “We do not have enough data to definitively say or support that there is no upper age limit on CCA diagnoses. Since it is not known yet, this should lead to the continuation of annual exams.” 

If you or someone you know has been diagnosed with CCA of the vagina or cervix, you are asked to contact the University of Chicago Registry for Research on Hormonal Transplacental Carcinogenesis, the so-called DES Cancer Registry. Researchers appreciate your help in reporting as they work to monitor the cases of CCA of the vagina/cervix in DES Daughters or women who suspect they are DES Daughters.

Precancerous Cell Changes Caused by Human Papillomavirus Infection

High-grade squamous intraepithelial lesion (HSIL) is the term used to represent precancerous changes in cells of the cervix characteristically resulting from human papillomavirus (HPV) infection. Certain factors are known to predispose women to HSIL, such as cigarette smoking, a weakened immune system, other vaginal infections, and a family history of cervical cancer. These exposures make it more likely for HSIL to progress to cervical cancer. 

DES Daughters have been found to have an increased risk of HSIL. Early research consistently revealed their risk was twice that of unexposed women. But, because those studies were conducted during the DES Daughters’ younger years, it was unclear whether that risk continued as they aged.

A 2016 study evaluating over 4,000 women from the NCI Follow-up Study group of DES Daughters observed them for 30 years, from 1982 to 2013. The incidence of HSIL in the women with DES exposure was significantly higher in comparison to that seen in the roughly 1,800 unexposed participants. In keeping with the findings of earlier research, DES Daughters had an almost two-fold increased risk of HSIL, and this remained in effect until they reached at least 44 years of age. This increase was found to be positively correlated with DES exposure at an earlier gestational age and with higher doses.

DES DAUGHTER PAP/PELVIC EXAM
The screening exam for DES Daughters is similar to the routine pelvic examination for unexposed women, but it is more comprehensive. Print the recommendations for the DES Daughter annual exam to bring with you to your appointment. Your healthcare clinician can follow them, and you will be reassured your exam is done properly for your health indication. Here is a Pap screening fact sheet specifically for DES Daughters.

After a hysterectomy, DES Daughters should continue having annual Pap/pelvic exams. Even though the cervix was removed during surgery, DES Daughters remain at risk for CCA of the vagina and should be screened for it every year. The directions for DES Daughter annual exams should be shared with the doctor, who will focus on checking the vaginal tissue for any signs of cancer. 

Cervical cancer screening guidelines are evolving, with the August 2018 recommendation from the US Preventive Services Task Force (USPSTF) suggesting that many women can skip years between Pap exams. (Note that these screening guidelines are in the process of being updated and have not yet been finalized.) The USPSTF explicitly states this guideline does NOT apply to individuals with in utero exposure to diethylstilbestrol or those who have a compromised immune system (e.g., women living with HIV). DES Daughters can print the guidelines and highlight the exclusion to show their healthcare team. Pointing this out should help them in advocating for receiving yearly Pap/pelvic exams.

While the need for annual Pap smears for cervical cancer screening is under discussion, the recommendation for a yearly pelvic exam is also being questioned for all women. Special consideration should be given to the needs of DES Daughters, and some might say the pelvic portion of the Pap/pelvic exam is the most essential part of the screening for CCA of the vagina and cervix. Thus, the need for annual pelvic exams may be questioned for some women but not for DES Daughters.

For some DES Daughters, being told a Pap smear is abnormal had become a common occurrence, but by around age 40, many DES Daughters reported that their Pap results started coming back as normal. However, no matter what the age, there should be a follow-up appointment with a doctor after every abnormal pap.

For DES Daughters who live in countries without specific guidelines on pelvic exam and pap smear frequency, we suggest giving the US National Institutes of Health (NIH) guidelines to your doctor and asking your medical professionals to use them to guide your treatment. Access the US guidelines easily by printing the “Print and Take to Your Gynecologist” resource for professionals.

 

Breast Cancer

Risk
Breast cancer has many risk factors, and DES exposure is one of them. Previous studies have demonstrated a slight increase in breast cancer risk among DES Daughters throughout their lifetime. The latest analysis of the DES Combined Cohort Follow-up Study published in 2017 by researchers from the National Cancer Institute showed a 33% increase in breast cancer risk in DES Daughters in their 40s. 

To put this in context, the NCI’s Surveillance, Epidemiology, and End Results (SEER) Program estimates the risk that any American woman will be diagnosed with breast cancer in the next 10 years as 1.5% at age 40 to 2.4% at age 50. A 33% increase for those exposed to DES means their risk from age 40 to 50 is approximately 2–3%. 

Much of the increased risk appears to be caused by the effects of DES on fertility, mainly later age at first childbirth. More research is being done to study how DES Daughters metabolize estrogen and whether this also relates to the excess breast cancer risk. The extra risk begins to lessen after age 50, even though breast cancer risk in general — independent of DES exposure — tends to increase with age. Please see the report on this 2017 study in the VOICE Winter 2018.

Breast Cancer Screening
DES Action encourages all DES Daughters to remind their healthcare team of their increased breast cancer risk and discuss an appropriate screening protocol, which likely will include annual breast screenings and yearly clinical breast exams. DES Daughters should also pay regular attention to the appearance and feel of their breasts and report any notable changes to their doctors. Any woman with dense breast tissue (DES-exposed or not) has a higher risk for breast cancer and may need a 3D mammogram, which looks through layers of breast tissue. If you have dense breast tissue, please discuss the appropriate screening with your doctor. (See this discussion in our video interview with Dr. Gary Levine, Radiologist and Breast Screening Specialist – MemorialCare Breast Centers, CA).

Breast Cancer Type
There is no specific gene mutation or malignant tumor type of breast cancer associated with the increased risk for breast cancer among DES Daughters over the age of 40. Instead, prenatal DES exposure may increase the growth of any cells that develop into breast cancer – this potential for a more rapid growth rate results in an increased risk for DES Daughters.
Once diagnosed with breast cancer, the treatment for DES Daughters is the same as that for unexposed women.

How DES Causes Harm
A 2010 study in mice by Yale University researchers found that DES does not mutate a DNA sequence. Instead, prenatal DES exposure appears to alter the regulating system that influences how genes operate by turning them on and off. It is believed DES may cause changes in the operation of tumor-suppressing genes that can lead to breast cancer formation. 

Structural Changes of the Reproductive Tract

DES Daughters have an increased incidence of structural changes in their reproductive organs, including a T-shaped uterus. The uterine lining of a T-shaped uterus appears to be the same as that of an unexposed woman, so researchers suggest the fundamental difference (except for the shape) is in the underlying structure of the fibromusculature. Of note is that pregnant DES Daughters have an increased risk of premature delivery, whether they have a T-shaped uterus or not. 

A 2019 study published in the Journal of Human Reproductive Sciences suggests that a brief procedure called hysteroscopic metroplasty, which removes the abnormal tissue, may improve pregnancy rates and live births among patients with a T-shaped uterus. The study’s authors concluded that “hysteroscopic metroplasty is a simple procedure which can potentially improve outcomes in sub-fertile women, but the data is not robust. 

There is a need for a centralized database for registration of women with T-shaped uterine anomalies, which will help in defining clear diagnostic criteria, surgical indication & technique, and follow up of reproductive outcomes after the procedure.”

Prenatal DES exposure can adversely affect the shape and functioning of virtually the entire reproductive tract, including the vagina, cervix, uterus, fallopian tubes, and ovaries. Some DES Daughters report having an incompetent (weakened) cervix, which can be the cause of some second-trimester pregnancy losses. 

Infertility

Research has shown that DES Daughters have an increased risk for infertility. 

According to a 2001 study published in the American Journal of Epidemiology, DES Daughters exposed in utero before 9 weeks of gestation demonstrated a never-achieved pregnancy rate of 30.2% compared with a rate of 20.5% among DES Daughters whose exposure occurred later than 13 weeks into gestation. This is not unexpected, given that the reproductive tract develops during the early stages of fetal life. 

In 2011, an analysis was performed combining long-term data from three previous studies on the health conditions experienced by DES Daughters. The researchers found an increased risk of infertility in DES Daughters at a rate of 33.3% compared to 15.5% seen in unexposed women.

Treatment
In general, infertility treatments for DES Daughters are the same as for other women. Working with a doctor you like and trust is essential. 

Clomid and Uterine Cancer
Widely used for women undergoing infertility treatments, clomiphene citrate (also known as Clomid or Serophene) is implicated in an increased risk for uterine cancer. Research findings were not DES-specific, and all women should have a conversation with their doctors before taking it. 

Clomid is often prescribed early in treatment protocols, meaning many DES Daughters have been prescribed the drug through the years. If applicable, it may be worth having clomiphene use noted on your patient history so that healthcare professionals can be alert for the possibility of uterine cancer.

Ectopic Pregnancy

DES Daughters should get early confirmation of pregnancy to ensure the fetus is not developing outside of the uterus, which could cause serious complications. An NCI DES Follow-up Study found that ectopic (or tubal) pregnancy rates for DES Daughters were 14.6% compared with only 2.9% in the unexposed population.

 

Miscarriage, Stillbirth, and Preterm Labor

Several of the twelve adverse health impacts identified by NCI researchers involve DES Daughters having higher rates of complications during pregnancy compared with unexposed women. The NCI researchers found the incidence of preterm delivery was 53.3% in DES Daughters as opposed to 17.8% in unexposed women. Miscarriage rates among DES Daughters compared to unexposed women were 50.3% versus 38.6%. Stillbirths were also higher, pegged at 8.9% in DES Daughters compared with 2.6% in women not exposed to DES.

Understanding the cause of a threatened second-trimester pregnancy loss is important. Some second-trimester losses may occur in DES-exposed women because of an incompetent (weak) cervix, while others result from premature labor. This is an important distinction since treatments used in these conditions are different. 

A stitch called a cerclage may be inserted into the cervix to keep it closed if an incompetent cervix is the problem. In the case of premature labor, a cerclage would be of little use, and after careful consideration, the doctor may recommend bed rest, drugs, or both to suppress labor.

Because of their increased risks for miscarriage, stillbirth, and preterm labor, all DES Daughters should be given high-risk obstetric care starting at the earliest stage of pregnancy. Sadly, most early miscarriages are not preventable. However, careful monitoring of the cervix is warranted. 

Preeclampsia

DES Daughters have a 1.4 times higher risk for this pregnancy complication involving a form of high blood pressure and edema (fluid retention) than unexposed women. That translates into 26.4% of DES Daughters dealing with preeclampsia during pregnancy compared with 13.7% of unexposed women. This finding represents yet another reason why DES Daughters should be carefully monitored through their pregnancies as high-risk obstetric patients, even after a previous successful birth. 

Endometriosis

DES Daughters have an increased risk for this painful chronic disease in which endometrial tissue is found outside the uterus in the pelvic cavity. The tissue responds to the hormones of the menstrual cycle as if it were located inside the uterus, and thus, it thickens and then bleeds. This blood cannot leave the body by the usual route, and its presence triggers an inflammatory response, which causes pain. As the inflammation resolves, it leaves scars and adhesions that result in more pain.

Data from the Nurses’ Health Study II shows a staggering 80% higher endometriosis incidence in DES Daughters than in unexposed women. The numbers were even greater among DES Daughters who reported dealing with infertility. A review of this study, including additional information, can be read in the DES Action VOICE Spring 2005 newsletter.

A meta-analysis published in 2020 showed similar results by comparing six studies that had investigated the impact of in-utero exposures on the risk of endometriosis. When the studies’ results were combined and analyzed, the researchers found that DES Daughters had a 65% increased relative risk of developing endometriosis. That means for every 100 non-DES-exposed women with endometriosis, there are 165 DES Daughters with endometriosis. 

DES Daughters often have anatomical complications such as cervical stenosis (narrowing of the cervical canal) and changes in estrogen receptors that may increase the likelihood of developing endometriosis. 

The good news is that for most women, including DES Daughters, the pain of endometriosis disappears after menopause. 

Uterine Fibroids

These benign tumors (officially called leiomyomata) can cause pain, bleeding, infertility, and pregnancy complications. They are the leading cause of hysterectomies nationwide. 

When the responses to the Nurses’ Health Study II from 1989 to 2009 were analyzed, the results showed DES Daughters had a 12% increased incidence of uterine fibroids. This follow-up study published in 2014 revealed that the strongest correlation with fibroids occurred in those exposed to DES during the first three months of gestation. An article about this study ran in the DES Action VOICE Summer 2014 newsletter.

Investigations into the possible link between DES exposure and uterine fibroids are ongoing because other studies have shown conflicting results. A study by the NCI DES Follow-up Study published in 2005 did not find an increased incidence of uterine fibroids. 

At the same time, research conducted by the National Institute of Environmental Health Sciences (NIEHS) Sister Study did show a DES link, with larger fibroids reported by DES Daughters than women who were not exposed. That has led to the speculation that in DES Daughters, these benign tumors may have either started at an earlier age, grown faster, or both. 

As with endometriosis, for many women, uterine fibroids regress after menopause.

Paraovarian Cysts

Prenatal DES exposure is associated with an increased risk for paraovarian cysts. These are non-cancerous tumors consisting of fluid-filled sacs adjacent to the ovaries. 

Researchers with the NCI DES Follow-up Study worked with data generated in the 1990s. They pointed out that while the risk for paraovarian cysts in DES Daughters is increased, no heightened risk for ovarian cysts was found among DES Daughters. But studies are continuing.

Paraovarian cysts are common among all women in the US, and treatment generally includes surgery, depending on the symptoms of discomfort experienced. Details about this study can be viewed in the DES Action VOICE Spring 2005 newsletter. 

Adenosis

Vaginal adenosis is a condition found primarily in DES Daughters when a type of tissue develops on the surface of the vagina that is not generally found there in unexposed women. A layer of flat cells called squamous cells normally lines the vagina. 

However, DES Daughters often have glandular cells lining sections of the vagina. These are the cells normally found lining the uterus, fallopian tubes, and cervix. When glandular cells are located in the vagina, they are called adenosis. These cells can be (but usually are not) a precursor to cancer and should be carefully monitored. 

Though this condition can be asymptomatic, these extra glandular cells are to blame for secreting the profuse vaginal discharge many DES Daughters have experienced. Many DES Daughters experience a lessening of vaginal discharge as they age.

According to the latest research, there appears to be a dose-response relationship regarding adenosis. Its presence was shown to increase the earlier DES was given in the pregnancy. It was also more likely to occur with higher DES doses. 

Menopause

Earlier Menopause
A 2006 study looking at the data from the NCI Follow-up Study found that DES Daughters, as a group, tend to begin menopause slightly earlier than unexposed women, with the earliest being in those exposed to the highest cumulative doses of DES in the womb.

It appears the experience of menopause for DES Daughters is no different from that of women who were not exposed to DES. A review of this study in the DES Action VOICE Fall 2006 newsletter has a thorough explanation.

DES Daughters and HRT
There has been no research specifically looking at DES exposure and hormone replacement therapy (HRT) use and no evidence to show it is unsafe. However, since DES Daughters were exposed, in many cases, to a high level of a synthetic hormone before birth, the precautionary principle suggests DES Daughters should avoid extra hormonal exposures. 

A study on DES Daughters in the postmenopausal period titled “Estrogen Metabolism in Postmenopausal Women Exposed In-utero to Diethylstilbestrol” was published in 2018. The researchers found higher estrogen levels in DES Daughters during this life stage due to a diminished ability to break down estrogen. This finding might predispose them to an increased risk of postmenopausal breast cancer.

Writing in the DES Action VOICE Summer 2013 newsletter, DES Daughter Carol O’Leary shared her tips for surviving menopause without HRT. Menopause can be debilitating for some women whose quality of life is seriously diminished by their symptoms. In that case, if HRT is absolutely necessary, they should consider using the lowest HRT dose possible for the shortest length of time. But caution is advised. This should be discussed with a healthcare provider to determine the safest and best course of action.

Autoimmune Disease – No DES Link Except For Rheumatoid Arthritis

Despite animal research done in the 1990s that found an association between DES and autoimmune disease, there has been no confirmation of that finding in human studies, with the exception of a possible link to rheumatoid arthritis. This is vexing because DES mouse studies are usually a good predictor of the human experience.

Researchers speculate that perhaps the human cohort of participants was not large enough to tease out additional autoimmune diseases. Another theory is that those exposed to DES may develop autoimmune disorders at earlier ages than the general population. Still, the overall rate of autoimmune disease may be the same among the DES-exposed and unexposed. Read more in an article from the DES Action VOICE Winter 2011 newsletter.

Depression

DES exposure before birth may be linked to an increased risk for adult depression and anxiety. Results from the Nurses’ Health Study II published in the American Journal of Epidemiology in 2010 (with more than 76,000 participants) indicate a history of depression reported by 19.7% of DES Daughters compared with 15.9% of unexposed women. The study was reviewed in the DES Action VOICE Spring 2010 newsletter.

Since that review, a 2019 study published in the journal Epidemiology surveyed nearly 5,000 DES-exposed and over 2,700 unexposed participants in the NCI’s DES Combined Cohort Follow-up Study. Among women, 26% of DES Daughters and 23% of unexposed women reported depression. The men surveyed showed no significant difference related to DES exposure, with 17% of both DES Sons and unexposed men reporting depression. The researchers also found no statistically significant increased risk of depression in DES Children, even when limited to those taking antidepressants. 

Analysis of the findings controlled for various factors, including physical health problems, but not for a family history of depression. The authors did find a weak association between DES and depression for only DES Daughters with a low exposure dose or exposure before 8 weeks gestation: They were 1.2 times more likely to have depression than unexposed women. 

Cardiovascular Disease and Pancreatic Disorders

DES studies continue with additional medical issues now possibly linked to exposure. These conditions have been found to occur at higher rates for DES Daughters and DES Sons than for individuals who were not exposed.

  • high cholesterol
  • hypertension
  • cardiovascular disease (coronary artery disease and myocardial infarction)
  • pancreatic disorders and pancreatic cancer

Specifics on the early National Cancer Institute (NCI) DES Follow-up Study research findings are in a DES Action VOICE Spring 2013 newsletter article.

An increased risk for cardiovascular conditions was seen, including a mild association of DES exposure with hypertension and high cholesterol. Scientists have been seeing mounting evidence that endocrine disruptors like DES are implicated in increased risks for cardiovascular disease. 

Some of the previous findings were seen in a study published in October 2017. Here, the researchers were able to more clearly demonstrate an increased risk of heart attacks and an association with coronary artery disease in DES Daughters and Sons.

A possible association between DES exposure and type 2 diabetes was seen in 2013, along with a potential increased risk of pancreatic cancer. However, a 2022 study by the same lead author reviewed the 5-year follow-up data from the same NCI participants and found no increased diabetes risk. The analysis did substantiate a clear elevation in pancreatic cancer risk — but only in DES Daughters. Additionally, an association with other pancreatic disorders and pancreatitis was found in both DES Daughters and DES Sons. 

No special screenings or treatments for these conditions have been identified, but DES Daughters and Sons should stay aware of potential increased risks.

Sex, Sexuality, and Gender

Endocrine-disrupting compounds are being examined in gender identity studies, but research has not found a conclusive DES link. One confounding thought now under investigation regards the layering of endocrine disruptive exposures, both prenatally and perinatally. Researchers want to understand if there is an association and whether DES exposure might be a cause or, perhaps combined with other exposures, be a trigger for variations.

Questions have been routinely raised in the DES community regarding the possibility that prenatal DES exposure may be linked to increased rates of homosexual, transgender, and transsexual identity. Animal studies point in that direction, yet no evidence-based research in human populations has been able to confirm it. The DES Action VOICE Spring 2003 newsletter ran an article on DES and sexuality that describes what findings were seen in human studies.

In January 2020, new research from the National Institute of Health DES cohort study appeared in the Archives of Sexual Behavior titled Gender Identity and Sexual Orientation Identity in Women and Men Prenatally Exposed to Diethylstilbestrol. Until now, no credible evidence had been available to quantify the DES LGBTQ+ community in relation to those unexposed. The study sheds a bit more information on this topic and was covered in our VOICE Spring 2020. For more discussion on this study, DES exposure, and human sexuality, sex, and gender studies, click here.

To gain some insight into the struggles faced by transgender individuals, read a letter that was sent to DES Action. But note that some statements may not hold up to scientific scrutiny.

Emotional Impacts

DES Action was formed in part because DES creates emotional trauma for all who come in contact with it: DES Mothers (and Fathers), DES Daughters, DES Sons, and DES Grandchildren and beyond. It is truly an intergenerational family issue.

DES Action’s decades of outreach to those exposed to the drug have taught us that upon first learning of their exposure, some DES Daughters react with shock, disbelief, and even a sense of betrayal. Many DES Mothers respond the same way with an added layer of guilt for taking a drug that hurt their child, even unknowingly. It can strain the mother-daughter relationship even though both are innocent.

Some DES Daughters want to brush off the known risks as “not a concern” to them, only to grow more interested if they develop DES health problems. Meanwhile, others investigate all possible consequences as soon as they learn of their exposure. Other responses reported by DES Daughters are fear and anxiety when new health problems are identified.

Then, there are anger issues. Sadly, some DES Mothers feel the brunt of that emotion from their daughters. But this anger is more commonly directed against doctors, drug companies, and the world in general.

Experience shows that keeping the lines of communication open can be helpful. Staying current on the latest DES findings and health screening recommendations can open discussions with family members. 

Taking action, including being vigilant in getting proper medical care, can also reduce feelings of helplessness. 

DES As An Endocrine Disruptor

DES is an endocrine-disrupting chemical. This means it interferes with the function of the body’s hormonal system, negatively impacting development, reproduction, and metabolism and promoting disease. 

The DES community is described as the poster population for what can happen when individuals are exposed to these chemicals before birth. Their experience triggered research into endocrine disruptors and how hormonally active substances interfere with prenatal development and cause various adverse health outcomes later in life.

Another such chemical is bisphenol A (BPA), a synthetic estrogen with a very similar chemical structure to that of DES. Health impacts linked to BPA are remarkably familiar to those known to be associated with DES exposure but occur at much lower doses.

There is an essential distinction between the two that must be considered: Pay attention to the exposure dose. Here is an explanation of the similarities and differences between the two endocrine disruptors: DES and BPA.

Also, because many of these chemicals are common in our environment, rather than exposure through a drug like DES, identifying and eliminating the exposure potential can be challenging. Here’s a link for ways to reduce environmental exposures in our daily lives.

References 

 

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