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What is diethylstilbestrol?

Diethylstilbestrol, or DES, is a synthetic (man-made) form of estrogen. Estrogen is a female hormone. DES was given to millions of pregnant women between 1938 and 1971. It was discontinued in the United States in 1971. That is when researchers discovered that it increased some women’s chances of developing cancer. DES was used in other countries until at least the early 1980s.

DES was given to pregnant women to prevent complications during pregnancy. These could include having a miscarriage or giving birth too early. Researchers found that the daughters of the women who used DES were more likely to get a certain kind of cancer of the vagina and cervix (called clear cell adenocarcinoma, or CCA). These women are sometimes called “DES daughters.”

Has DES caused any other problems?

Yes. Women who took DES during pregnancy have a slightly increased risk of getting breast cancer. Daughters of women who took DES during pregnancy also may have a higher risk of breast cancer.

Up to one-third of DES daughters have reproductive tract problems. These problems increase their risk of not being able to get pregnant. They also raise the risk of having a miscarriage or having a baby too early. Even with the increased risk, however, most of these women have no problem getting pregnant and delivering healthy babies.

The sons of women who took DES during pregnancy (sometimes called “DES sons”) have a higher risk of some reproductive tract problems, as well. These can include abnormally small or undescended testicles. However, these men seem to have normal fertility.

Path to improved health

How do I know if I was exposed to DES?

If you were pregnant between 1938 and 1971, try to remember if you may have taken a prescription medicine during your pregnancy. If you did, try to get your medical records from the doctors who took care of you. Remember, DES was used in other countries until the early 1980s.

If you were born between 1938 and 1971, ask your mother if she remembers taking any prescription medicine during her pregnancy.

Things to consider

I took DES during pregnancy. What should I do?

The increase in your risk of getting breast cancer is small. But you should still tell your doctor that you took DES during pregnancy. They will discuss this risk factor with you. They will most likely recommend regular breast screenings and medical exams.

Be sure to tell your children that you took DES during your pregnancy. Encourage them to tell their doctors.

I am a DES daughter. What special health care needs do I have?

Be sure to tell your family doctor that you were exposed to DES.

If you have never had a pelvic exam, your doctor will want you to have one. Your doctor will check your vagina, uterus, cervix, and ovaries for lumps. Your exam may also include a colposcopy. This is an exam in which your doctor uses an instrument (called a colposcope) to magnify the view of the tissues in your vagina and cervix.

It is important to have pelvic exams and Pap smears every year.

I am a DES son. What special health care needs do I have?

Tell your family doctor that you were exposed to DES. Your doctor will recommend that you follow routine health screenings. You also should report any urinary or genital problems to your doctor.

Questions to ask your doctor

• I took DES when I was pregnant. What is my risk of developing cancer?
• I was exposed to DES before I was born. What is my risk of developing cancer?
• How common are these types of cancer?
• What other reproductive problems might I have because of my exposure to DES?
• Can a woman’s use of DES affect future generations beyond sons and daughters?

Resources

National Cancer Institute: Diethylstilbestrol (DES) and Cancer

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What is metabolic syndrome?

Metabolic syndrome is the term used to describe a set of risk factors for heart disease. These include high blood pressure, high cholesterol, and diabetes or high blood sugars.

What is insulin resistance?

Your body changes most of the food you eat into glucose (a form of sugar). Insulin is a hormone produced by the pancreas. Insulin allows glucose to enter all the cells of your body and be used as energy.

For some people, over time, their body’s tissues stop responding to insulin. Doctors refer to this condition as insulin resistance. If you have insulin resistance, your body will make more and more insulin. Because your tissues don’t respond to it, your body can’t use glucose properly.

How does this relate to metabolic syndrome?

Insulin resistance often goes along with other health problems. These include obesity, diabetes, high cholesterol, and high blood pressure. These problems are all risk factors for heart disease. When a person has many of these problems at the same time, doctors commonly call it metabolic syndrome. It is sometimes called insulin resistance syndrome or metabolic syndrome X. Many people who have type 2 diabetes also have metabolic syndrome.

Symptoms of metabolic syndrome

For the most part, metabolic syndrome does not have any true signs or symptoms. If you gain weight around your waist, it can be one indicator of metabolic syndrome.

But some of the other diseases that go along with metabolic syndrome do have symptoms. These include possible frequent urination and unusual thirst when you have diabetes.

What causes metabolic syndrome?

A number of factors can act together to cause metabolic syndrome. A person who takes in too many calories and too much saturated fat and does not get enough physical activity may develop metabolic syndrome. Other causes include insulin resistance and a family history of the risk factors for metabolic syndrome.

How is metabolic syndrome diagnosed?

Your doctor will do a physical exam and blood tests. He or she can diagnosis metabolic syndrome if at least 3 of the following are true:

• You are overweight or obese, and you carry the weight around your middle. For men, this means a waist that measures greater than 40 inches around. For women, it means a waist that measures greater than 35 inches around.
• You have higher than normal blood pressure (130/85 mm Hg or greater).
• You have a higher-than-normal amount of sugar in your blood (a fasting blood sugar of 100 mg/dL or greater).
• You have a higher-than-normal amount of fat in your blood (a triglyceride level of 150 mg/dL or greater).
• You have a lower-than-normal high-density lipoprotein (HDL) cholesterol level (an HDL level less than 40 mg/dL for men and less than 30 for women). HDL cholesterol is the “good” cholesterol.

The more of these risk factors you have, the higher your risk of heart disease.

Can metabolic syndrome be prevented or avoided?

A healthy lifestyle can help prevent metabolic syndrome. This includes losing weight if you’re overweight. It also includes getting more physical activity and eating a healthy diet. Also, if you smoke, you should stop.

Metabolic syndrome treatment

If you already have metabolic syndrome, making these healthy lifestyle choices can help reduce your risk of heart disease and other health problems. If lifestyle changes alone can’t control your risk factors for heart disease, such as high blood pressure, your doctor may prescribe medicine to help.

Maintain a healthy weight.

Your doctor can measure your body mass index (BMI) to determine a healthy weight for your height. He or she can help you make a plan to lose weight if you’re overweight, and to maintain your weight through a healthy diet and regular physical activity. Carrying extra weight in your abdomen is especially unhealthy. Losing this weight or exchanging it for muscle weight will improve health.

Get more physical activity.

Not being active is one of the biggest risk factors for heart disease. It’s important to get exercise on a regular basis. Start by talking with your family doctor, especially if you haven’t been active for a while. You may need to begin with some light exercise, such as walking. Then you can gradually increase how hard you exercise and for how long. A good goal for many people is to work up to exercising 4 to 6 times a week for 30 to 60 minutes at a time. A minimum of 150 minutes a week is best for good health. Two days of resistance or strength training each week is also recommended for health. Your doctor can help you set a goal that’s right for you.

Eat a healthy diet.

When combined with exercise, a healthy diet can help you lose weight, lower your cholesterol level, and improve the way your body functions. Foods high in dietary fiber should be a regular part of your diet. You should eat several servings of fruits, vegetables, and whole-grain bread every day. Also, limit the amount of saturated fat, trans fat, sodium (salt), and added sugar in your diet.

Living with metabolic syndrome

Improving your heath through diet and exercise if often enough to prevent metabolic syndrome. You may also need to take medicine for diabetes, high cholesterol, and high blood pressure. Being proactive about your health will help reduce your risk for heart disease.

Questions to ask your doctor

• I have type 2 diabetes or prediabetes. Is it possible I have metabolic syndrome?
• I have metabolic syndrome. Should I be screened for diabetes?
• Should I talk with a dietitian about changing the way I eat?
• What kind of exercise is best for me?
• Are there any medicines I should take for metabolic syndrome?
• My mother has diabetes. Am I at higher risk of developing metabolic syndrome?

Resources

National Institutes of Health: What Is Metabolic Syndrome?

National Institutes of Health, MedlinePlus: Metabolic Syndrome

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If you have depression, your doctor may prescribe medicine to treat it. This medicine is called an antidepressant. There are many types of antidepressants. Finding the one that’s right for you can take time. It’s important to work with your doctor to find it.

Path to improved health

Your doctor will consider many factors when choosing the antidepressant medicine to give you:

• If you were depressed before and a certain antidepressant worked well, that medicine might be the right choice for you again.
• If any of your brothers, sisters, parents, uncles, or aunts had depression and a certain antidepressant worked well for them, that medicine might work for you, too.
• The choice of an antidepressant depends on your health. Certain antidepressants may have a bad effect on a health problem you have. That medicine wouldn’t be the right choice for you.
• Antidepressants can have side effects. The right medicine for you may be the one that gives you the fewest side effects.
• The choice of an antidepressant may depend on how often you must take it. It is important to take antidepressants as prescribed and daily medications may make this easier.
• Some antidepressants cost more than others. Your doctor will choose an antidepressant that works for you and your budget.
• Your doctor will likely choose a medicine they have experience prescribing.
• Some antidepressant can help you with sleeplessness, anxiety, and lack of energy if these are part of your symptoms.
• If you’re taking other medicines, your doctor will consider how an antidepressant will work with these other medicines.
• Some antidepressants don’t work well with certain foods. If your doctor gives you one of these antidepressants, they will let you know which foods you should stop eating.

Keep in mind that antidepressant medicines are not “downers”  or “uppers.” You will not get  high when you take them. They are not addictive.

You’ll know if your antidepressant is working based on how you feel. You’ll be able to sleep better. You’ll have more energy to meet your day-to-day obligations. You can take care of yourself. Your appetite will be closer to normal. You’ll have an increased desire to engage in life. You and your family and friends will notice these changes. Be patient, though. It may take some time to get back to the way you felt before the depression.

While antidepressants can help with symptoms of depression, that’s only part of the treatment. These medicines work best when you try to have an active lifestyle with exercise, get eight hours of sleep a night, and eat healthy foods. Your doctor may also recommend working with a counselor to help you improve the thoughts of depression.

How to take antidepressants

Antidepressants are usually taken every day. It can take 1 or even 2 months to see the full results. You may need to try different doses or change medications to find the antidepressant that works best for you.

Your doctor will let you know how long to take your antidepressant. If this is the first time you have been treated for depression, you will probably continue to take this medicine for at least 6 months after you begin to feel better. If this is the second time you’ve been depressed, you might keep taking the medicine for at least a year. Depression that comes back a third time may require you to continue taking an antidepressant for a longer time.

Do not stop taking antidepressants suddenly.  You can get unwanted side effects if you stop taking your antidepressant suddenly. If you want to stop taking your medicine, talk to your doctor first. They can try to help you avoid these side effects.

Alcohol and antidepressants

Talk to your doctor about drinking alcohol while taking an antidepressant. You should be careful about drinking until you know how the medicine affects you. The effects of alcohol can combine with the effects of the antidepressant and cause problems. Regular heavy drinking can make it harder to treat depression. Certain kinds of medicine can lead to seizures for heavy drinkers.

Antidepressants and other medicines

Antidepressants can effect many other medicines. If you’re taking an antidepressant, tell your doctor about all other medicines you take, including over-the-counter (OTC) medicines and herbal health products (such as St. John’s wort). They can let you know if your regular medicines may cause problems when combined with an antidepressant.

Antidepressants for children and teens

In some cases, the use of antidepressants has been linked to an increase in suicidal thoughts and behavior in children, teens, and young adults. The Food and Drug Administration (FDA) now requires antidepressants to carry a warning about the risk of suicide in children, teens, and young adults 24 years of age or younger. However, this doesn’t mean that people in this age group shouldn’t take antidepressants. It means they should be carefully monitored by their doctor and loved ones while taking the antidepressant.

Many doctors will want to see a child or teen sometime in the first few weeks after starting an antidepressant to assess any risk for suicide. If you’re worried your child may be suicidal, call your doctor right away or take your child to the nearest emergency room.

Things to consider

All antidepressants have some side effects. However, not all people taking antidepressants have these side effects. Most of the side effects happen in the early weeks of therapy and lessen over time. You may experience the following:

• Anxiety
• Bladder problems
• Blurred vision
• Constipation
• Diarrhea
• Dizziness when standing up
• Dry mouth
• Excessive tiredness
• Feeling of weakness
• Hand tremors
• Increased heart rate
• Increased sleepiness
• Insomnia
• Muscle twitching
• Nausea
• Sexual dysfunction (inability to ejaculate or to have an orgasm)
• Tremor
• Vomiting
• Weight gain or loss

Talk to your doctor if these side effects don’t go away. They may change your dosage or suggest another medication.

Considerations for women

If you’re planning to get pregnant, talk to your doctor about your medicines before you try to get pregnant. If you accidentally get pregnant while taking an antidepressant, tell your doctor right away. Your doctor will know if your antidepressant is safe to take while pregnant.

Most medicines you take can pass into your breast milk. That means it may be passed on to your baby. If you’re planning to breastfeed or you currently breastfeed, talk to your doctor about your medicine.

In most cases, it’s okay to take birth control pills or hormone replacement therapy (also called HRT) at the same time as depression medicines. Taking hormones may even help some depressed women feel better. However, if your birth control pills seem to be causing symptoms of depression, discuss it with your doctor. They may suggest you use another method to prevent pregnancy for several months to find out if your birth control pills are causing depression.

Antidepressant discontinuation syndrome

Antidepressant discontinuation syndrome can occur if you suddenly stop taking your antidepressant medicine. Antidepressant discontinuation syndrome is not dangerous or life threatening. It usually goes away within a week. The symptoms include:

• Anxiety
• Feelings of sadness
• Irritability
• Fatigue
• Headaches
• Nausea and vomiting
• Dizziness

You’re more likely to have antidepressant discontinuation syndrome if you stop taking certain antidepressants, such as paroxetine and sertraline. However, you can get symptoms from stopping any antidepressant medicine.

If you accidentally missed a dose of your antidepressant medicine, start taking it again as soon as possible. If you’re out of medicine, call your doctor so they can refill your prescription.

If you decided to stop taking your antidepressant medicine on your own, talk to your doctor about why you stopped. For example, was the medicine causing an unpleasant side effect? Did it cost too much? Your doctor can help by altering your dosage or suggesting another antidepressant.

If your doctor recommended you take a lower dosage of your medicine and you’re experiencing symptoms of antidepressant discontinuation syndrome, talk with your doctor. You may need to take a higher dosage before weaning your body from the medicine completely.

To keep antidepressant discontinuation syndrome from happening again, take your medicine exactly as your doctor tells you. If you want to stop taking it, talk to your doctor first. Just because you’re unable to stop taking your medicine suddenly doesn’t mean you’re addicted. Your body often needs time to adjust to lower levels of the medicine. That’s why your doctor may recommend tapering off an antidepressant rather than abruptly stopping it.

Questions to ask your doctor

• How can I know if I have depression?
• Are there ways to treat depression that don’t involve medicine?
• If I am depressed, should I also be talking to a mental health professional?
• Are there coupons I can use to help lower the cost of antidepressants?
• How long will it take to get the dosage right for my medication?
• How will I know the medicine is working?

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