Exogenous estrogens and endometrial carcinoma.

Over the past 5 years the cases of 8 young women with severe atypical endometrial changes while taking Oracon sequential contraceptives have been reviewed. The average age of the 8 patients was 40.1 years gravity and parity ranged from 0 to 6 and average Oracon usage was 6 years. Oracon is the only contraceptive agent that contains dimethisterone. In 6 cases abnormal uterine bleeding while using Oracon prompted diagnostic prcedures. In 2 cases the condition was found after hysterectomy for other causes. Only Stage 1 disease with no myometrial invasion was found in the 7 patients diagnosed adenocarcinoma. In 1 case only severe atypical endometrial hyperplasia was found. All 7 adenocarcinomas were well differentaited with a clear-cell pattern in 4. Squamous metaplasia was observed in 1. Long duration of ingestion of the drug and higher dosage increased the patients risk of developing adenocarcinoma. All 8 patients had hysterectomies so the further development of these conditions could not be determined. Oracon has recently been withdrawn from the market because of the risk. Therefore close attention should be given to women with a history of Oracon usage. Estrogen dosage should be kept as low as possible while providing menopausal symptom relief. The length of therapy should be short.