The following information describes the branch’s research programs and program areas.
Program Official: Candace Tingen
This program supports studies that investigate the processes of normal menstruation and menstrual disorders across all reproductive ages with a focus on etiology, prevention, treatment, genetic predisposition, racial/ethnic differences, and environmental influences. Abnormal menstrual bleeding (irregular or excessive bleeding) affects quality of life and can herald underlying gynecologic pathology. Examples include the presence of endometrial polyps, uterine fibroids, adenomyosis, structural abnormalities, or anovulatory conditions including polycystic ovary syndrome, outside of their impact on fertility. Emphasis is placed on promoting research of periods of reproductive transition (including puberty/adolescence).
Program Official: Candace Tingen
Uterine leiomyomata (fibroids) represent the most common benign gynecologic tumor in women and are associated with an array of detrimental health effects including abnormal uterine bleeding, pelvic pain, infertility, miscarriage, and preterm labor. They represent a significant reproductive health disparity, with African American women diagnosed two to three times more frequently than Caucasian women. The mechanisms that initiate fibroid growth are poorly understood, resulting in limited therapeutic approaches. Additional investigation into the pathogenesis of fibroid development and growth is aimed at development of effective and safe conservative treatments.
Program Official: Lisa Halvorson
Endometriosis (endometrial tissue outside the uterus) affects approximately 10% of women of reproductive age and contributes significantly to the development of pelvic adhesions, infertility, ectopic pregnancy, and chronic pelvic pain. Adenomyosis, defined as the presence of endometrial tissue within the uterine muscle (myometrium), may be associated with pelvic pain, pressure symptoms on the bowel and bladder, abnormal uterine bleeding, infertility, and pregnancy loss. Current prevalence estimates range from 10-30% by the fifth decade of life, with higher rates in women with concurrent endometriosis. Although adenomyosis and endometriosis share several features and may co-exist, current thinking is they should be considered distinct entities due to differences in risk factors, pathogenesis, and clinical presentation. Additional investigation is required regarding the key factors that contribute to the initiation, establishment, and progression of these disorders. Gaps remain in our understanding of the pathophysiology of these disorders, with particular interest in the importance of genomics, epigenomics, and progenitor/stem cells. The development of sensitive, less invasive diagnostics will advance development of improved therapeutic options with a focus on non-hormonal alternatives.
Program Official: Donna Mazloomdoost
GHDB supports research on pelvic floor disorders, which encompass pelvic organ prolapse, urinary incontinence, fecal incontinence, and other disorders of the lower gynecologic, urinary, and gastrointestinal tracts. According to the National Health and Nutrition Examination Survey, pelvic floor disorders affect almost one-quarter of women between ages 20 to 80. As the U.S. population ages, the number of women with pelvic floor disorders is expected to increase substantially.
This program focuses on the accumulation and analysis of high-quality evidence to inform directed methods for the prevention, diagnosis, and treatment of pelvic floor disorders. Additional interests include the identification of risk factors for the development of pelvic floor disorders, such as genetic predisposition, obstetric history, and the presence comorbid conditions.
Emphasis is also placed on characterization of the cellular and molecular changes that occur in the lower genital tract. Obstetric fistula and female genital cutting, areas germane to the international and immigrant communities, are also included in the portfolio.
Studies in this program area are funded through investigator-initiated independent funding mechanisms as well as through the Pelvic Floor Disorders Network (PFDN).
Program Official: Jennie Conroy
This program supports clinical, translational, and basic research on gynecologic pain conditions including chronic pelvic pain, painful menses (dysmenorrhea), and vulvodynia. Vulvodynia remains a poorly understood chronic pain syndrome, representing a complex, multifactorial clinical syndrome of unexplained vulvar pain and sexual dysfunction. Symptoms also may be associated with the urinary and gastrointestinal tracts and other pain syndromes. This elusive chronic pain syndrome continues to have many unexplored questions that would benefit from stimulation of research that focuses on prevalence, etiology, and potential treatment regimens. Additional information is available in the NIH Research Plan on Vulvodynia.
Of particular interest are multidisciplinary investigations to delineate the genetic, environmental, and psychosocial factors underlying the etiology of chronic gynecologic pain disorders. Current research efforts focus on a wide range of topics within the field of chronic gynecologic pain, including the characterization of various gynecologic pain phenotypes in order to improve diagnosis, as well as identification of pharmacologic and non-pharmacologic treatment approaches. The overall goal of these research efforts is to build a substantive scientific knowledge base, reduce the burden of gynecologic pain syndromes, and improve the quality of life for women affected by these conditions.