GHDB Research Programs

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 typical 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 anomalies, or anovulatory conditions including polycystic ovary syndrome, outside of their impact on fertility. Menstrual function during reproductive transitions (including puberty/adolescence) throughout the lifespan is also an area research interest for the branch.

Program Official: Candace Tingen

Uterine leiomyomas (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 Black/African American women diagnosed two to three times more frequently than White 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 uterine-sparing treatments.

Program Official: Candace Tingen

Endometriosis (endometrium-like tissue that grows 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, 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% to 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, they are currently considered as 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 PFDs, which encompass pelvic organ prolapse, urinary incontinence, fecal incontinence, and other disorders of the female lower gynecologic, urinary, and gastrointestinal tracts. According to the National Health and Nutrition Examination Survey, PFDs affect almost one-quarter of women between ages 20 to 80. As the U.S. population ages, the number of women with PFDs is expected to increase substantially.

This program supports the accumulation and analysis of high-quality evidence to inform directed methods for the prevention, diagnosis, and treatment of PFDs. Additional interests include the identification of risk factors for the development of PFDs, 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 this 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: Helena Ahn

This program supports clinical, translational, and basic research on gynecologic pain conditions including chronic pelvic pain, painful menses (dysmenorrhea), dyspareunia, vulvodynia, and vestibulodynia. These chronic pain conditions remain poorly understood, but represent complex, multifactorial clinical syndromes of unexplained pain and, often, sexual dysfunction. Symptoms also may be associated with the urinary and gastrointestinal tracts and other pain syndromes.

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 prevalence and etiology, the characterization of various gynecologic pain phenotypes 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.

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