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New branch works to improve gynecologic health from adolescence to menopause
The Gynecologic Health and Disease Branch (GHDB) may be new to NICHD, but its work is not. In 2013, the institute established the branch to bring a more targeted focus to its gynecological health research.
In June 2014, clinical gynecologist Lisa Halvorson, M.D., was appointed GHDB’s first chief. She came to NICHD from the University of Texas Southwestern Medical Center, where she did research on reproduction and fertility and cared for patients in her medical practice.
We sat down with Dr. Halvorson in the lead-up to National Women's Health Week (May 10–16, 2015) to talk about the branch and what she hopes it will accomplish on behalf of women’s health.
Follow the links below to read Dr. Halvorson's extended comments.
Q: Tell us about your background and what led you to NICHD.
I always had a passion for biology, specifically reproductive biology, women’s issues, and research. I originally thought I would get a Ph.D., but while I was in college I realized that, really, I wanted a more direct impact on patient care. So I decided to go to medical school and once there, because of my interests, gynecology was a natural direction, particularly since I found that I enjoyed both medicine and surgery. Gynecology allows you to do both.
I spent many years in academic medical centers, where I treated patients, ran my own molecular biology laboratory, and taught medical students, residents, and postdoctoral fellows. As I developed in my career, I became more involved in committees and in administrative work, and I realized that I wanted the opportunity to impact women’s health more broadly. And that’s what brought me to my position here.
Q: How does your experience as a clinician and a researcher influence your work at NICHD?
I think that my experience as a physician and an independent investigator will be very helpful in my ability to understand this job and to do it well.
First, having seen patients and understood where their problems are and the limitations of the treatments we have available will, hopefully, give me a leg up in understanding some of the directions that we need to go. And second, my experience as an investigator helps me understand some of the pressures and restrictions that scientists out in the extramural community have to live with.
Much of what I did before in my lab was to interpret the data that we were generating, to read the literature, to speak to other experts in the field, and to put all of that information together—really synthesize it to figure out which experiments were important to do next.
I’m really doing that same thing now, just in a broader context. I’m thinking about specific areas of research, techniques, topics, and ways in which NICHD can help to fund others to develop the specific experiments that they are going to run. So it’s really the same process, just at a broader level.
Q: What is the Branch's mission?
This branch promotes research that’s going to give us insight into gynecologic diseases and into their prevention and treatment. The mission of the branch is really very broad and it is to address gynecologic conditions starting at adolescence right on through the reproductive years and into the perimenopausal and early menopausal years.
Gynecologic diseases and conditions include irregular menstrual cycles, fibroids, endometriosis, pelvic floor disorders, chronic pelvic pain, and vulvodynia. There are other groups at NIH and within NICHD that look at some of these issues, but mostly as they impact a woman when she’s trying to get pregnant or as she’s trying to choose a contraceptive. The mission of our branch is to look outside those times in a woman’s life and try to learn more about these disorders.
Some of these diseases have racial disparities. For example, fibroids are more common among African-American women, and we’re very interested in finding out more about those disparities. My hope is that my branch can give all women the best possible treatment options for them as individuals.
Q: How does having a branch that is focused on gynecological health help NICHD and the field?
Medicine and research are very complex. By having a branch that’s focusing on this area, we can efficiently use the resources that we have to address the problems that we see in gynecological disease. And so hopefully, by having this branch, we’re using NICHD resources wisely and moving the field along as quickly as possible.
Q: What are some of the important areas of research for the branch for the next few years?
As you can imagine, as a new branch there are a lot of things that we would like to get done as quickly as possible. We certainly want to continue some of our high-priority, high-profile areas, including our Women’s Reproductive Health Research Career Development Program and the Pelvic Floor Disorders Network. We will also continue work on chronic gynecologic pain disorders, including vulvodynia.
But as a new branch, we also want to build new directions. As I said, my background has been in basic science—molecular biology—and so one of our new initiatives is going to be to apply genomics and epigenomics to these gynecologic disorders.
Q: When you say you will apply genomics to research on gynecological disorders, what do you mean?
In terms of the genomics, there are new powerful techniques that allow us to look at specific DNA sequences and how they may differ across populations. And these differences may predict who will get a disorder, how severe the disorder will be, and which treatment is likely to be most successful for the individual. These approaches are already being used very effectively in the cancer field and may be applicable to gynecological disorders.
Another area that I’d like to promote is the small business grant programs, applying small business options to gynecologic disorders. There are many technologies being developed that could be effectively applied to a lot of these conditions. I also think we need to look at more multidisciplinary approaches to chronic gynecologic pain conditions.
Q: Can you give me some examples of the types of technologies that might benefit from small business programs?
There are some medications coming out that are going to be useful in the treatment of endometriosis or fibroids. There are some diagnostic approaches for pelvic organ prolapse—ultrasound as well as some nonradiologic approaches. There are some neurostimulation approaches being used for incontinence. And a lot of these technologies would take a mix of academic and small business partnerships to really move them forward.
Q: What kind of advances do you see coming out of the branch-funded research in the near term?
There are many areas in which I see advances being made. One of them is the work being done through the Pelvic Floor Disorders Network. They are interested in pelvic organ prolapse as well as urinary incontinence and fecal incontinence. In particular, they are looking at the effectiveness of available treatments and whether specific treatments should be applied to specific women. Not all women are going to be optimally treated by one approach or the other.
For example, with urinary incontinence they’re developing some new surgical treatments. For fecal incontinence, there are some new neurostimulatory approaches that are being developed. There is a lot of hope that we’re going to know what the best treatments are, how to apply them, and even see some new developments on the relatively near horizon.
Q: Why is it important to train the next generation of researchers and research clinicians?
Part of our job now is to mentor up-and-coming investigators, to help them maximize their talents and their success in getting grants so that they can use their new ideas and new enthusiasm to really effectively approach the problems that we have.
We have some institutional training grants in my branch. We have a large network of institutions through the Women’s Reproductive Health Research Career Development Program, which we call the WRHR. The WRHR is focused on obstetricians and gynecologists as they transition into independent research careers.
We also help to support the Building Interdisciplinary Research Careers in Women’s Health program, which supports both M.D.s and Ph.D.s who are interested in women’s health issues.
Q: What advice do you have for new investigators?
I would advise them to not be shy about identifying their own mentors. We all need mentors at all stages of our careers. We need the various perspectives, the encouragement. Mentors can be older, they can be younger; they can be further along in their careers, they can just be colleagues. They can tell you that they understand your pain and that you’re on the right track. So I think mentoring’s important. There’s a lot to do and a lot of reasons to do it; it’s very satisfying.
Q: National Women's Health Week takes place in May. Do you have a specific message for women that would fit the spirit of the week?
I think the spirit of National Women’s Health Week blends in perfectly with the mission of the Gynecologic Health and Disease Branch; that is, we want women to be healthy. And what does that require? It’s a lot of things that we all know about but don’t really do as well as we could: Eat well, keep our weight down, exercise, quit smoking if we smoke, try to get plenty of sleep, and go see our health care provider, whether that be a gynecologist, internist, or family practice physician. It means that we should make sure that we’re up to date on our vaccines, Pap smears, on any routine testing that we need.
Broadly speaking, good health care is also good gynecologic health care.
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