NICHD research on uterine fibroids aims to learn more about what causes them, how they grow, factors related to who develops them, and fibroid treatments. As part of this research, NICHD scientists are exploring genetics, hormones, the immune system, and environmental factors that may play a role in starting the growth of fibroids or in continuing that growth.
An interim goal is to find a solution that does not involve removing the uterus. The long-term goal of this research is to eliminate fibroids from being a factor in women’s health at all.
NICHD research efforts related to uterine fibroids address this condition specifically, as well as some of the more general aspects of fibroids within the context of improving women’s health. Studies include efforts to understand:
- Epidemiology of uterine fibroids. Researchers believe that many women of childbearing age could have fibroids without knowing it, although these cases may not all be clinically significant.1 Likewise, certain factors, such as being African American, being older, having obesity, and having never been pregnant, increase the risk for fibroids. Some studies also suggest that women who undergo certain types of assistive reproductive technology are at higher risk for fibroids. NICHD research aims to understand the genetic and environmental factors that contribute to or prevent fibroids.
- Etiology of fibroids. These studies look at altered cell differentiation, tissue hyperproliferation, hormone interaction, cell signaling defects, altered mechanisms, and other topics about some of the general and specific mechanisms and factors that lead to fibroid growth.
- Treatments for fibroids. Hysterectomy is currently the only sure way to treat fibroids, and fibroids are a major reason many women have hysterectomies.2 NICHD research is seeking solutions to the symptoms of fibroids that don’t require removal of the uterus, such as medication and other mechanical means that leave the uterus (and a woman’s fertility) intact. Some of the more cutting-edge technologies include gene therapy and magnetic resonance imaging (MRI)–guided laser therapies.
- Clinical challenges of fibroids. Uterine fibroids and fibroid symptoms pose challenges not only to clinicians who provide ongoing treatment to affected women but also to clinical researchers who are studying the causes and course of fibroids in humans. NICHD research aims to bring advances in technology and clinical research to examine the problem of uterine fibroids.
Institute Activities and Advances
Through its intramural and extramural organizational units, NICHD supports and conducts a broad range of research on uterine fibroids. Short descriptions of this research are included below.
- Proteins help identify cells from the uterus that can become fibroids. Researchers discovered two proteins that can act as signposts, identifying certain types of cells that can grow into fibroids. Knowing how to spot these fibroid-growing cells will help scientists find ways to treat them. (PMID: 25658015)
- Exposure to pollution may increase fibroid risk. Some research shown that pollutants like pesticides and industrial chemicals can affect human hormones and may increase the risk of hormone-related disease. In this study, researchers found that women who were exposed to certain pollutants were more likely to be diagnosed with uterine fibroids. (PMID: 24802554)
- Cholesterol drugs may lower fibroid risk. Medications called statins are used to treat high cholesterol, but they may also help slow the growth of some types of tumors. In this study, researchers found that women who took statins were less likely to develop uterine fibroids or have fibroid symptoms. (PMID: 27371355)
- Researchers compare two fibroid treatments. A study comparing uterine artery embolization (UAE) and MRI-guided ultrasound for fibroids found that women who underwent UAE had longer recovery times and used more prescription medication but that ultrasound treatment required more time. (PMID: 28063909)
- Some fibroid risk factors remain poorly understood. A mutation in the MED12 gene has been linked to uterine fibroids. Of all racial groups studied, black women have the highest risk for fibroids, but they are not more likely than other groups to have the MED12 mutation. (PMID: 29666002)
- Fibroids do not increase risk of pregnancy loss. Researchers studied 900 couples undergoing fertility treatments. They found that uterine fibroids did not reduce a woman’s chance of having a successful pregnancy. (PMID: 28089575)
Other Activities and Advances
To achieve its goals for uterine fibroid research, NICHD supports a variety of other activities. Some of these activities are managed through the components listed above; others are part of NIH-wide or collaborative efforts in which NICHD participates. Some of these activities are listed below.
- NICHD’s Gynecologic Health and Disease Branch published its scientific vision, which summarizes research themes and provides direction for future research. The vision document is available at https://www.nichd.nih.gov/sites/default/files/2018-06/GHDB_ScientificVision_2018.pdf (PDF 1.6 MB).
- NICHD also held a conference on classification of uterine fibroids in 2007. A summary of that conference is available at http://www.sciencedirect.com/science/article/pii/S0015028210024635.
- The Human Endometrial Tissue and DNA Bank, supported through the FI Branch, aims to be an evolving bioinformatics resource for genes associated with the uterus. More information about the Tissue Bank is available at https://obgyn.ucsf.edu/center-reproductive-sciences-0 .
- Agency for Healthcare Research and Quality (AHRQ). (2007). Management of uterine fibroids: An update of the evidence. AHRQ Publication No. 07-E011. Retrieved June 13, 2017, from http://archive.ahrq.gov/downloads/pub/evidence/pdf/uterupdate/uterup.pdf (PDF 2.25 MB)
- AHRQ. (2005). The FIBROID Registry: Report of structure, methods, and initial results. AHRQ Publication No. 05-RG008. Retrieved June 13, 2017, from http://archive.ahrq.gov/research/fibroid/
- Catherino, W. H., Leppert, P. C., Stenmark, M. H., Payson, M., Potlog-Nahari, C., Nieman, L. K., et al. (2004). Reduced dermatopontin expression is a molecular link between uterine leiomyomas and keloids. Genes, Chromosomes & Cancer, 40(3), 204–217. Retrieved June 13, 2017, from http://onlinelibrary.wiley.com/doi/10.1002/gcc.20035/abstract;jsessionid=3BB1D23398422CF08AA1E966E3ACB25E.d01t04
- Leppert, P. C., Baginski, T., Prupas, C., Catherino, W. H., Pletcher, S., & Segars, J. H. (2004). Comparative ultrastructure of collagen fibrils in uterine leiomyomas and normal myometrium. Fertility and Sterility, 82(3), 1182–1187. Retrieved June 13, 2017, from http://www.fertstert.org/article/S0015-0282(04)01135-5/abstract
- Leppert, P. C., Catherino, W. H., & Segars, J. H. (2006). A new hypothesis about the origin of uterine fibroids based on gene expression profiling with microarrays. American Journal of Obstetrics and Gynecology, 195(2), 415–420. Retrieved June 13, 2017, from http://www.sciencedirect.com/science/article/pii/S0002937806000068
- Norian, J. M., Malik, M., Parker, C. Y., Joseph, D., Leppert, P. C., Segars, J. H., et al. (2009). Transforming growth factor β3 regulates the versican variants in the extracellular matrix-rich uterine leiomyomas. Reproductive Sciences, 16(12), 1153–1164. Retrieved June 13, 2017, from http://rsx.sagepub.com/content/16/12/1153.long
- Rogers, R., Norian, J., Malik, M., Christman, G., Abu-Asab, M., Chen, F., et al. (2008). Mechanical homeostasis is altered in uterine leiomyoma. American Journal of Obstetrics and Gynecology, 198(4), 474.e1–474.e11. Retrieved June 13, 2017, from http://www.sciencedirect.com/science/article/pii/S0002937807022399
- Norian, J. M., Owen, C. M., Taboas, J., Korecki, C., Tuan, R., Malik, M., et al. (2012). Characterization of tissue biomechanics and mechanical signaling in uterine leiomyoma. Matrix Biology, 31(1), 57–65. Retrieved June 13, 2017, from http://www.sciencedirect.com/science/article/pii/S0945053X11000898