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Concerns about gaps in knowledge about women's health across the life span are what spurred the National Institutes of Health (NIH) to establish the Office of Research on Women's Health (ORWH) in 1990. Until then, women could not be ensured of inclusion in clinical research that would impact both men and women.
Clearly biomedical and behavioral research is needed to address conditions and diseases that affect women. Cardiovascular disease (CVD), in particular, is of concern because it is a leading cause of death in women. Yet until 1990, most studies of CVD prevention and treatment had been done only in men or in populations that were predominantly male.
Today, we have policies that require including enough women in clinical trials for valid analysis of sex/gender differences in health status and response to treatments. Studies of conditions specific to women, too, are of great importance because they help us understand how these problems may affect women's longevity or their ability to be physically and mentally active.
Recent advances in biomedical research have helped us better understand fibroids, and led to new clinical approaches to their evaluation and management. Recently, ORWH sponsored an international meeting on uterine leiomyoma research, in collaboration with the National Institute of Environmental Health Sciences and the National Institute of Child Health and Human Development (NICHD) and other NIH institutes and agencies of the Department of Health and Human Services.1 Congress participants learned about discoveries in the epidemiology, genetics, and pathobiology of uterine fibroids that have clinical implications (see http://orwh.od.nih.gov/health/uterinefibroidmtg.html).
For example, studies suggesting a possible molecular link between leiomyomas and keloids related to abnormal mature collagen led to a new hypothesis about the role of genetic alterations in initiating development of uterine leiomyomas. New theories about the role of estrogen biosynthesis in uterine fibroid growth underscore the potential impact of hormones. Clinical registry data on results with uterine artery embolization were encouraging. And new research was presented on alternative management strategies, including selective progesterone-receptor modulators and GnRH and somatostatin analogs.
Among the topics for future leiomyoma research are assessment of risks and benefits of various treatments, particularly differences in short-term complications and long-term outcomes; characterization of the best candidates for different treatment options, through factors such as race, ethnicity, and age; identification of the type and degree of follow-up necessary with each type of management; and how much treatment costs. To facilitate expanded studies of uterine leiomyomas, ORWH will also support the establishment of a tissue repository for uterine leiomyoma and normal myometrial samples with researchers in the NICHD that would provide a source of tissue samples available to the research community.
The ORWH will continue to encourage and support research that will pursue new concepts about the pathogenesis, epidemiology, genetics, clinical management, and therapeutics of uterine leiomyomas that can be integrated into clinical practices. We are also committed to supporting sex-specific studies and sex/gender comparisons that are critical to furthering our knowledge about the many conditions, diseases, environmental factors, and behaviors that may affect women's health across the life span. Our ultimate goal is improved evidence-based strategies for the clinical care of women.
1. Meeting Highlights. NIH International Congress on Leiomyomas. Contemporary OB/GYN Newsline. July 2005. Available at http:// http://www.contemporaryobgyn.net/obgyn/article/articleDetail.jsp?id=168479.