Abnormal Bleeding and Uterine Fibroids
Key people: Prof Martha Hickey, Prof Peter Rogers, Dr Jane Girling, Dr Sarah Holdsworth-Carson
Heavy menstrual bleeding (HMB) is a significant social and public health issue that is thought to affect 20-50 per cent of menstruating women. It is defined as ‘excessive menstrual blood loss which interferes with a women’s physical, social, emotional and/or material quality of life’ (National Institute for Health and Clinical Excellence 2007). Development of targeted treatments has been limited by poor understanding of mechanisms responsible for heavy menstrual bleeding.
A common cause of heavy menstrual bleeding are uterine fibroids. These benign tumours are the most common tumour in women and the most common reason women choose to have a hysterectomy. Fibroids vary in size, quantity and location within the uterus. The symptoms of uterine fibroids are also hugely variable (pelvic and back pain, heavy and prolonged menstrual bleeding, enlarged abdomen, pressure pain and pregnancy complications).
Our recent work has confirmed that fibroids are derived from a single uterine cell that abnormally divides and differentiates into a multi-cellular benign tumour. Our research also suggests that the heavy menstrual bleeding associated with uterine fibroids may be regulated by different mechanisms from bleeding in women without uterine fibroids.
The variable nature of uterine fibroids leads us to question how these symptoms may be a reflection of fibroid location/size/quantity, how to better treat and diagnose this common gynaecological disease and whether invasive surgical procedures to remove fibroids can be avoided.
We have a unique opportunity to utilise a new minimally invasive therapy for symptomatic uterine fibroids called Magnetic Resonance guided Focused Ultrasound (MRgFUS) for fibroid-related research. This treatment is used to identify and treat individual uterine fibroids. At the Women’s, we collect uterine tissues from women scheduled for treatment of their fibroids with MRgFUS and use these tissues to identify differences in genes and cells among women with and without problem bleeding. It is hoped that the information we generate will allow us to identify genes involved in fibroid development and the cause of the related symptoms, which may lead to new and better therapeutic targets.