April 19, 2022
Consider a woman’s typical menstrual cycle: while its length can vary, the average period occurs once every 28 days. The menses phase, when women bleed, generally lasts between three to five days. Many women experience a variety of symptoms during or around menses, including cramping, fatigue, bloating, and more.
Now factor in the up to 80 percent of women who will develop uterine fibroids in their lifetime. These benign uterine tumors, which are four times more common in women of color, do not always result in physical symptoms. However, many women with fibroids experience symptoms that are quite severe, including periods lasting longer than a week, multiple periods, passing blood clots vaginally, pelvic pain, anemia, pregnancy complications, and infertility, among others.
For decades, fibroid treatment has been limited to surgery for the most severe case, with a myomectomy (removal of the tumor) or hysterectomy (removal of the uterus) being the most common procedures, both of which can be life-threatening depending on the severity of the case. Many women who do not have surgery can experience painful symptoms for decades with no relief. This is especially common in underrepresented communities, where women do not always have access to medical care. Also, the social stigma surrounding menstruation results in many affected individuals not talking about their symptoms and just attributing it as “part of being a woman.”
Enter Ayman Al-Hendy, Professor of Obstetrics and Gynecology at the University of Chicago. Specializing in complex gynecological conditions, Al-Hendy’s current research focuses on why uterine fibroids disproportionately affect women of color and how new treatments can potentially improve fibroid patients’ quality of life.
“Fibroids usually develop during womens’ reproductive age through menopause,” Al-Hendy said. “For women of color, however, fibroids tend to develop much earlier. Women of color also tend to experience more significant and severe symptoms due to fibroids.”
Al-Hendy is one of a team of physicians who collaborated on the development of two new oral treatments for uterine fibroids. The first treatment, ORIAHNN, received U.S. Food and Drug Administration approval in 2020, becoming the first FDA-approved oral treatment for uterine fibroids. Another oral treatment, Myfembree, received FDA approval in 2021. Both pills are designed to reduce symptoms associated with uterine fibroids and help more patients avoid a surgical treatment option that could potentially affect fertility.
“Fibroids typically resolve themselves following menopause, so the oral treatments are a great option,” Al-Hendy said. “They inhibit ovulation, so women also cannot get pregnant while taking the medication, making it an ideal treatment for younger women and particularly young women of color who typically experience fibroid-related symptoms at an earlier age. Also, fibroids sometimes improve after pregnancy, so women who temporarily go off the oral treatment to get pregnant may no longer need it after giving birth.”
Phase 3 clinical trials of these two new medications were featured in the New England Journal of Medicine in 2020 and 2021. Each study included about 800 participants. Results indicated significant improvement in fibroid symptoms and quality of life, with an average 70% response rate six months after beginning the oral treatment and up to a 90% response rate after one year.
“Fibroids have been a surgical disease for centuries, and it’s time we make them a medical disease again,” Al-Hendy said. “It will take a while to shift the way people think about this, but once the oral treatments become more common, I think it will start to kick in.”
Al-Hendy is also studying the biology of fibroids in women of color. Another research project funded by the National Institutes of Health focuses on understanding why fibroids are more common in women of color. The study is currently focused on exploring whether certain environmental factors, such as air or food pollution, could potentially affect estrogen and in turn impact fibroid development. Vitamin D deficiencies are also being investigated as a possible fibroid link. Although the study is currently based in the U.S., Al-Hendy plans to expand the research to include several African countries as well.
In addition to his work on uterine fibroids, Al-Hendy is also exploring stem cell-based therapy to treat female infertility. This research focuses on two diseases, premature ovarian insufficiency (POI) and polycystic ovarian syndrome (PCOS), both of which can prevent women from ovulating or getting pregnant. Limited options exist for women with these conditions who wish to become pregnant, and often using an egg donor is the only option for a successful pregnancy, ruling out the option of giving birth to one’s own biological child.
Al-Hendy is developing a new treatment involving use of a patient’s own bone marrow stem cells, which are laparoscopically injected into the ovary to make it more responsive. The result is that ovaries are stimulated to produce eggs with the end goal leading to a successful pregnancy. Past studies in animals have been extremely successful, with ovary response rates generally improving within two to three weeks and the animal continuing to be fertile for 90 days following the procedure. The offspring of animals were similar to those in the healthy control group.
In 2021, approval was granted to test the procedure in humans, and while no human pregnancies have yet resulted, Al-Hendy says initial data is very promising. Future procedures will be done transvaginally rather than laparoscopically, making them less invasive. Al-Hendy is currently seeking approval to test the procedure using donor stem cells, which he hopes will happen this summer.
For more information about Al-Hendy’s research, visit his laboratory website.