From Endometriosis to Asherman’s: Ob/Gyn Chair Tackles the Toughest Cases
You grew up in Easton, Conn., where you developed a love of science and nature. What appealed to you about Ob/Gyn?
Since childhood, I’ve loved the natural world and being outdoors. That, combined with how I like to work with people, drove me to biological sciences and to medicine. I always knew I was going to do research and that I wanted to be a physician. At some point in college, I said, “I’m going to do both.” And I stuck to that. Luckily, being a physician-scientist is a wonderful career.
What really attracted me to Ob/Gyn is the long-term relationships you can form with patients. Plus, Ob/Gyn offers preventive medicine and primary care, but can also involve surgery. I’ve always loved that full spectrum of care and continuity with patients. I love to focus on what’s important to my patients. I love making people feel better, but I also have this desire to really understand things at a fundamental, molecular level.
I was drawn to reproductive endocrinology and infertility because of my interest in uterine development, fertility issues, and then later, endometriosis and related issues.
You were pivotal in shifting the thinking about endometriosis as a condition that only causes symptoms in the pelvic region. Can you talk about this?
Yes, that is something I have championed—changing the paradigm to show that endometriosis affects multiple organ systems. People now describe endometriosis as a systemic disease. We were the first to use that term and to show that it is not just the lesions in the pelvis, but that it can also affect the heart, brain, and metabolism.
This helps us understand endometriosis better. Many women have had symptoms that were dismissed because we didn’t have that comprehensive understanding of the disease, and it is validating for them to have their diffuse symptoms all come together under a single diagnosis.
Directly as a result of our work, we now know the condition is a much bigger problem than just lesions in the pelvis. However knowing this, we can also find new ways to treat it. We aren’t focusing on surgical treatments, and we’re also moving away from hormonal treatments. Instead, we have discovered several other treatments for endometriosis that involve understanding what molecular pathways are active, and treating those.
We’ve published research that explore nonhormonal treatments including immune therapies and microRNAs, which are small RNA molecules that regulate gene expression. And our big push now is looking at the immunology of endometriosis and at how inflammation is involved. This has helped us understand why some people have a lot of pain and some don’t as well as develop new treatments.
What is the focus of your clinical trial for Asherman’s syndrome?
We have a pilot clinical trial underway. It’s the only one in the country that can potentially help patients when surgery for this condition hasn’t been successful.
In Asherman’s syndrome, the lining of a woman’s uterus is scarred and very thin. The lining can’t grow into the nice, lush environment that supports an embryo.
In the general population, Asherman’s syndrome is rare. But among women who can’t get pregnant, it’s not uncommon. It’s heart-wrenching when someone can’t get pregnant or is having recurrent miscarriages because of Asherman’s. That’s why it’s so important for us to offer women treatment and new hope. And I believe we can!
Two of our faculty are doing basic research to try and understand Asherman’s and its causes. One of the ways the uterine lining heals when it gets severely damaged is by recruiting stem cells from other areas of the body. What we’ve shown in our animal models is that if we administer a drug that mobilizes one’s own stem cells from the bone marrow, and therefore more stem cells are in circulation where they can reach the uterus—the stem cells can repair the endometrium.
How has the way we talk about women’s gynecologic health changed?
A generation or two ago, we didn’t talk about many gynecologic issues in public. We didn’t talk about menopause, about having periods, about things like endometriosis. And many of the gynecologic problems we weren’t discussing are very common. Endometriosis affects 10% of the population. A quarter of women in the general population have symptomatic, problematic uterine fibroids at some point in their life.
For too long, these topics were in the shadows and taboo. Thankfully, we are more open as a society now and we feel freer to talk about these things. If people don’t speak up about the issues they are having, they won’t get appropriate treatment, and it is more difficult to inspire research to make real progress in women’s health.
What advice do you have for women when they experience a health problem?
If your doctor's not listening it to you, find a new one. Get a second opinion, and find a specialist in whatever problem you have. Often that means going to an academic center that is studying your condition, where they have the most up-to-date information and latest technologies.
