Status of Research on Uterine Fibroids (leiomyomata uteri)

 at the National Institutes of Health

Compiled by the Office of Research on Women’s Health, NIH, DHHS

March 2006

Introduction 

Uterine fibroids (leiomyomata uteri) are the most common benign (non-cancerous) 

tumors that are present in the muscular wall of the uterus of women over 30 years of age 

and are more common in African American women (1-2). According to current

textbooks of medicine, it is estimated that leiomyomas are present in 20-25 percent of 

reproductive age women but are 3 - 9 times more frequent in black than in white women 

(3). However, a recently completed epidemiological study of uterine fibroids by the 

National Institute of Environmental Health Sciences (NIEHS) (4) found that by age 50 

the cumulative incidence of uterine fibroids was over 80 percent for African American 

women and about 70 percent for white women. These numbers are much higher than 

reported from medical records. The differences suggest that while many women have 

fibroids, not all have clinically symptomatic fibroids and seek medical care. Data 

suggests that large fibroids cause more symptoms than small fibroids, leading scientists 

to question what causes fibroids to grow and become clinically symptomatic. 

However, fibroids are one of the leading causes for hysterectomy in the United States. 

Even though they are benign, fibroids may cause reproductive problems such as uterine 

enlargement, heavy or abnormal uterine bleeding, pelvic pressure, severe cramping, pain, 

infertility, and miscarriage. Research is beginning to provide information about why 

fibroids develop or why they grow. 

Fibroids result in a substantial cost to the United States health care system. A recent 

study (5) has found that the disease results in 2.1 billion dollars in direct costs annually, 

1.7 billion of which are a direct result of inpatient hospital costs due to hysterectomy. 

These expenses are disproportionately borne by African-American women due to the 

increased prevalence of the condition in that racial and ethnic group (6). Building upon 

their studies of gene regulation in uterine fibroids (7-9), National Institute of Child Health 

and Human Development (NICHD) intramural investigators have noted similarities 

between fibroids and keloids, a disorder of wound healing that is also increased 

disproportionately in African-Americans (10). The NICHD intramural team has noted 

that the shared abnormalities in formation of connective tissue between keloids and 

fibroids raise the possibility of a genetic predisposition that may explain the increased

prevalence of the two conditions (11,12). The results of these studies build upon the 

Fibroid Growth Study conducted by the National Institute of Environmental Health 

Sciences (NIEHS), that revealed fibroid growth greater than 3 inches (5 centimeters) was 

largely due to deposition of connective tissue, not an increase in cell number (13). 

1
There has been much recent attention to research on uterine fibroids, and progress is 

beginning to be encouraging and revealing. In a trans-NIH effort, the Office of Research 

on Women’s Health (ORWH) served as the lead convener to a February 2005 conference 

entitled, Advances in Uterine Leiomyoma Research: 2nd NIH International Congress,

held at NIH (14, 15). Primary NIH sponsors included: the National Institute of Child 

Health and Human Development (NICHD), the National Institute of Environmental 

Health Sciences (NIEHS), the National Cancer Institute (NCI), the National Center for 

Research Resources (NCRR) and the National Institute of Biomedical Imaging and 

Bioengineering (NIBIB); other collaborators were the Centers for Disease Control and 

Prevention (CDC), Food and Drug Administration (FDA), Agency for Healthcare 

Research and Quality (AHRQ), Health Resources and Services Administration (HRSA), 

Substance Abuse and Mental Health Services Administration (SAMHSA), and Office on 

Women’s Health (OWH), Office of the Secretary, Department of Health and Human 

Services (DHHS), representing a truly comprehensive effort to assess the current state of 

knowledge about fibroids. This conference brought together extramural and intramural 

researchers from across the United States and from other countries, clinicians, patient 

advocates, and others to explore such timely topics as the disease burden and clinical 

manifestations of fibroids, and the epidemiology, genetics, and pathobiology of fibroids. 

There was much excitement as advances in knowledge and new research tools were 

described. The summary of this conference is in press (15). 

One major development resulting from a recommendation during the international 

congress was the collaboration of the ORWH with NICHD intramural investigators to 

establish a fibroid tissue bank that will promote research on fibroid disease by providing 

access to tissue samples for NIH-funded investigators throughout the world. 

The National Institute of Environmental Health Sciences (NIEHS) 

Despite the morbidity and high medical costs associated with fibroids, there has been 

little epidemiological study of this condition. African-American women have been 

thought to be at higher risk, but because this supposition was based on hysterectomy

statistics, it was not known if this was a true difference or was due to differences in 

diagnosis and treatment. The NIEHS Uterine Fibroid Study, an epidemiologic study of 

uterine leiomyomata in women age 35-49, randomly selected from membership in a 

prepaid health plan in Washington, DC, was initiated in 1996 to better define the cause of 

this health disparity. Ultrasound screening of premenopausal women and medical record 

review of surgically menopausal women provided data to estimate age-specific 

cumulative incidence. The data showed that more than 80 percent of black women and 

about 70 percent of white women develop fibroids before they reach menopause. Health 

disparity issues for uterine fibroids are reflected in the high prevalence statistics and in

the fact that African American women have larger and more numerous tumors. Data 

from the study have been analyzed to identify risk factors for fibroids. Earlier 

menopause, fewer births after age 24, alcohol intake, and a physically inactive lifestyle 

were factors associated with fibroid development in both African American and white 

women. Prenatal DES exposure and higher circulating LH levels (Luteinizing Hormone 

– a hormone produced by the pituitary to promote ovulation) were also linked to fibroid 

2
development. NIEHS is currently examining vitamin D and IGF-1 (Insulin-like Growth 

Factor-I – a protein found in tissue and blood that stimulates the growth of cells). 

Participants in the study were recontacted in 2001 and 2004 to monitor symptom

development and treatment choices. The following site provides a description of the 

NIEHS study on fibroids: http://dir.niehs.nih.gov/direb/studies/ufs/home.htm 

 

Uterine Fibroid Growth Study: The Fibroid Growth Study is designed to investigate why 

some fibroids grow to become health problems while others do not. Funding is provided 

jointly by the NIEHS and the National Center for Research on Minority Health and 

Health Disparities (NCMHD). Scientific direction and oversight is provided by NIEHS. 

The University of North Carolina Hospitals, the General Clinical Research Center and the 

Integrated Laboratory Systems, Inc. are collaborators in this research. The study has four 

specific aims. First, fibroid growth will be evaluated over time by magnetic resonance 

imaging (MRI). Second, the relationship between fibroid growth and symptoms or 

outcome (i.e., surgery/no surgery) will be determined. Third, markers that may be related 

to growth will be identified. Lastly, hormone and lifestyle factors that may be related to 

fibroid growth will be examined. It is hoped that the findings from this study will help 

develop strategies to prevent fibroids in women at high risk for problems and develop 

new therapies that reduce the need for radical surgical procedures like hysterectomy. 

More information about the Fibroid Growth Study is available at: 

http://www.niehs.nih.gov/fibroids/home.htm 

Environmental Estrogens and Fibroids - a Rat Model: The environmental components of 

this disease, such as exposures to estrogens, phthalates, and solvents are currently under 

study using exposure assessment methods in women with fibroids coupled with 

mechanistic studies in cell culture systems and animal models. One hypothesis derived 

from mechanistic studies is that uterine smooth muscle tumor cells closely resemble 

normal uterine smooth muscle cells during pregnancy but have escaped controls that 

cause these cells to regress or die. Specifically, the pregnancy-like phenotype allows 

these cells to proliferate in response to estrogens, estrogen-like compounds, and other 

environmental cues. However, the neoplastic cells fail to regress or die as do normal 

smooth muscle cells at the time of parturition (delivery) when supraphysiological levels 

of prostaglandins, oxytocin, and other parturition-related hormones trigger the contractile 

response of the uterus during labor and remodeling of the uterus after delivery. Studies 

conducted using the Eker rat as an animal model for uterine leiomyoma support the 

research hypothesis. For example, treatment of young rats with estrogenic compounds 

like diethylstilbestrol (DES) accelerates the growth of the leiomyoma, while tumor 

incidence in aged rats is significantly reduced with multiple pregnancies and deliveries. 

The NIEHS/NCMHD epidemiologic study on fibroids has confirmed these relationships 

in women: pregnancy is protective, and prenatal exposure to DES is associated with 

increased incidence of fibroids in adulthood. 

Environmental Estrogens and Fibroids - In Vitro Human, Potbellied Pig, and Mouse 

Comparisons/Model Systems: Intramural research at the NIEHS has focused on defining 

the pathogenesis of fibroids in humans and model systems, and in assessing the role of 

environmental and endogenous factors in the induction of this disorder. In vitro model 

3
systems for studying fibroids are limited in that human derived leiomyoma cells grow 

poorly in culture and begin to senesce early. Investigators at the NIEHS have overcome 

these obstacles with the creation of an hTERT immortalized uterine leiomyoma cell line. 

This cell line will help to advance in vitro research in understanding the mechanisms of 

fibroid development and in identifying targets for treatment intervention strategies. The 

NIEHS is also assessing the utility of the potbellied pig as a model for spontaneously 

occurring fibroids. Unlike commercially raised hogs, potbellied pigs provide an aging 

population, with the life span estimated to be as long as 20-25 years, with an average of 

10-15 years. Intact potbellied pig females are subject to cyclic hormonal influences about 

every 21 days, somewhat approximating the year-round cyclic hormonal influences of the 

menstrual cycle in women. The potbellied pig appears to have a high incidence of 

spontaneous fibroids, previously unrecognized due to the low-density and scattered 

distribution of pet pigs. Studies are underway to understand the biological relevance of 

these tumors to fibroids found in women. In determining the role of environmental 

agents in fibroid growth and development, researchers at the NIEHS have found that in 

mice, prenatal and neonatal exposures to DES result in uterine leiomyomas similar to 

those observed in women. This model will be useful in elucidating molecular 

mechanisms by which environmental agents possibly induce or influence this disease.

An NIEHS grantee at the University of Texas MD Anderson Cancer Center is working to 

understand the etiology of uterine leiomyoma at the molecular level and to elucidate the 

molecular mechanisms by which exposure to endocrine disruptors may impact the 

development of these tumors. One of the aims of this project is to determine if loss a 

tumor suppressor gene function is an alternative pathway for development of leiomyoma. 

In addition this researcher is attempting to determine if the prepubertal period is a 

window of susceptibility for exposure to environmental exposures and determine at the 

molecular level whether this exposure impacts the expression of genes that may 

contribute to the development of leiomyoma. These experiments will yield new insights 

into the molecular mechanisms responsible for the altered responsiveness of uterine 

leiomyomas to endogenous and exogenous hormones and increase our understanding of 

the potential mechanisms by which exposure to endocrine disruptors could contribute to 

the development of this disease. 

Another NIEHS funded study at Vanderbilt University proposes to significantly increase 

our understanding of environmental toxins and uterine gene expression. Specifically, the 

investigators describe a series of experiments to elucidate the mechanisms underlying the 

early and late estrogenic responses. They propose to test the hypothesis that the early 

responses are estrogen receptor independent, but that they initiate a cascade of events to 

prepare targets for the later estrogenic dependent events. Determination of this early and 

late response cross talk may provide information translatable to other estrogenic target 

tissues and may provide a better understanding of how fibroids develop. Finally, these 

studies may provide essential mechanistic data to evaluate how environmental toxins 

influence uterine disease. 

4
National Cancer Institute (NCI) 

Uterine fibroids or uterine leiomyomata (singular: leiomyoma) are the most common 

gynecologic tumors in women. Although they are usually non-cancerous, they are often 

associated with infertility and account for about 200,000 hysterectomies and 18,000 

myomectomies performed annually in the U.S. The following are summaries of NCIfunded projects related to uterine fibroids research: 

A project directed at resolving the controversy concerning the relative contributions of

progesterone and estrogen in the development of leiomyomas will use normal and 

neoplastic myometrium (muscular wall of the uterus) to examine the hormonal 

mechanisms that regulate the process. The study uses a progesterone receptor (PR) 

knockout mouse to study the role of PR in myometrial proliferation and tumorigenesis. 

Results from this study will provide insight into factors affecting leimyomata 

development and could help in designing better therapy. The availability of DNA 

microarray technology has resulted in gene expression data for many types of tumors, and 

the researchers of one study are developing data mining tools and computer programs for 

analysis of this data with the long-term goal of applying these methods to cancer 

discovery and classification. Uterine leiomyomata are among the tumor types being 

studied in this grant. 

National Center for Research Resources (NCRR) 

The National Center for Research Resources develops and supports critical research 

technologies and resources which underpin and advance health-related research 

supported by the NIH and other research organizations. Through the General Clinical 

Research Center (GCRC) and the Research Centers in Minority Institutions (RCMI) 

Programs, NCRR supported four fibroid research subprojects in FY 2005. In the future, 

NCRR will continue to support the clinical research infrastructure for investigators 

conducting fibroid research. 

Scientists at the University of North Carolina, Chapel Hill General Clinical Research 

Center are developing strategies to prevent fibroid problems and new therapies that may 

reduce the need for radical surgical procedures like hysterectomy. 

At the GCRC at Pennsylvania State University Hershey Medical Center, scientists are 

using serial ultrasound to determine if oral contraceptives accelerate fibroid growth and 

accelerate the development of new fibroids in women with existing fibroids. 

Scientists at Meharry Medical College utilize the RCMI-supported Clinical Research 

Center to collaborate with investigators at Penn State. They are determining the role of

oral contraceptives in the development and growth of uterine fibroids using serial 

ultrasound evaluations in African American and Hispanic women. In addition, scientists 

are also evaluating serum and urine levels of sex steroids to determine if African 

5
American women produce higher levels of these hormones than their Caucasian and 

Hispanic counterparts. These studies are of particular interest because of the increased 

prevalence of uterine fibroids in African American women as compared to other racial 

and ethnic groups in the United States. 

National Institute of Child Health and Human Development (NICHD) 

Uterine fibroids constitute a significant public health concern. While uterine fibroids 

represent the most common gynecologic tumor in women, the mechanisms that initiate 

uterine fibroids growth and pathogenesis are not completely understood. This disorder is 

clinically important because it is a significant source of abnormal uterine bleeding, 

anemia, and pelvic pain and pressure. These symptoms frequently lead to various medical 

and/or surgical interventions. Surgical procedures are of primary concern because uterine 

fibroids remain the leading indication for a hysterectomy in the United States. Thus, both 

the economic costs and effect on quality of life can be substantial. Increased emphasis on 

a condition that poses a serious reproductive threat for many women and represents a 

disproportionate burden for African American women would enhance our ability to 

preserve the fertility and reproductive health of all women. 

NICHD Initiatives: Several recent NICHD-sponsored research initiatives have been 

announced. The objectives of these initiatives are to strengthen research in this critical 

area of women’s health, contribute to reducing the burden of this disease, and improve 

the quality of life for women affected with this disorder. The Leiomyomata Uteri: Basic 

Science and Translational Research Program, in collaboration with ORWH, supports 

eight projects funded in 2003. The Cooperative Reproductive Science Research Centers 

at Minority Institutions Program, in collaboration with ORWH and NCRR, supports a 

clinical research project on uterine fibroids at Meharry Medical College. The Women’s 

Reproductive Health Research (WRHR) Career Development Program, in collaboration 

with ORWH, is an ongoing training and career development program for junior ob/gyn 

physician scientists. The WRHR Program is located at 20 medical schools and 

universities nationwide. 

Overview of NICHD Research: To address the need for increased attention in this area, 

the NICHD in collaboration with ORWH sponsored the Leiomyomata Uteri: Basic 

Science and Translational Research Program. The long-term goals of this initiative 

include strengthening the science base, improving our understanding of how uterine 

fibroids develop and grow, and providing clues to more effective conservative 

management that would go a long way to preserve the fertility and reproductive health of 

all women. 

The eight NICHD extramural projects that were funded in the fall of 2003 highlight 

major areas of basic science and translational research. In one study, the investigators are 

examining how female sex hormones activate specific proteins that may promote uterine 

cell proliferation and tumor growth through the creation of a microarray that is suitable 

for profiling the expression of selected genes in women of different ages and racial 

6
groups. Another research project is initiating a genome-wide screen to characterize the 

genetic pathways and genetic liability for developing uterine fibroids, with particular 

emphasis on racial overexpression in African American women. One other project is 

investigating the pathophysiology of uterine fibroids from the point of view of gene 

interactions. Understanding cell death and cell survival pathways active in uterine 

fibroids may help explain long-term tumor regression. To increase our understanding of 

the molecular mechanisms of estrogen-dependence in uterine fibroids, scientists are 

investigating the relationship with the immune response and treatment associated with a 

selective estrogen receptor modulator in animal and human cell lines. 

In another study, the focus is on selected enzymes responsible for estrogen biosynthesis 

that are produced locally in uterine fibroids and the critical roles they play in the growth 

and development of fibroids. One line of research is targeting the role that growth factors 

and hormones play in the pathogenesis of uterine fibroids. The investigators are 

reviewing gene interactions and their relationships to hormones and connective tissue that 

may contribute to fibroid growth. To advance our current knowledge about the molecular 

regulation of uterine fibroids, scientists are identifying the mechanisms responsible for 

cell cycle regulation in uterine fibroids that may explain the differences among tumors. 

Animal models and human cell lines are being used to assess whether fibroid tumors 

develop as a response to injury. This type of insult can promote cell proliferation that is 

stimulated by growth factors and hormones. 

Other NICHD-supported extramural scientists are approaching this area of research from

several fronts. One research project is exploring how defective cell cycle regulation and 

estrogen receptor signaling pathways contribute to our understanding the regulatory 

mechanisms involved in growth and regression of uterine fibroids in women who have 

received gonadotropin releasing hormone analogues. Another study is investigating the 

use of high intensity focused ultrasound treatment for uterine fibroids as a new 

therapeutic modality. To find an effective alternative medical treatment for symptomatic 

fibroids, investigators are studying an antiprogestin in a clinical trial to determine if there 

is improvement in the quality of life when compared to a placebo. Since many women 

with fibroids use oral contraceptives and hormones are thought to stimulate fibroid 

growth, a clinical trial is enrolling women on oral contraceptives to determine if there is 

acceleration in the growth rate of their uterine fibroids. Another research project is 

concentrating on the natural history of fibroids during and after pregnancy. These 

investigators are also exploring the association of fibroids with specific adverse 

pregnancy outcomes in a diverse cohort of over 3,000 women from 13 counties in North 

Carolina. 

NICHD intramural investigators have continued to explore the mechanisms responsible 

for fibroid development and growth through basic and translational research studies 

conducted on campus, and in collaboration with the NCI, NIEHS, the Department of 

Obstetrics and Gynecology at the Uniformed Services University of the Health Sciences, 

and the University of South Florida in Tampa. In the past 3 years the group has 

conducted and published several research papers on uterine fibroids (6-12, 16, 17). The 

advances in understanding of disease development arose of genetic studies, which 

7
indicated that uterine fibroids have many features in common with a disorder of 

pathologic wound healing, keloids. The connective tissue generated by the cells 

comprising uterine fibroids is markedly abnormal and this fact may contribute to fibroid 

growth, as abnormally-formed connective tissue can not be remodeled and absorbed as 

would normally-formed connective tissue. Collectively, the results of the studies 

suggested that the abnormal secretion of this connective tissue may contribute the 

persistence and growth of uterine fibroids (12). These findings may explain why some

therapies (such as GnRH agonist) provide only temporary reduction in size, and do not 

result in long-term benefit. 

The NICHD intramural team has also initiated clinical trials of new medical therapies for 

uterine fibroids that do not induce a ‘medical menopause.’ A current trial should be 

concluded within a few years. A second trial using a medication designed to interfere 

with formation of the connective tissue is being launched, based upon the translational 

studies conducted by NICHD investigators. A third line of clinical research pursued by

NICHD investigators involves genetic conditions where uterine fibroids are associated 

with renal cancers in collaboration with other investigators at the NIH. 

Studies have shown that African-American women pursuing advanced treatment for 

infertility, such as in vitro fertilization, do not achieve the same rates of success as 

Caucasian women for reasons that were unclear but access to medical care was suspected 

to be a factor. In the past two years, NICHD intramural investigators examined this issue 

in a setting where access to medical care was not a barrier to care. The team observed that, 

in fact, the presence of uterine fibroids in African-American women was largely, if not 

entirely, responsible for the reduction in success of advanced infertility treatment (18).

Office of Research on Women’s Health (ORWH) 

ORWH considers research related to uterine leiomyoma (fibroids) and other benign 

gynecologic disorders as important priorities for women’s health research. Given the 

prevalence of these conditions in all women, and the health disparities found for this 

disorder among women of color, ORWH has actively collaborated across the NIH, with 

other Federal partners, the extramural scientific community and advocacy groups to 

expand research in this area. 

ORWH served as the lead convener to a February 2005 conference entitled, Advances in 

Uterine Leiomyoma Research: 2nd NIH International Congress, held at NIH (14, 15). 

Primary NIH sponsors included: NICHD, NIEHS, NCI, NCRR, and NIBIB; other 

collaborators were CDC, FDA, AHRQ, HRSA, OWH, and SAMHSA. This conference 

brought together extramural and intramural researchers, clinicians, patient advocates, and 

others to explore such timely topics as the disease burden and clinical manifestations of 

fibroids, the epidemiology, genetics, and pathobiology of fibroids. The conference also 

included extensive discussions of recent advances in the clinical management, 

translational research frontiers, including clinical trials and new therapeutic targets that 

are being evaluated for the treatment of fibroids. 

8
ORWH has maintained and expanded its collaborations to co-fund of research related to 

uterine fibroids with several NIH institutes and centers, as well as with AHRQ. During 

fiscal year 2005, ORWH co-funded a number of research grants that focus on the basic 

science related to uterine fibroids, the study of the alternatives to hysterectomy and 

intermediate outcomes of hysterectomy. 

The ORWH is co-funding with NICHD a basic science initiative that focuses on 

leiomyomata uteri, with a special emphasis on the biological processes that lead to their 

development, and their long-term sequelae. The objective of this important program is to 

strengthen research in this critical area of women's health, contribute to reducing the 

burden of this condition, and improve the quality of life for women affected with this 

disorder. Some of these grants focus on identifying genes that predispose women to 

develop fibroids and the genetic contributions to the etiology, growth and natural history 

of these tumors, and possible gene-environment interactions. Factors related to the 

immune response that may permit the use of targeted therapies are being evaluated in 

another project and may eventually serve as a non-surgical alternative. Numerous studies 

are focusing on the molecular mechanisms of estrogen-dependence in certain fibroid 

tumors, and the molecular regulation of uterine leiomyoma. Additional projects focus on 

elucidating the cellular, molecular and biochemical mechanisms regulating the 

proliferation and motility of human uterine smooth muscle cells. 

ORWH is currently co-funding a major research study with AHRQ that focuses on 

uterine fibroids, alternatives to hysterectomy and intermediate outcomes of hysterectomy. 

This project expands on a prospective longitudinal study of 811 women with noncancerous uterine conditions of which uterine fibroids are the most common and for 

which hysterectomy is considered a reasonable treatment option. These conditions also

include abnormal bleeding, symptomatic uterine leiomyomata, and pelvic pain or 

endometriosis. This study addresses the differences in clinical and quality of life 

outcomes at 4 to 8 years among women who have participated in three different treatment 

options (hysterectomy, uterus-preserving surgery, or non-surgical treatments) for their 

uterine conditions. This study will also develop predictive models of treatment choice 

and satisfaction from a broad array of domains. 

New in fiscal year 2005, ORWH funded with NICHD the establishment of the first ever 

Leiomyoma Tissue Bank to address the problem of tissue availability for research. This 

tissue bank will provide samples to NIH-funded investigators and Department of Defense 

investigators on an on-going basis, thereby facilitating expanded research activities 

focusing on fibroids. 

9
References: 

1. DeCherney, A.H., Nathan L. Current Obstetric & Gynecologic Diagnosis & 

Treatment (9th Ed); 2003. p. 693. 

2. Blaustein’s Pathology of the Female Genital Tract (5th Ed); 2002 p.564. 

3. DeCherney, A.H., Nathan L. Current Obstetric & Gynecologic Diagnosis & 

Treatment (9th Ed); 2003. p. 693. 

4. Baird et al, Am J Obstet Gynecol. 2003; Baird and Dunson, Epidemiology 2003. 

5. Flynn M, Jamison M, Datta S, Myers E. Healthcare resource utilization due to 

uterine fibroids in the United States. In press. 

6. Payson M, Leppert P, Segars JH. Epidemiology of Myomas. Obstet. Gynecol.

Clin. NA. In press. 

7. Tsibris JCM, Segars J, Enkemann S, Coppola D, Wilbanks G, O’Brien WF, 

Spellacy WN. New and old regulators of uterine leiomyoma growth from 

screening with cDNA arrays. Fertil. Steril. 80:279-81, 2003. 

8. Catherino WH, Prupas C, Tsibris JCM, Leppert PC, Payson M, Nieman LK, 

Segars JH. Strategy for elucidating differentially expressed genes in leiomyoma 

identified by microarray technology. Fertil. Steril. 80:282-90, 2003. 

9. Catherino WH, Salama A, Potlog-Nahari C, Leppert PC, Tsibris J, Segars JH. 

Gene expression studies in leiomyomata: new directions for research. Sem.

Reprod. Med. 22:83-90, 2004. 

10. Catherino WH, Leppert PC, Stenmark M, Payson M, Potlog-Nahari C, Nieman 

LK, Segars JH. Reduced dermatopontin expression is a molecular link between 

uterine leiomyomata and keloids. Genes Chromosomes Cancer 40:204-217, 2004. 

11. Leppert PC, Baginski T, Prupas C, Catherino W, Pletcher S, Segars J. 

Comparative ultrastructure of collagen fibrils in uterine leiomyomas and normal 

myometrium. Fertil. Steril.82 Suppl 3:1182-7, 2004. 

12. Leppert P, Catherino WH, Segars JH. A new hypothesis about the origin of 

uterine fibroids based on expression profiling with microarrays. Am. J. Obstet. 

Gynecol. In press. 

13. Davis K. Uterine fibroid growth study. Presentation at 2nd NIH International 

conference on uterine fibroid research. February, 2005. 

14. Conference Diary. Advances in Uterine Leiomyoma Research. WOMEN’S 

HEALTH in Primary Care. Vol. 8, 4: 166-169, 2005. 

15. Conference Summary accepted for publication. The 2nd NIH International 

Congress on Advances in Uterine Leiomyoma Research. Fertil. Steril 

16. Catherino WH, Segars JH. Microarray analysis in fibroids: which list is the 

correct list? Fertil. Steril. 80:293-294, 2003. 

17. Tsibris JCM, Maas S, Segars JH, Nicosia SV, Enkemann SA, O’Brien WF, 

Spellacy WN. New potential regulators of uterine leiomyomata from DNA arrays: 

the ionotropic glutamate receptor GluR2. Biochem. Biophys. Res. Comm. 

312:249-54, 2003. 

18. Feinberg EC, Larsen FW, Catherino WH, Zhang J, Armstrong AY. Comparison 

of ART utilization and outcomes between Caucasian and African American 

patients in an equal-access-to-care setting. Fertil. Steril. In press. 

10
11