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Your Environment. Your Health.

Women's Health and the Environment

Introduction

group of diverse women standing together

Health is influenced throughout the lifespan by many factors, including sex, gender, racial ethnicity, culture, socioeconomic status, and the environment. Women's health is an essential part of the NIEHS research agenda. Researchers investigate environmental, lifestyle, and behavioral factors to prevent or reduce the chance of women developing health problems.

Certain health conditions and diseases are specific to women, two of which are endometriosis and uterine fibroids.

Endometriosis – This common gynecological disease affects about 5.5 million women in the U.S. It occurs when the lining of the uterus grows on the surface of organs in the pelvic and abdominal areas. Endometriosis can cause great pain and menstrual complications, and it is a leading cause of infertility. There are treatment options for the condition.

Uterine fibroids – Also known as leiomyomas, these non-cancerous tumors are made of smooth muscle cells and fibrous connective tissue, and they can range from microscopic to several inches in size. Fibroids usually are not a critical problem but may cause physical pain and may affect emotional health. They can appear with endometriosis. Fibroids are a leading cause of hysterectomies in the United States.

The following clinical trials are currently recruiting

Many women (70% or more) have fibroids by age 50, although they may not be aware of them. Up to half of these women have symptoms that can include:

  • Heavy menstrual bleeding
  • Prolonged menstrual periods
  • Pelvic pressure or pain
  • Frequent urination or constipation
  • Painful intercourse

What is NIEHS Doing?

NIEHS-supported research seeks to understand the how endometriosis and uterine fibroids develop and how the conditions may be affected by the environment.

Endometriosis research efforts include the following:

  • In the Pregnancy & Female Reproduction Group, uncovering a link between the transcription factor Gata2 and a hormone receptor that may aid in the development of endometriosis treatment.1
  • Examining the role of inflammation and environmental exposures in the development of endometriosis with the goal of detecting disease and identifying preventative measures to reduce the risk of endometriosis.
  • Finding a potential connection between dioxins and endometriosis. Scientists at NIEHS found evidence for single exposures to a dioxin during pregnancy can disrupt the offspring’s adult uterine response to hormones.2
  • Discovering exposure to low levels of bisphenol A (BPA) during fetal development permanently altered the uterine genome in mice. Some of the changes emerged only after sexual maturity and were not present in birth or early life. The genes affected are implicated in endometriosis, as well as infertility, osteoporosis, obesity, and some cancers.3
  • Using cell-based models to better understand how endocrine disrupting chemicals may impact endometriosis.
  • Studying effects of environmental chemicals on the reproductive tract, including the uterus.

The Women’s Risk of Endometriosis (WREN) study found:

  • Persistent environmental chemicals, such as some pesticides, may affect endometriosis risk.4
  • Higher levels of bisphenol A (BPA) in urine are associated with increased risk of endometriosis in women’s pelvic areas.5
  • Women fed soy formula as infants had more than twice the level of endometriosis when they reached adulthood than women who did not.6

Study of Environment, Lifestyle & Fibroids (SELF) – More than 80% of African American women are likely to develop fibroids. Of these women, as a result, 1 in 5 will have a hysterectomy, as compared to 1 in 15 white women. To learn why there is a difference, SELF enrolled more than 1,600 African American women, ages 23 to 34, without a prior clinical diagnosis of fibroids. SELF uses ultrasound screening to detect new fibroids and follow fibroid growth over a five-year period. Researchers are looking at vitamin D deficiency, reproductive tract infections, ancestry, and other possible risk factors for fibroid development.

Fibroid Growth Study – Understanding how fibroids grow is important because large fibroids are more likely to cause health problems than smaller ones. NIEHS researchers examined differences between fibroids that are likely to grow versus those that do not. They studied 116 women for up to one year, some of whom underwent myomectomies (fibroid-removal surgery). They found:

  • Fibroid growth rates were similar in black and white women younger than age 35.7 However, the growth rates were higher in older black than in older white women, with different patterns of gene expression in the tumors.8
  • Short growth spurts are common for fibroids, suggesting that tumor biology may change rapidly.9
  • Among women who already have large fibroids (greater than 2 inches in diameter), the severity of symptoms—rather than the size of the fibroids or other factors—lead women to opt for treatment. Aggressive management of pain and bleeding may be effective in reducing the need for surgical intervention.10

Postpartum Uterine Regression Study – To investigate pregnancy-related changes in fibroids, NIEHS Women’s Health Group researchers collaborated with a University of North Carolina at Chapel Hill study using ultrasound examinations. Women whose ultrasounds showed they had fibroids in early pregnancy had another ultrasound a few months after the end of their pregnancy. Among 171 women with one initial fibroid, 36% had no identifiable fibroid in the follow-up ultrasound; fibroids that did not disappear tended to decrease in size.11 Understanding the reasons behind these changes may lead to new research or strategies for non-surgical fibroid treatment.

Uterine Fibroid Study – This study involved women ages 35-49 who were randomly selected from the membership rolls of a large health care system. Researchers found:

  • Adequate vitamin D in premenopausal women is associated with a reduced risk of uterine fibroids in both black and white women.12
  • An increased fibroid risk in the daughters of women who took prenatal diethylstilbestrol (DES) to prevent pregnancy complications.13
  • Black women were disproportionately having surgery for fibroids, although race did not influence size, location, or number of fibroids between black and white women once at surgery.14

Role of Growth Factors in Uterine Leiomyoma Growth – A growth factor is a substance, such as a protein, that may stimulate development of tissue. The Molecular Pathogenesis Group within the National Toxicology Program’s laboratory is looking at growth factors in uterine fibroid development. Growth factors are made by our bodies, but environmental chemicals, such as cadmium, may affect production. This research approach is a new way to determine how fibroids develop and how they may be treated.

Breast Cancer Research

The NIEHS Sister Study examines environmental and familial factors that may affect breast cancer and other diseases. More than 50,000 women across the U.S. and Puerto Rico, between ages 35–74 whose sister had breast cancer, joined this landmark research effort. Because of their shared environment, genes, and experiences, studying sisters provides a greater chance of identifying risk factors and ways to prevent breast cancer. Many research articles from this ongoing study are published.

The Breast Cancer and the Environment Research Program, co-funded by NIEHS and the National Cancer Institute, studies environmental and genetic factors over women's lifespans that may alter the chance of developing breast cancer. The studies seek to understand if environmental exposures during specific periods, such as puberty or pregnancy, may increase breast cancer risk.

Other Research

Research related to cookstoves concerns community-based interventions primarily in Guatemala, Ecuador, Nepal, Pakistan, Ghana, and U.S. Fueled by wood, coal, or dung, traditional cookstoves or open fires produce smoke that contributes to 4.3 million estimated annual deaths, with women and young children affected the most. Cookstove smoke contributes to chronic illnesses and other health effects, especially related to the heart and lungs.

Reproductive System Disorders research concerns how exposure to environmental pollutants can lead to diseases, disorders, and conditions that affect functioning in female and male reproductive systems.

Traffic-related air pollution (TRAP) and pregnancy disorders were reviewed by the National Toxicology Program, housed at NIEHS. Air pollution is an established risk factor for hypertension and cardiovascular disease in adults, and increasing evidence show air pollution may increase hypertensive disorders of pregnancy. NTP concluded that exposure to TRAP is presumed to be a hazard to pregnant women for developing hypertensive disorders of pregnancy (e.g., gestational hypertension, preeclampsia, eclampsia).

Further Reading

Stories from the Environmental Factor (NIEHS Newsletter)

Fact Sheets

Breast Cancer Risk and Environmental Factors

Cosmetics and Hair Dye

Reproductive Health in Females and Males

Press Releases

Additional Resources

Related Health Topics


  1. Rubel CA, Wu SP, Lin L, Wang T, Lanz RB, Li X, Kommagani R, Franco HL, Camper SA, Tong Q, Jeong JW, Lydon JP, DeMayo FJ. A Gata2-dependent transcription network regulates uterine progesterone responsiveness and endometrial function. 2016. Cell Reports 17(5):1414-1425. [Abstract Rubel CA, Wu SP, Lin L, Wang T, Lanz RB, Li X, Kommagani R, Franco HL, Camper SA, Tong Q, Jeong JW, Lydon JP, DeMayo FJ. A Gata2-dependent transcription network regulates uterine progesterone responsiveness and endometrial function. 2016. Cell Reports 17(5):1414-1425.]
  2. Burns KA, Zorrilla LM, Hamilton KJ, Reed CE, Birnbaum LS, and Korach KS. A single gestational exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin disrupts the adult uterine response to estradiol in mice. 2013. Toxicological Sciences 136(2):514-26. [Abstract Burns KA, Zorrilla LM, Hamilton KJ, Reed CE, Birnbaum LS, and Korach KS. A single gestational exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin disrupts the adult uterine response to estradiol in mice. 2013. Toxicological Sciences 136(2):514-26.]
  3. Jorgensen EM, Alderman MH 3rd, Taylor H. 2016. Preferential epigenetic programming of estrogen response after in utero xenoestrogen (bisphenol-A) exposure. FASEB Journal [Online 16 June 2016]. [Abstract Jorgensen EM, Alderman MH 3rd, Taylor H. 2016. Preferential epigenetic programming of estrogen response after in utero xenoestrogen (bisphenol-A) exposure. FASEB Journal [Online 16 June 2016].]
  4. Upson K, De Roos AJ, Thompson ML, Sathyanayayana S, Scholes D, Barr DB, Holt V. 2013. Organochlorine Pesticides and Risk of Endometriosis: Findings From a Population-based Case–control Study. EHP 121: 1319-1324. [Abstract Upson K, De Roos AJ, Thompson ML, Sathyanayayana S, Scholes D, Barr DB, Holt V. 2013. Organochlorine Pesticides and Risk of Endometriosis: Findings From a Population-based Case–control Study. EHP 121: 1319-1324.]
  5. Upson K, Sathyanarayana S, De Roos AJ, Koch HM, Scholes D, Holt VL. 2014. A population-based case-control study of urinary bisphenol A concentrations and risk of endometriosis. Human Reproduction 29(11):2457-2464. [Abstract Upson K, Sathyanarayana S, De Roos AJ, Koch HM, Scholes D, Holt VL. 2014. A population-based case-control study of urinary bisphenol A concentrations and risk of endometriosis. Human Reproduction 29(11):2457-2464.]
  6. Upson K, Sathyanarayana S, Scholes D, Holt VL. 2015. Early-life factors and endometriosis risk. Fertility and Sterility 104(4):964-9761. [Abstract Upson K, Sathyanarayana S, Scholes D, Holt VL. 2015. Early-life factors and endometriosis risk. Fertility and Sterility 104(4):964-9761.]
  7. Peddada SD, Laughlin SK, Miner K, Guyon JP, Haneke K, Vahdat HL, Semelka RC, Kowalik A, Armao D, Davis B, Baird DD. 2008. Growth of uterine leiomyomata among premenopausal black and white women. Proceedings of the National Academy of Sciences of the United States of America. 105(50); 19887-19892. [Abstract Peddada SD, Laughlin SK, Miner K, Guyon JP, Haneke K, Vahdat HL, Semelka RC, Kowalik A, Armao D, Davis B, Baird DD. 2008. Growth of uterine leiomyomata among premenopausal black and white women. Proceedings of the National Academy of Sciences of the United States of America. 105(50); 19887-19892.]
  8. Davis BJ, Risinger JI, Chandramouli GVR, Bushel PR, Baird DD, Peddada SD. 2013. Gene expression in uterine leiomyoma from tumors like to be growing (from black women over 35) and tumors likely to be non-growing (from white women over 35). PLoS One 8(6):e63909. [Abstract Davis BJ, Risinger JI, Chandramouli GVR, Bushel PR, Baird DD, Peddada SD. 2013. Gene expression in uterine leiomyoma from tumors like to be growing (from black women over 35) and tumors likely to be non-growing (from white women over 35). PLoS One 8(6):e63909.]
  9. Baird DD, Garrett TA, Laughlin SK, Davis B, Semelka RC, Peddada SD. 2011. Short-term change in growth of uterine leiolyoma: tumor growth spurts. Fertility and Sterility 95(1);242-246. [Abstract Baird DD, Garrett TA, Laughlin SK, Davis B, Semelka RC, Peddada SD. 2011. Short-term change in growth of uterine leiolyoma: tumor growth spurts. Fertility and Sterility 95(1);242-246.]
  10. Davis BJ, Haneke KE, Miner K, Kowalik A, Barrett JC, Peddada S, Baird DD. 2009. The fibroid growth study: determinants of therapeutic intervention. Journal of Women's Health 18(5):725-732. [Abstract Davis BJ, Haneke KE, Miner K, Kowalik A, Barrett JC, Peddada S, Baird DD. 2009. The fibroid growth study: determinants of therapeutic intervention. Journal of Women's Health 18(5):725-732.]
  11. Laughlin SK, Herring AH, Savitz DA, Olshan AF, Fielding JR, Hartmann KE, Baird DD. 2010. Pregnancy-related fibroid reduction. Fertility and Sterility 94(6):2421-2423. [Abstract Laughlin SK, Herring AH, Savitz DA, Olshan AF, Fielding JR, Hartmann KE, Baird DD. 2010. Pregnancy-related fibroid reduction. Fertility and Sterility 94(6):2421-2423.]
  12. Baird DD, Hill MC, Schectman JM, Hollis BW. 2013. Vitamin D and the risk of uterine fibroids. Epidemiology 24(3) 447-453. [Abstract Baird DD, Hill MC, Schectman JM, Hollis BW. 2013. Vitamin D and the risk of uterine fibroids. Epidemiology 24(3) 447-453.]
  13. Baird DD, Newbold RN. Prenatal diethylstilbestrol (DES) exposure is associated with uterine leiomyoma development. Reproductive Toxicology 2005 20:81-84. [Abstract Baird DD, Newbold RN. Prenatal diethylstilbestrol (DES) exposure is associated with uterine leiomyoma development. Reproductive Toxicology 2005 20:81-84.]
  14. Moore AB, Flake GP, Swartz CD, Heartwell G, Cousins D, Haseman JK, Kissling GE, Sidawy MK, Dixon D. Association of race, age and body mass index with gross pathology of uterine fibroids. The Journal of Reproductive Medicine. 2008 Feb;53(2):90-6. [Abstract Moore AB, Flake GP, Swartz CD, Heartwell G, Cousins D, Haseman JK, Kissling GE, Sidawy MK, Dixon D. Association of race, age and body mass index with gross pathology of uterine fibroids. The Journal of Reproductive Medicine. 2008 Feb;53(2):90-6.]
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