Centre for Reproductive Health

Critchley group

Menstruation, abnormal uterine bleeding (AUB; including, heavy menstrual bleeding (HMB)), iron deficiency and anemia. Studies on local mechanisms, diagnosis and treatment and impacts.

 

Professor Hilary OD Critchley (BSc (Hons), MBChB (Hons), MD, DSc, FRCOG, FRANZCOG, FMedSci, FRSE)

  • Professor of Reproductive Medicine
  • Consultant Gynaecologist, NHS Lothian

Contact details

Address

Street

The Centre for Reproductive Health
Institute for Regeneration and Repair (IRR)
4-5 Little France Drive
Edinburgh BioQuarter

City
Edinburgh
Post Code
EH16 4UU

Availability

Main research area and why it is important

Our research specifically examines local mechanisms within the womb-lining (endometrium) involved in menstruation and abnormal uterine bleeding (AUB). Menstruation displays features of an inflammatory event and is a physiological event of repeated "tissue injury and repair" We study the cascade of events that occur in cells of the endometrium and that lead to its shedding. These events are triggered by withdrawal of the hormone, progesterone. This occurs at the end of each monthly cycle prior to a period. We are interested in the complex dialogue between circulating steroid hormones and the many different cell types, including immune cells that constitute the endometrium.

We also study factors that switch on production of molecules involved in blood vessel growth and repair in the endometrium; both necessary events to prepare for the next menstrual cycle. If we can understand how the womb heals itself without scarring as women go through their menstrual cycles we hope we will contribute valuable information relevant to inflammation and scarring throughout the body. If these events are disturbed then abnormal menstrual bleeding may be the result. We are therefore studying endometrial samples collected from women attending with menstrual complaints including women with fibroids. We hope that information about the molecular and cellular pathways involved in menstruation will help identify new targets for treatment, especially if these treatments could be delivered directly to the uterus.

Development of novel medical treatments for management of debilitating menstrual complaints aims to enable women to avoid surgery and thereby preserve uterine function and fertility potential.

Selected recent publications:

  • Whitaker, L. H. R., Middleton, L. J., Daniels, J. P., Williams, A. R. W., Priest, L., Odedra, S., Cheed, V., Stubbs, C. E., Clark, T. J., Lumsden, M. A., Hapangama, D. K., Bhattacharya, S., Smith, P. P., Nicholls, E. P., Roberts, N., Semple, S. I., Saraswat, L., Walker, J., Chodankar, R. R., Critchley, H. O. D., UCON Collaborative (2023). Ulipristal acetate versus levonorgestrel-releasing intrauterine system for heavy menstrual bleeding (UCON): a randomised controlled phase III trial. EClinicalMedicine, 60, 101995. https://doi.org/10.1016/j.eclinm.2023.101995

  • Munro, M. G., & Critchley, H. O. D. (2023). Our path from abnormal uterine bleeding and iron deficiency to impaired fetal development: A long and winding road. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 162 Suppl 2, 3–6. https://doi.org/10.1002/ijgo.14942

  • Jain, V., Chodankar, R. R., Maybin, J. A., & Critchley, H. O. D. (2022). Uterine bleeding: how understanding endometrial physiology underpins menstrual health. Nature Reviews Endocrinology, 18(5), 290–308. https://doi.org/10.1038/s41574-021-00629-4

  • Critchley, H. O. D., Munro, M. G., Shakur-Still, H., & Roberts, I. (2021). Menstruation should not be overlooked in control of anaemia. Lancet (London, England), 397(10268), 26. https://doi.org/10.1016/S0140-6736(20)32718-5

  • Chodankar, R. R., Murray, A., Nicol, M., Whitaker, L. H. R., Williams, A. R. W., & Critchley, H. O. D. (2021). The endometrial response to modulation of ligand-progesterone receptor pathways is reversible. Fertility and sterility, 116(3), 882–895. https://doi.org/10.1016/j.fertnstert.2021.02.008
  • Al-Hendy, A., Lukes, A. S., Poindexter, A. N., 3rd, Venturella, R., Villarroel, C., Critchley, H. O. D., Li, Y., McKain, L., Arjona Ferreira, J. C., Langenberg, A. G. M., Wagman, R. B., & Stewart, E. A. (2021). Treatment of Uterine Fibroid Symptoms with Relugolix Combination Therapy. The New England journal of medicine, 384(7), 630–642. https://doi.org/10.1056/NEJMoa2008283
  • Warner, P., Whitaker, L. H. R., Parker, R. A., Weir, C. J., Douglas, A., Hansen, C. H., Madhra, M., Hillier, S. G., Saunders, P. T. K., Iredale, J. P., Semple, S., Slayden, O. D., Walker, B. R., & Critchley, H. O. D. (2021). Low dose dexamethasone as treatment for women with heavy menstrual bleeding: A response-adaptive randomised placebo-controlled dose-finding parallel group trial (DexFEM). EBioMedicine, 69, 103434. https://doi.org/10.1016/j.ebiom.2021.103434
  • Critchley, H. O. D., Babayev, E., Bulun, S. E., Clark, S., Garcia-Grau, I., Gregersen, P. K., Kilcoyne, A., Kim, J. J., Lavender, M., Marsh, E. E., Matteson, K. A., Maybin, J. A., Metz, C. N., Moreno, I., Silk, K., Sommer, M., Simon, C., Tariyal, R., Taylor, H. S., Wagner, G. P., … Griffith, L. G. (2020). Menstruation: science and society. American journal of obstetrics and gynecology, 223(5), 624–664. https://doi.org/10.1016/j.ajog.2020.06.004
  • Critchley, H. O. D., Maybin, J. A., Armstrong, G. M., & Williams, A. R. W. (2020). Physiology of the Endometrium and Regulation of Menstruation. Physiological reviews, 100(3), 1149–1179. https://doi.org/10.1152/physrev.00031.2019
  • Munro, M. G., Critchley, H. O. D., Fraser, I. S., & FIGO Menstrual Disorders Committee (2018). The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 143(3), 393–408. https://doi.org/10.1002/ijgo.12666
  • Maybin, J. A., Murray, A. A., Saunders, P. T. K., Hirani, N., Carmeliet, P., & Critchley, H. O. D. (2018). Hypoxia and hypoxia inducible factor-1α are required for normal endometrial repair during menstruation. Nature communications, 9(1), 295. https://doi.org/10.1038/s41467-017-02375-6

Full list of publications:

google scholar

pubmed

research explorer

Current research projects:

  • Determining the endometrial phenotype of women with abnormal uterine bleeding (AUB).
  • Unravelling the causes of declining uterine function with age
  • Mechanisms of action selective progesterone receptor modulators (SPRMs) on the endometrium and uterus.
  • Novel magnetic resonance imaging (MRI) of uterine morphology in women with AUB.

Recent clinical studies:

Low dose dexamethasone as treatment for women with heavy menstrual bleeding: A response-adaptive randomised placebo-controlled dose-finding parallel group trial Dexamethasone for Excessive Menstruation (DexFEM).  

Team members:

  • Dr Varsha Jain
  • Professor Neil Roberts

Principal collaborators

Local:

  • Professor Neil Carragher
  • Dr Ooi Thye Chong
  • Dr Douglas Gibson
  • Professor Andrew Horne
  • Dr Robert Illingworth
  • Dr Jackie Maybin
  • Professor Neil Roberts
  • Professor Philippa Saunders
  • Dr Pamela Warner
  • Dr Lucy Whitaker
  • Professor Emeritus Alistair Williams

National:

  • Professor Siladitya Bhattacharya (Aberdeen)
  • Professor Justin Clark (Birmingham)
  • Professor Dharani Hapangama (Liverpool)
  • Professor Gavin Kelsey (Babraham Institute, Cambridge)
  • Professor Mary Ann Lumsden (Glasgow)
  • Professor Ashley Moffett (Cambridge)
  • Professor Ian Roberts & Dr Sima Berendes (LSHTM, London)
  • Professor Brian Walker (Newcastle)

International:

  • Professor Linda Griffith (Massachusetts Institute of Technology, USA)
  • Professor Sun-Wei Guo (Fudan University, Shanghai, China)
  • Professor Myriam Hemberger and Professor Wendy Dean (University of Calgary, Canada)
  • Professor Doug Lauffenburger (Massachusetts Institute of Technology, USA)
  • Professor Mac Munro (Los Angeles, USA)Professor Felice Petraglia (Florence, Italy)
  • Professor Peter Rogers (Melbourne, Australia)
  • Professor Carlos Simon (Valencia, Spain)
  • Dr Ov Slayden (Portland, USA)
  • Dr Margherita Turco (Basel, Switzerland)
  • Dr Steve Yellon (Loma Linda University, USA)

Current responsibilities include:

  • Wellbeing of Women Research Advisory Committee (RAC) Chair from 2024-
  • Immediate Past Chair 2023-2025: International Federation of Gynecology and Obstetrics (FIGO) Committee for Menstrual Disorders and Related Health Impacts (MDRHI); Chair 2021-2023
  • Centre for Trophoblast Research (CTR), Cambridge –  Chair CTR Scientific Advisory Board
  • World Endometriosis Society (WES) Ambassador (from 2018)

Current Editorial Board Membership:

Physiological Reviews (from 2019 - ) Associated Editor

F1000 Research / co-Head of Faculty for Women’s Health

Awards:

2021: Elected as an International Member to the US National Academy of Medicine (NAM)

2021: Professor Critchley recipient of the Society for Reproductive Investigation (SRI) DeCherney Society Lifetime Distinguished Service Award: recognises an individual who has made outstanding contributions to the Society for Reproductive Investigation and significant contributions to the field of reproductive medicine and women's health.

2021: Professor Critchley recipient of RCOG Annual Academic Award. This prize has been awarded by the RCOG in recognition of her distinguished service to academic obstetrics and gynaecology, in particular her outstanding contributions to scientific discovery, pre-clinical and clinical research, academic education and training.

2020: The SRF (Society for Reproduction and Fertility) Distinguished Scientist Anne McLaren Award 2020 has been awarded to Professor Hilary O D Critchley, MRC Centre for Reproductive Health, The University of Edinburgh, for her outstanding contributions in the field of women's reproductive biology.

2019: Featured in Celebrating Women in Science in Scotland Exhibition, Royal Society of Edinburgh – an “exhibition celebrating some of Scotland's finest female scientists”. https://www.rse.org.uk/women-science-exhibition/

2019: Exemplar of international recognition: NIH, Bethesda, USA: (UK invited participant) meeting: Menstruation, Science and Society (goal to discuss promising new discoveries and avenues of research surrounding menstruation).

2017: University of Edinburgh awarded Queen's Anniversary Prize for "Clinical innovations to respond to major unmet needs in women's health" submitted on behalf of the University of Edinburgh by JE Norman and HOD Critchley

2014: Awarded Lady Margaret MacLellan Award, Tenovus Scotland for contributions to 'Women's Health'.

Public and Media engagement:

Recently Professor Critchley was interviewed by 'Faculti' - Academic streaming platform, which is covering the latest research, analysis and scholarship world-wide. Professor Critchley talked on the topic: Menstruation: Science and Society, on women's health concerns that are underrepresented and lacking understanding of basic uterine and menstrual physiology.  She discussed  the research gaps; opportunities in menstrual science and education of women's health. You can view Faculti interview  via this link.

Sources of Funding

More information on funding at Hilary Critchley's Research Explorer profile.