Cyprus Women’s Health Research (COHERE) Initiative: Determining the relative burden of women’s health conditions and related co-morbidities in an Eastern Mediterranean population

There is lack of population level data on prevalence and distribution of common benign women’s health conditions such as endometriosis, uterine fibroids, polycystic ovary syndrome from the Eastern Mediterranean region despite their significant consequences on quality of life. In particular, there is complete absence of any health statistics from Northern Cyprus, which is an emerging region in Europe (Rahmioglu et al., 2012). The Cyprus Women’s Health Research (COHERE) Initiative is the first large-scale epidemiological study in the region, aiming to determine the relative burden of benign women’s health conditions and related co-morbidities in women living in Northern Cyprus.

The COHERE Initiative is a population-based, cross-sectional study targeting 10% of all women aged 18-55 (N=8000) living in Northern Cyprus. Aims include: (1) estimation of prevalence rates of gynaecological conditions and associated symptomatology, and auto-immune, inflammatory, metabolic and pain comorbidity profiles, (2) investigation of how various reproductive and lifestyle factors affect women’s health including diet, exercise, employment patterns, oral contraceptive use, and childbirth, (3) investigation of the geospatial distribution of identified conditions around the island and also comparison of disease rates with other countries, (4) genotyping of a subset of 1000 women to understand the genetic architecture of this population (5) quantification of women’s access to health care and estimate the social burden of diseases such as endometriosis in Northern Cyprus.

The study has three main steps: (1) Collection of self-reported data using a detailed health questionnaire, which is an expanded version of the World Endometriosis Research Foundation (WERF) Endometriosis Phenome Harmonisation Project (EPHect) standardised questionnaire (Vitonis et al., 2014), including questions on demographics, menstrual history, pregnancy, pain (pelvic pain, bladder and bowel pain, migraine), medical history, life-style factors and resource use. (2) Collection of saliva samples for genotyping. (2) Gynaecology clinic follow up, including a pelvic ultrasound scan. There is also a follow-up food frequency questionnaire, which aims to collect detailed data on dietary habits.

The COHERE Initiative will generate prevalence rates for conditions, define the clinical profiles for women’s health conditions, and estimate the economic burden of these conditions in Northern Cyprus. The results will also provide insights into the current status of health-care among women living in a currently under-investigated region. The genetic findings will inform future gene mapping studies for investigation of the heritable component of conditions in this population/region. The COHERE Initiative will serve as a resource to conduct follow-up studies investigating effect of the ‘Mediterranean lifestyle’ as well as genetic factors on common women’s health conditions that maybe specific to Eastern-Mediterranean populations.

The project has two main local collaborators, Cyprus Bahceci IVF Hospital and Eastern Mediterranean University. These collaborators are aiding with the local field work including, collection of questionnaire-based symptomatology and medical history data, gynaecological profiles of women, along with lifestyle factors such as diet, and clinical validation of gynaecological health conditions.

Training opportunities:
We are a multi-disciplinary, dynamic group based at both the Endometriosis CaRe Centre (Nuffield Department of Women’s and Reproductive Health) and the Wellcome Centre for Human Genetics. Student will benefit from an exciting combination of clinical and basic research environments offered by both. In addition, student will have the opportunity to travel and take part in the fieldwork in Northern Cyprus. Student will be strongly encouraged to publish their work, present at international conferences, attend bi-weekly group meetings, journal clubs, as well as departmental seminars and training courses.

This study provides extensive opportunities to gain experience in various statistical methodologies including; analysis of large-scale epidemiological datasets, genomic analysis including investigation population genetic architecture and association testing using array-based genotyping data, geospatial mapping of the data to unravel spatial clustering of conditions, and estimation of economic and social burden of diseases in this population. Moreover, it will provide multitude of opportunities to take part in designing follow-up studies and conducting fieldwork in Northern Cyprus.

The group also benefits from a strong international network of collaborators in the fields of endometriosis, reproductive and endocrine conditions, statistical genetics, genomics, bioinformatics, and functional biology locally, with whom students will be able to collaborate (e.g. Harvard Medical School, Boston,US; University of Michigan, Grand Rapids, US; Queensland Institute of Technology, Brisbane, Australia; Baylor College of Medicine, Houston, USA; University of Madison-Wisconsin, Madison).

Themes: Women's Health, Epidemiology