Our Research Focus

Contact Person: Cathrine Ebbing

Fertility, pregnancy, and childbirth are unique and highly central fields of women's health. In our time, declining fertility has been highlighted as a societal issue. Pregnancy and childbirth represent significant stressors and serve as an important "stress test" for women's health.

Globally, complications during pregnancy, birth injuries, and infections are conditions that impose long-term health challenges on women.

The research group for pregnancy, fetal development, and childbirth at the Department of Clinical Medicine 2 and Haukeland University Hospital aims to uncover new knowledge about women’s health from a life-course perspective. They achieve this through studies of fertility, pregnancy, fetal life, and childbirth—conditions that particularly concern women’s lives.

The research sheds light on how circumstances before and during conception, pregnancy, and the period related to birth can have consequences for women’s health and the next generation. Some of the issues addressed include lifestyle and conditions related to conception, high-risk pregnancies (including preterm births), birth injuries, and infections, as well as how women’s health in a life-course perspective is interconnected with these factors.

The research group seeks to identify targeted and personalized interventions and recommendations that can strengthen society's and women’s self-care, aiming for better lives for women.

The research group is led by Professor Cathrine Ebbing. The group is based in the Women’s Clinic at Haukeland University Hospital. Most members of the research group are physicians specializing in obstetrics and gynecology, with midwives also part of the team.

Contact person: Eva Gerdts

Cardiovascular diseases are one of the leading causes of premature death or reduced quality of life for women worldwide. In 2022, 23% of deaths among Norwegian women were caused by cardiovascular disease. In Norway, the most common heart conditions are atrial fibrillation and heart failure, with heart attacks being the third most common. More women than men died from heart disease caused by high blood pressure or heart failure, while fewer women died from heart attacks.

Many believe that cardiovascular diseases primarily affect men. In reality, just as many women as men live with atrial fibrillation in Norway, and more women than men live with heart failure. Current treatments are primarily developed based on research conducted on men and often work less effectively for women. Therefore, heart disease is a significant cause of reduced women’s health today, both because these are very common conditions and because we have insufficiently studied women with heart disease.

We know that risk factors for cardiovascular disease differ between women and men. While high blood pressure, obesity, smoking, diabetes, and high cholesterol increase the risk of cardiovascular disease in both sexes, high blood pressure, obesity, diabetes, and smoking have a particularly strong impact on women’s risk. Additionally, it is well-documented that pregnancy complications and several factors related to fertility predispose women to cardiovascular disease at a young age.

Research Highlights:

• High Blood Pressure and Women’s Cardiovascular Health: Our research investigates why high blood pressure is more damaging to women’s hearts and arteries. Collaborating with international research partners, we have studied the hearts of women and men with high blood pressure in clinical and population studies using ultrasound examinations.

  Eva Gerdts' research shows that women are more likely than men to develop changes in the heart due to high blood pressure, particularly leading to thickened heart muscle in the left ventricle and an enlarged left atrium. Furthermore, we have found that treatment for high blood pressure is less effective in reversing these heart changes in women than in men.

• Blood Pressure and Heart Attack Risk: Ester Kringeland's research has demonstrated that the harmful effects of high blood pressure begin at a lower threshold in women than in men, and high blood pressure is a stronger risk factor for heart attacks in women. This underscores why high blood pressure is more damaging to women’s hearts and a major cause of cardiovascular disease and death in women.

• Inflammatory Diseases and Obesity: Helga Midtbø’s research shows that having inflammatory diseases or obesity increases the risk of heart disease even further.

• Long-term Effects of Obesity: Dana Cramariuc’s research recently revealed that women more often experience persistent reduced heart function after bariatric surgery compared to men.

We are now working to identify new underlying mechanisms that explain why women are more susceptible to cardiovascular damage from high blood pressure. In collaboration with our international network, we are analyzing various molecular markers in biobank samples from large patient cohorts and population studies to better understand the reasons behind the differing effects of blood pressure and obesity on women’s cardiovascular systems compared to men’s.

This includes metabolomics, proteomics, and genomic analyses. For example, Hilde Halland recently discovered that protein patterns in blood change differently with obesity in women compared to men.

Our goal is to integrate information about biomarkers, imaging markers, and clinical factors into a system that better identifies women with high blood pressure who are at particular risk of developing cardiovascular disease. These markers will reflect mechanisms that can be targeted for the development of new treatments. Additionally, we are studying how blood pressure trends throughout life affect the risk of cardiovascular disease in old age. Our research may help determine whether the same threshold for diagnosing high blood pressure should be applied to women and men.

Contact Person: Inger Haukenes

One in three women experiences significant symptoms during menopause, leading to a considerable reduction in quality of life and contributing to increased absenteeism from work.

The silence and stigma surrounding women’s menopause have left a knowledge gap not only among women themselves but also within healthcare education, the health services, and Norwegian workplaces. This lack of awareness means that women seeking help often fail to identify their symptoms as menopause-related. Instead, symptoms like pain, low mood, headaches, or fatigue are categorized as "diffuse and generalized women’s ailments," which are also among the leading causes of sick leave for women in this age group. Women in midlife are a vital resource in the Norwegian workforce, playing a crucial role in addressing the aging population in public healthcare systems.

Many women and men aged 45 to 55 are at the peak of their careers and still considered young in the context of working life. Therefore, we cannot afford to lose women to long-term sick leave, disability assessments, or early retirement due to menopause symptoms.

Research Gaps in Menopause, Work, and Health

There is limited research on menopause, work, and health in general. In Norway, there are currently no studies specifically addressing "menopause and work." Internationally, findings suggest that information and communication about menopause in the workplace can help reduce stigma and alleviate symptoms. Although research on menopause and absenteeism is scarce, existing studies suggest reduced work capacity and a higher likelihood of sick leave. Studies also show that women with significant symptoms consider changing jobs, reducing their working hours, or leaving the workforce entirely. Having control over one’s work situation is a key factor in remaining employed.

What can help women with significant menopause symptoms remain in the workforce? Key factors include:

• Positive experiences with primary healthcare services
• Leaders knowledgeable about menopause who are willing to implement measures to reduce symptoms
• Peer support and experience-sharing among colleagues
• Increased flexibility and control over work situations
• The option to take breaks
• Practical adjustments such as temperature control, access to cold water, and breathable work clothing

The KLAR Project

The project KLAR - Women’s Health, Menopause, and Work (funded by the Grieg Foundation, 2024-2027) focuses on four key areas to increase knowledge:

1. Study 1 explores how menopause is experienced by women and addressed in healthcare and the workplace within the context of the Norwegian welfare state. Interviews are conducted with women both in and out of the workforce, leaders in private and public sectors, and personnel from public and private healthcare services to identify factors that support a sustainable working life for women in menopause.

2. Study 2 utilizes Norway’s unique health and welfare registries to examine variations in diagnosis patterns, healthcare trajectories, and absenteeism among midlife women. This study provides a broad overview that complements the in-depth insights from Study 1.

3. Study 3 investigates the relevance, applicability, and adaptation of European menopause workplace guidelines (EMAS) to Norwegian workplaces. Researchers will engage experts across various levels of the workforce, from employees to leaders and trade unions, to gather feedback on EMAS and work towards consensus on guidelines.

4. Ongoing Communication and Knowledge Sharing is a continuous effort aimed at disseminating information to businesses, organizations, healthcare services, and the public. This aspect is prioritized to meet the growing demand for knowledge about women’s health, menopause, and work.

Through these initiatives, the KLAR project aims to address the gaps in knowledge and provide practical solutions for improving women’s health and participation in the workforce during menopause.

Contact person: Sivakami Rethnam Haug

Oral Health-Related Quality of Life and Gender Differences

Oral health-related quality of life refers to how an individual’s oral health impacts their overall quality of life, encompassing physical, psychological, and social aspects. It is not just about the absence of disease but also about well-being and functional capacity related to the oral cavity. Despite an excellent dental care program in Norway, supported by general dentists, specialists, and state-of-the-art equipment, a higher proportion of women than men report low oral health-related quality of life.

Women’s Unique Oral Health Needs

Women have specific needs and considerations when it comes to oral health. Hormonal fluctuations have a surprisingly significant impact on the oral cavity. Puberty, menstruation, pregnancy, menopause, and the use of contraceptive medications all influence women’s oral health.

Pain, particularly tooth pain, among women is an area that has not been adequately addressed or thoroughly researched in Norway. Pain is a subjective experience, but when it comes to toothache, women report higher levels of pain than men. A larger proportion of women experience discomfort, issues, or problems related to teeth and the oral cavity compared to men. Dental problems, pain, dentures, and other oral conditions are more commonly associated with women, who also report more emotional distress, insecurity, and stress due to these conditions.

Research Gaps in Gender and Oral Health

Research on gender differences and women’s oral health has traditionally been underprioritized. Women are more affected by conditions such as:

• Temporomandibular disorders (TMD)
• Osteoporosis
• Burning mouth syndrome
• Salivary dysfunction
• Sjögren’s syndrome and other autoimmune diseases that can impact the oral cavity

At the Department of Clinical Dentistry, we are dedicated to studying these gender differences, particularly through clinical and patient-centered research as well as dental education research. The goal is to develop more gender-specific treatment options to better meet the unique needs of women in oral healthcare.

Contact person: Marte-Helene Bjørk 

Migraine is a debilitating condition for many women, yet there is limited understanding of why the disease affects some so severely or how it can be effectively prevented.

Eighteen percent of women and six percent of men experience migraines. Young girls are five times more likely than boys to develop the most severe form of the condition: chronic migraine. Society spends over a billion Norwegian kroner annually on migraine-related costs, with more than 80 percent of this due to work-related issues caused by migraines in women. Despite this significant burden, little research focuses on identifying the underlying causes or effective treatments specifically for women.

Professor Marte-Helene Bjørk, a neurologist, leads the Female Task Force at the Norwegian Center for Headache Research (NorHead), a Center for Clinical Treatment Research (FKB) funded by the Norwegian Research Council.

The researchers have collected extensive data on genetics, environmental exposures, diagnoses, medication use, academic performance, and employment statistics. The goal is to understand the factors in women’s childhood, adolescence, and adulthood that are associated with the development of severe migraines and identify the most effective treatments. Machine learning algorithms are being used to analyze these data.

Bjørk and her team are also conducting clinical trials on medications and medical treatment technologies, with a specific focus on discovering effective treatments tailored to women.

For more information, visit: NorHead.

Contact person: Marte-Helene Bjørk 

Epilepsy and Migraines Affect Up to One in Four Women of Childbearing Age

Uncertainty about the safety of medications for these conditions during pregnancy means that many women do not receive effective treatment.

Previous research has shown that some anti-seizure medications, such as valproate (marketed as Orfiril in Norway), which is effective for epilepsy and migraines, carry a high risk of birth defects such as spina bifida and neurodevelopmental disorders like autism. This has led to restrictions on its use for women across Europe unless no alternatives are available. It is essential to identify which newer and effective anti-seizure medications can be used safely by women.

Professor Marte-Helene Bjørk, a neurologist, led the SCAN AED project, which compiled extensive health registry data on all children born in the Nordic countries. Bjørk and her team examined which medications the mothers of these five million children used and what diagnoses the children later received.

Their research found that certain anti-seizure medications appear to be safe, such as:

• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)

These are safe when used alone or in combination.

However, children exposed to topiramate (Topamax) during pregnancy had a significantly increased risk of both birth defects and conditions like autism and intellectual disabilities. These findings led to the introduction of a new pregnancy prevention program for topiramate in Europe in early 2023. Topiramate is used to treat migraines and epilepsy.

Impact on Clinical Guidelines

Major changes to international clinical treatment guidelines for these conditions are anticipated, ensuring safer treatment options for women.

The SCAN AED project was funded by NordForsk.

The research group is led by Professor Camilla Krakstad at the Department of Clinical Science and the Centre for Cancer Biomarkers (CCBIO), University of Bergen (UiB). The group also has strong ties to the Women's Clinic at Haukeland University Hospital in Bergen.

The team focuses on gynecological cancer, with a particular emphasis on improving diagnosis and treatment for patients with uterine cancer.

The research is built on three key pillars:

1. Expert Researchers: A diverse and passionate team dedicated to making discoveries that benefit patients.
2. Clinical Collaboration: Strong partnerships with clinical departments enable the collection of samples and data from relevant patients.
3. Engaged Patients: Positive patient participation, with individuals willingly contributing to research efforts.

The research community includes both clinicians and basic scientists, who collaborate using various methods to generate new knowledge about gynecological cancers.

Recent Achievements

• Biomarkers: The team has identified several promising biomarkers to improve diagnosis and tailor treatments more effectively.
• Clinical Studies: Contributions to clinical trials and investigations of how treatments affect patients' quality of life in the years following a cancer diagnosis.
• Imaging: Close collaboration with Professor Ingfrid S. Haldorsen's team at the Mohn Imaging and Visualization Center to explore the use of radiological data for better diagnostics.

Areas of Focus

Mechanisms of Cancer Spread and Treatment Resistance:

• Use of advanced cell models and genetic analyses to study changes associated with aggressive diseas

Improving Treatment Outcomes:

• Research aimed at optimizing therapeutic strategies and identifying patients who would benefit most from specific interventions.

The research group includes approximately 25 members and receives funding from:

• University of Bergen (UiB)
• Western Norway Regional Health Authority (Helse Vest)
• The Norwegian Cancer Society (Kreftforeningen)
• The Research Council of Norway (Norges forskningsråd)
• The Trond Mohn Research Foundation

The group is dedicated to advancing knowledge in gynecological cancer for the ultimate benefit of patients.

Photo:

Bergen Forskningsgruppe for gynekologisk kreft

Contact person: Daniela Elena Costea

Cancer of the External Female Genital Organs (Vulva and Vagina): A Rare and Under-Researched Cancer

Cancers originating in the external female genital organs (vulva and vagina) are rare, with limited research dedicated to them. However, the incidence of this cancer type is steadily increasing, particularly among women under 60. In Norway, approximately 80 patients are diagnosed with these cancers annually.

Despite the heterogeneity of this disease, most patients receive the same standard treatment. Unfortunately, the prognosis remains poor due to the lack of effective treatments for locally advanced, radiation-resistant diseases or systemic disease. One of the major challenges is understanding why patients with similar disease characteristics experience differing outcomes despite undergoing the same primary treatment regimen.

Biomarkers for stratifying patients have not yet been identified for this cancer type. The research group is focused on:

• Defining biomarkers for personalized treatment.
• Establishing representative experimental models to better understand the biology of this cancer and to test new drugs.

The Role of Organoids

Organoids are three-dimensional in vitro tissue culture models that closely mimic the original tumors. They offer a promising tool for selecting personalized treatments.

One of the group’s main objectives is to establish an organoid platform for vulvar cancer, which will:

• Serve as the foundation for identifying the biological properties of these tumors.
• Help characterize potential responses to specific medications.
• The team aims to use organoids to identify treatments tailored to individual patients.
• This cutting-edge approach combines experimental pathology and clinical insights to improve outcomes for women with vulvar cancer.

This work is a collaboration between the Experimental Pathology Research Group, led by Daniela Elena Costea at the Gade Laboratory for Pathology, University of Bergen (UiB), and Professor Line Bjørge at the Women’s Clinic, Haukeland University Hospital, and the Department of Clinical Medicine 2, UiB.

For further insights, read:"Printer mini-svulster i 3D for å finne medisin mot vulvakreft | Norske Kvinners Sanitetsforening (sanitetskvinnene.no) (In Norwegian).

Contact person: Karl Johan Tronstad  

The research group is based at the Department of Biomedicine (IBM) at the University of Bergen. They conduct biomedical laboratory studies and advanced analyses of patient samples to investigate molecular and cellular disease mechanisms. A key focus is the critical role of energy metabolism in maintaining cellular health.

An important area of research for the group is myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This debilitating condition disproportionately affects women compared to men. The underlying disease mechanism remains unknown, and there are currently no biomarkers or effective treatments.

The group collaborates closely with the research team led by Øystein Fluge and Olav Mella at the Cancer Department of Haukeland University Hospital, which conducts clinical trials aimed at finding treatments for ME.

Link Between ME and Infections

ME often develops as a long-term consequence of an infectious illness. Several types of infections have been associated with ME, including mononucleosis and COVID-19. One prominent theory suggests that such infections cause a persistent immune system dysfunction, which subsequently impacts various organs and systems in the body.

There are parallels with other chronic diseases driven by similar mechanisms, many of which also predominantly affect women. It is plausible that gender differences in the immune system and/or energy metabolism could explain why 70-80% of ME patients are women.

The group’s objective is to gain a deeper understanding of the mechanisms underlying ME. This knowledge could pave the way for the development of biomarkers and treatments for the condition.

Contact person: Bård Bogen

Bone mineral density increases as we grow from childhood to adulthood. After reaching adulthood, it gradually declines, making bones more prone to fractures. This is particularly true for women, as the loss of bone mass accelerates after menopause. For many, the loss of bone mass becomes significant enough to be classified as osteoporotic or having brittle bones. Osteoporotic fractures, often referred to as low-energy fractures, occur from minor incidents, such as a fall from standing height. Research shows that women experience a much higher incidence of common low-energy fractures, such as wrist fractures, spinal compression fractures, and hip fractures, compared to men. These fractures can significantly impact health and functional ability, especially with advancing age.

Impact of Osteoporosis Diagnosis

Receiving a diagnosis of osteoporosis or experiencing a fracture can be life-changing. Many individuals significantly reduce their activity levels due to fear of further fractures. However, research indicates that maintaining an active lifestyle is crucial—not only for overall health but also because physical activity strengthens bones. There is a clear need for increased expertise on how to advise older individuals with low-energy fractures on safe exercise and physical activity.

Risk of Subsequent Fractures

Studies further show that individuals who have suffered one low-energy fracture are significantly more likely to experience additional fractures. It is therefore essential that these individuals undergo bone density assessments to evaluate their risk. If osteoporosis is diagnosed, appropriate treatment—such as osteoporosis medication and fall-prevention training—can be initiated.

Fracture Liaison Services (FLS)

Many hospitals worldwide have established Fracture Liaison Services (FLS) to identify older patients with fractures and refer them for assessment and treatment. Research shows that these services can significantly reduce the risk of subsequent fractures. In Norway, several hospitals offer such services, although Bergen does not yet have one.

Developing FLS in Bergen

The Bergen Geriatric Research Group is working to develop such services in Bergen. A pilot project is currently underway at Haraldsplass Deaconess Hospital, where individuals admitted to the orthopedic department are identified and offered bone density measurement and fall risk assessment. The primary goal of the pilot is to gain practical experience and generate insights into how an FLS can be effectively implemented in Bergen.

Additionally, funding has been applied for to support a Ph.D. project aimed at developing a training and information program for postmenopausal women with osteoporosis and osteoporotic fractures.