A University of �鶹��ý at Mānoa physician is working to change how a common but often overlooked gynecologic condition is diagnosed and treated.

Kimberly Kho, who holds the nation’s first professorship in advanced gynecological surgery in the (JABSOM), recently authored a clinical expert series review on adenomyosis in . The publication places Kho among a select group of internationally recognized experts in women’s health.

“These articles are meant to synthesize the existing medical literature and turn it into meaningful clinical guidance,” Kho said. “The goal is that a physician could read it, deepen their understanding of the disease, and immediately apply what they learned in their practice on Monday morning.”

Adenomyosis occurs when tissue similar to the lining of the uterus grows into the uterine muscle, causing severe menstrual bleeding, chronic pelvic pain and fertility challenges. Despite affecting roughly one in three women, the condition remains underdiagnosed and under-researched.

“It’s astonishing how common it is,” Kho said. “But if you look at the research funding for adenomyosis, which then correlates to our scientific understanding of the disease and specific therapies, it’s just a drop in the proverbial bucket compared to how much and how many this disease impacts.”

Advances in diagnosis, care

Kho’s review provides a practical roadmap for OB–GYN physicians, covering disease mechanisms, diagnostic advances and modern treatment options. A major shift highlighted is the move toward noninvasive diagnosis using imaging tools such as ultrasound and MRI, rather than relying on hysterectomy for confirmation.

“Our paradigm for diagnosing has really evolved because our technologies have evolved. This allows us to name the condition and start treating it, rather than the alternative, which was often to write off the symptoms,” Kho said.

The review also challenges the idea that hysterectomy is the only effective treatment.

“There are many excellent uterine-preserving options,” Kho said. “Medical, interventional and surgical treatments can manage symptoms while preserving uterine function and future fertility.”

Kho hopes the publication will help establish clearer guidance for physicians worldwide while expanding access to advanced gynecologic care in �鶹��ý.

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Cheers, hugs and tears flowed at the University of �鶹��ý at Mānoa (JABSOM) as the Class of 2026 opened envelopes revealing the next step in their medical journeys.

On March 20, 78 students participated in Match Day, learning where they will continue their training in residency programs across the country.

This year’s class is strongly committed to primary care, with 56% matching into internal medicine, family medicine, pediatrics and OB-GYN—fields that remain in high demand across �鶹��ý. Additionally, 33% of graduates will remain in �鶹��ý for residency.

Staying home to serve �鶹��ý

For many students, staying home made Match Day especially meaningful.

“As cheesy as it might sound, I think it means the world to me,” said Kerrick Chinen. “I grew up in this place, these people have raised me, and it’s an absolute honor to be back serving the people and practicing even more at home.”

He added, “The heart said I really wanted to stay at home, but I knew the reality of it. It was a little dicey. So it was an absolute relief opening that envelope up and seeing the University of �鶹��ý.”

Jonathan Carino shared a similar goal. “That’s always been my intention,” Carino said. “To do residency somewhere not in �鶹��ý didn’t sit right with me, and I’m really glad I’m staying home here at UH.”

JABSOM Dean Sam Shomaker said that commitment reflects the school’s mission to serve the state’s most pressing health care needs.

“Primary care is the backbone of a healthy community, and �鶹��ý continues to face a critical need in these areas,” Shomaker said. “We are proud to see so many of our students choosing this path and staying true to our mission of training physicians who will serve our communities here at home.”

It was also a notable year for surgery, with 19% of the class matching into surgical specialties.

Nationally, more than 38,000 medical students matched into residency programs this year, marking the largest Match in the history of the National Resident Matching Program.

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The nation’s first professorship in advanced gynecological surgery at a major academic institution was established last year at the (JABSOM) at the University of �鶹��ý at Mānoa, expanding access to specialized care in �鶹��ý.

Just months after arriving, Kimberly Kho is already advancing that effort. Kho joined JABSOM after building one of the nation’s leading programs in minimally invasive gynecologic surgery at the University of Texas Southwestern Medical Center. Her work focuses on treating benign gynecologic diseases—noncancerous conditions that affect millions of women but can still be life-altering.

She is also helping train OBGYN residents in the diagnosis and treatment of conditions such as chronic pelvic pain, fibroids and endometriosis.

“These are benign diseases, meaning they’re not cancer,” Kho said. “But they can be completely debilitating.”

Addressing a critical gap in care

Conditions such as uterine fibroids and endometriosis are common and often severe. Fibroids affect an estimated 70 to 80% of women with a uterus, while endometriosis impacts about one in nine women.

For many patients in �鶹��ý, access to specialized treatment has historically been limited, with some traveling to the mainland for advanced care.

“People were leaving the state to seek this kind of care or being presented with treatment options that didn’t honor their values, including more radical surgeries that would lead to loss of fertility,” Kho said. “Now we’re building the ability to provide those advanced, complex services here.”

Kho, who brings nearly two decades of experience, is working to build a multidisciplinary program that improves collaboration and expands awareness of these often misunderstood conditions.

“We have to educate our community, our patients and other healthcare providers,” she said.

Kho said �鶹��ý already has the talent and expertise needed to support this work.

“What’s amazing is that the skill sets are already here,” she said. “The radiologists, pain specialists, physical therapists, they are all here. They just needed someone to help organize and bring those teams under the umbrella of multidisciplinary care together.”

A pioneer in obstetrics and gynecology (OBGYN) who strengthened women’s health education in �鶹��ý is being honored with a new endowed professorship at the University of �鶹��ý at Mānoa’s (JABSOM).

Established through a gift from UH Mānoa Professor of Law Emeritus Linda Krieger in honor of her father, John Krieger, the professorship recognizes his lasting impact on OBGYN training in the state in the 1960s.

John Krieger moved to �鶹��ý in 1963, when the state faced a shortage of OBGYNs. Although already in practice, he returned to residency training to meet local licensing requirements.

“My father had been in practice for about six or seven years, but you couldn’t get a medical license here for a year if you moved here, so he went back to being a resident,” said Linda Krieger, a nationally respected law scholar and civil rights advocate. “That experience got him very interested in working on medical education, especially at the residency level.”

Krieger helped build OBGYN residency education at what was called The Queen’s Hospital at the time and later led residency training when JABSOM expanded to a four-year program.

“This was their whole life,” Linda said of her parents’ connection to �鶹��ý. “My father really loved the multiculturalism here and the diversity of people and cultures. He felt very committed to that kind of community.”

First recipient carries legacy forward

The inaugural John A. Krieger Endowed Professorship was awarded to Lynne Saito-Tom, professor in the Department of OBGYN and Women’s Health at JABSOM. To Saito-Tom, the honor reflects her family’s deep commitment to education.

Her grandparents were unable to attend school beyond elementary level but believed strongly in higher education, ensuring their children went to college. Growing up in Wahiawā, her parents sacrificed daily—waking before sunrise and commuting long hours—so she could pursue her goals.

“Thanks to their sacrifices, I was able to pursue my educational goals of becoming a physician, the first in my family,” Saito-Tom said.

She added, “Dr. John Krieger, the first resident program director of our department, developed a strong curriculum for residency training, and I plan to utilize this endowment to advance medical education, including creating innovative curriculum, supporting trainees and enhancing faculty development.”

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From China to �鶹��ý, Hongwen (Winnie) Wu has turned a career as a board-certified obstetrician-gynecologist (OB-GYN) into groundbreaking reproductive biology research. This fall, she earned her PhD in the Developmental and Reproductive Biology graduate program at the at the University of �鶹��ý at Mānoa, becoming the first Kosasa Graduate Student Assistantship recipient.

The prestigious assistantship, funded by Thomas Kosasa of Pacific IVF and a professor emeritus at JABSOM, was created to strengthen connections between the (YIBR), the OB-GYN Department, and Pacific IVF.

“Through a dynamic approach, I aspire to significantly contribute to improving individual patient health and advancing the broader landscape of women’s health research,” said Wu, who joined JABSOM’s Developmental and Reproductive Biology program from China in fall 2019.

Advancing fertility research and education

As a PhD student, Wu carried out her research in Steve Ward’s lab at YIBR, focusing on female fertility. She studied the protein EXOC5 in ovarian aging and discovered it is essential for normal egg development, with its absence leading to ovarian failure.

During her time at JABSOM, Wu co-authored five manuscripts and presented her work at seven local and four national conferences, including the Society for the Study of Reproduction and the Society for Reproductive Investigations. She received the 2024 ARCS Award in Medicine, served as a teaching assistant, volunteered at research events, and was a visiting scholar at Northwestern University.

Her long-term goal is to remain in �鶹��ý as a research physician/scientist, blending cutting-edge research with clinical expertise to advance women’s healthcare.

“Winnie’s performance as the first Kosasa Assistantship-supported DRB student has been exemplary,” said Monika Ward, interim director of YIBR. “She contributed research of relevance to all four parties: DRB, YIBR, OB-GYN and Pacific IVF.”

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Native Hawaiian scientist Alika Maunakea of the University of �鶹��ý at Mānoa (JABSOM) has spent more than 20 years studying epigenetics–—how environment shapes health across generations. With colleague Monika Ward of JABSOM and the , they examined how maternal obesity before pregnancy may influence autism risk.

Related UH News story: UH study links maternal obesity to autism-like traits in offspring

Q: What motivated this research, and what did you discover?

We were struck by the worldwide rise in autism and by data showing that mothers who are obese face a 50–60% higher risk of having a child with autism. What wasn’t clear was when that risk takes hold—is it during pregnancy or even before? In our study, we found that maternal obesity before conception was enough to increase the likelihood of autism-related traits in offspring, at least in our mouse model. That finding points to an important window of time that hasn’t received much attention.

Q: How confident are you that these findings translate to humans?

While our work was done in mice, many of the same genetic pathways we studied are conserved in humans. What’s striking is that autism-related genes known to raise risk in people were also affected in the mouse model, not by mutations but by epigenetic changes that altered gene expression. So while it’s not proof, it strongly suggests that similar mechanisms could be at play in humans, and that gives our findings real relevance.

Q: Does obesity guarantee autism risk for a child?

No, it’s important to stress that obesity is not a determining factor. In our study, even among mice with obese mothers, about 60% developed normally. What maternal obesity does is raise the risk, which is very different from guaranteeing an outcome. That nuance matters, because it shows there’s room to intervene and reduce risks rather than assuming outcomes are fixed.

Q: What does this mean for timing—before vs, during pregnancy?

We’ve long known pregnancy is a critical period, but our study highlights that the preconception window is just as important. Health status before pregnancy can shape risks for children, not just for autism but also for other chronic conditions. This means lifestyle changes made even before planning a pregnancy, such as improving diet, exercise and overall metabolic health, may help improve outcomes for both parent and child.

Q: Is it ever too late to make lifestyle changes?

No. The message is that any step to improve health is worthwhile. Even outside the context of pregnancy, better diet and exercise lower risks for chronic disease. But when we’re talking about planning a family, those same changes may also lower risks for future children. So the preconception period is a powerful window of opportunity, but positive changes at any stage are valuable.

Q: Where does the research go from here?

The next step is to see whether improving health before conception can actually lower the autism risk we observed, and whether those benefits extend across multiple generations. We also found that male offspring were more affected than females, so we want to explore why that is and how long these effects last. These are unanswered questions with big implications for human health.

Q: How should the public understand this research?

Most importantly, this isn’t about blame. Obesity is shaped by many factors, like access to healthy foods, safe places to exercise, and healthcare resources. Our work shows opportunities where supportive policies, healthcare guidance, and community programs can make a difference. Beyond autism, improving metabolic health before conception is simply good practice for lifelong health, both for parents and for their children.

Q: How does Native Hawaiian knowledge influence your work?

As a Native Hawaiian epigeneticist, I draw inspiration from our ʻike kupuna (ancestral knowledge). For centuries, Hawaiians understood that pregnancy timing and environment shape a child’s health. For example, a saying advises strengthening the unborn child through diet and herbal remedies, an early recognition that what mothers do before and during pregnancy can affect future generations. Our research in epigenetics reflects that same idea: the environment can influence health outcomes long before birth.

A new University of �鶹��ý at Mānoa (JABSOM) endowment for a professorship dedicated to advancing benign gynecological surgery will enhance the Department of Obstetrics, Gynecology, and Women’s Health (OBGYN). The OBGYN department now holds the largest endowment among all JABSOM departments.

Benign gynecological conditions, such as uterine fibroids, endometriosis and ovarian cysts, affect many women and can cause significant pain and stress. The Advanced GYN Surgery Professorship will support a faculty member who will elevate training for OBGYN residents in areas like chronic pelvic pain, fibroids and endometriosis.

“Our department has long been recognized for excellence in gynecologic oncology and urogynecology, yet there has been a significant gap in dedicated expertise for advanced and complex benign gynecologic surgery,” said Ivica Zalud, OBGYN department chair. “The need for highly specialized faculty—at the full professor level, with fellowship training, board certification, and national recognition—is critical in ensuring that our learners receive the highest standard of clinical training in surgical care.”

“This endowment is a step towards filling a major void in �鶹��ý’s health care system,” said JABSOM Dean Sam Shomaker. “Having a nationally recognized expert in this area, right in our backyard, will improve clinical care and give OBGYN residents the training they need to help �鶹��ý’s women as they go into practice in our community.”

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A University of �鶹��ý at Mānoa faculty member’s personal interest in channel swimming has led to highlighting the rare interactions between cookiecutter sharks (Isistius brasiliensis) and humans, particularly among channel swimmers in �鶹��ý. The study, led by Steven Minaglia, an associate professor of obstetrics and gynecology and women’s health at the University of �鶹��ý at Mānoa and an avid channel swimmer, showed how environmental conditions can increase the likelihood of these attacks.

Cookiecutter sharks, known for their distinctive feeding method that leaves cookie-cutter-shaped wounds, are typically found in deep tropical and subtropical waters. Despite their small size, these sharks can pose a significant threat, although rarely. Of the seven reported cookiecutter shark attacks on humans worldwide, six occurred in �鶹��ý, and five of those involved channel swimmers.

Finding the link

Minaglia’s study analyzed data from 1961 to 2023, covering 129 successful solo channel swims and five shark-related injuries. He discovered a link between these attacks and environmental conditions, particularly on moonless nights. The risk of shark attacks significantly increases during complete darkness compared to when the moon or sun is visible. Other factors, such as swim start times and the time of year, also correlate with the likelihood of an attack.

Minaglia’s study was prompted by his ongoing personal research on channel crossings in �鶹��ý to determine optimal swimming conditions. He planned to swim the 26-mile Kaʻiwi Channel between Oʻahu and Molokaʻi in 2020, but was concerned because of a series of shark attacks among swimmers the previous year.

“When I noticed that five out of six shark bites occurred on moonless nights, I felt a duty to publish these important findings that can potentially improve safety for channel swimmers,” said Minaglia, who successfully swam the challenging Kaʻiwi Channel in 22-hours in October 2020 during a full moon. He noted the strong currents during full moons also made it a difficult swim.

Minaglia compiled an electronic database in 2018 with data from the . His research is one of only three papers addressing cookiecutter shark attacks on live humans.

The study, supported by Queen’s University Medical Group where Minaglia serves as director of urogynecology and reconstructive pelvic surgery, is available as open access on .

“I hope this research provides valuable insights into safe swimming practices for the global swimming community,” Minaglia said.

A placenta (commonly known as the “afterbirth” or “ʻiewe” in Hawaiian) is a temporary organ which connects the mother to the fetus via the umbilical cord. Its purpose is to deliver nutrients and oxygen to the fetus while serving as a barrier to prevent infections or viruses from entering the developing fetus.

A new study by researchers at the (JABSOM) at the University of �鶹��ý at Mānoa and examined placentas donated by women who delivered in �鶹��ý from 2006 to 2021, and found the presence of microplastic particles in the placenta.

Microplastics are visible to the naked eye, and examples can range from the plastic beads once found in exfoliating soaps, to particles from disintegrating plastic bags, to bits of plastic found in microwavable containers which are then inadvertently consumed by humans.

“We were shocked that these little pieces of plastic were getting across the mom’s gut and landing in the placenta,” said Men Jean Lee, an obstetrician and researcher at JABSOM and Kapiʻolani Medical Center. Lee, Rodrigo Weingrill and Johann Urschitz from UH ����ԴDz�’�� co-authored the research recently published in .

The researchers collected and studied 10 placentas in 2006, 2013 and 2021 and found the presence of microplastics grew each year.

• In 2006, 6 of the 10 placentas contained microplastics.
• In 2013, microplastics were found in 9 of the 10 placentas.
• In 2021, researchers found microplastics in all 10 placentas.

“We believe that the plastics may be floating around in food or being inhaled. It’s coming through our digestive fluids or lungs, and the particles are getting absorbed through the gut and traveling through the bloodstream, and then somehow collecting in the placenta during pregnancy,” Lee said. “The big question is, as it’s traveling through the placenta, can it get through the umbilical cord and then to the baby? We don’t know that right now.”

Link to global plastic production

We know that the rise in microplastics found in the placentas of �鶹��ý mothers corresponds with the skyrocketing levels of global plastic production.

According to the Journal of Hazardous Materials, more than 6,000 megatons of plastic were produced in 2020. Less than 2,000 megatons were produced in 2000.

The big question is, as it’s traveling through the placenta, can it get through the umbilical cord and then to the baby?
—Men Jean Lee

Lee believes H�鶹��ý‘s remote location creates an added dependency on plastic.

“We’re the world’s most remote population center or island chain. We’re 2,300 miles from California and 4,000 miles from Japan,” Lee said. “For daily conveniences, we commonly use plastic wrap, plastic containers, plastic bags and single use water bottles.”

She suggests �鶹��ý‘s location in the center of the Pacific Ocean, tropical climate, and lack of recycling centers can exacerbate how these plastics are disintegrating or breaking down.

“The incineration of garbage, landfills and marine pollution affect our communities. When trash is being burned, dust particles are released, and can spread into the air we breathe,” Lee said. “In fact, we are concerned about how the debris from the recent Lahaina fires may contain microplastics and other chemical toxins in the remains of the fires. Meanwhile, we already know that sunlight, heat and salt can speed up the breakdown of these everyday plastics. I’ve noticed plastic bags, even shoes, wear out quickly in �鶹��ý and turn to dust. I never experienced this when I was living back in New York.”

Can microplastics enter the fetus too?

Lee and the JABSOM researchers will continue their research, now focused on seeing if the microplastics can pierce the protection of the placenta and enter the fetus before birth.

“We’re not trying to scare people,” Lee said, but acknowledges there are other questions that still need to be answered. “What are the sources of maternal microplastics? What are the plastics doing in the mother’s body and the placenta? Are they benign, or are they crossing over to the fetal side into the umbilical cord that is connected to the baby? If they are getting to the other side, are they affecting fetal growth and what happens to the baby when he/she grows up?”

A maternal-fetal medicine fellow at the University of �鶹��ý at Mānoa (JABSOM) brings focus to discriminatory regulations on postpartum sterilization for Medicaid recipients, particularly women from low-income backgrounds. Melanie Maykin’s was published in a November 10 issue of The Lancet Regional Health—Americas. The manuscript also led to �鶹��ý Senate Concurrent Resolution 191 (SCR191), Urging the United States Department of Health and Human Services to amend its policies relating to postpartum sterilization waiting periods for Medicaid recipients.

“We’re excited to bring awareness to this issue, especially as we reflect on systemic discrimination and inequities within our healthcare system. Still, there is much more work to do,” said Maykin, who is with JABSOM’s Department of Obstetrics, Gynecology and Women’s Health.

Postpartum sterilization, a permanent form of birth control, is a procedure performed prior to a woman’s release from the hospital. Under the existing Medicaid insurance regulations, women must complete the mandated Medicaid Title XIX form at least 30 days in advance of the procedure or risk being denied or personally billed for the procedure. This rule does not apply to those who have commercial insurance. However, publicly insured (Medicaid) women who would appreciate the convenience, the economy and the autonomy in planning the size of their family with this procedure, are faced with existing barriers.

State legislation introduced

Maykin’s manuscript received the attention of �鶹��ý State Sen. Chris Lee, who was inspired to write SCR191, which passed committees in the �鶹��ý House and Senate during the 2021 Legislature. The measure seeks to abolish the time factor that has become obstructive to low-income women and their families.

“This [federal] legislation, which was initially implemented to protect individuals from reproductive coercion, ultimately created barriers to equal access specifically for low-income people,” Maykin said. “It’s an important reminder that when creating legislation or attempting to repair the harm we’ve caused with existing policy, we must intentionally center the voices of affected communities.”

According to Lee, SCR191 puts the state of �鶹��ý on record as objecting to the Medicaid requirement. The resolution was also sent to �鶹��ý‘s Congressional delegation, and federal department agencies.

“As far as I know, this is the first time a state has come out against this inequitable practice,” Lee said. “There are individuals and organizations pushing against this, but �鶹��ý is the first state.”

Supporting testimonies at the �鶹��ý Legislature were presented by the �鶹��ý Section of the American College of Obstetricians and Gynecologists, among whom were OB-GYN practitioners, fellows and JABSOM faculty.

Maykin said that providing informed consent 30 days prior to birth, which is already a very unpredictable event, assumes that patients have the privilege of continuity in healthcare to see the same provider or group who knows them well.

“Moreover, this system depends on reliable transmission of the consent form to labor and delivery units. That is just not the reality for many low-income patients,” Maykin said.

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