Improving diagnosis of Polycystic Ovary Syndrome

The CRE in PCOS New Knowledge topic Improving Diagnosis of PCOS is led by Professor Robert Norman:
  • Understanding menstrual patterns and ovulation
  • Pubertal transition
  • Improved androgen assays
  • Standards for PCOS on ultrasound
  • AMH serum assays to simplify diagnosis

If you would like further information about a research topic please contact the project lead.

The International Guideline has prioritised PCOS diagnosis in research. Refining features across clinical and biomedical hyperandrogenism, oligo/anovulation and PCOM on ultrasound are important and are now the subject of international collaborative research.

Improving Diagnosis Polycystic Ovary Syndrome

Understanding menstrual patterns and ovulation

Without long term follow-up data, it is hard to differentiate patterns of ovulation and menstruation in PCOS and those of normal adolescence (which are often irregular). Building on ongoing assessment of menstrual patterns and ovulation through puberty, in the current cohort study groups, the project will look at the adolescence–adulthood transition (Raine cohort); conception to 40 years across three generations (Lucina cohort); and from 18–55 years in the Australian Longitudinal study for women’s health.

Project Lead: Professor Roger Hart

Pubertal transition

This project will prospectively study development of clinical, biochemical, and psychological PCOS features through childhood, pubertal transition and adolescence, with the Raine cohort and longitudinal adolescent studies (Patton) newly accessible under the CRE. Chief Investigator (CI) George Patton, a psychiatric epidemiologist with expertise in population-based longitudinal studies in adolescents, will work with CI Roger Hart, CI Robert Norman, CI Helena Teede and CI Alexia Peña Vargas (a paediatrician internationally recognised in PCOS). This team will also undertake clinical research exploring the impact of peri-pubertal interventions, building on emerging evidence that targeting insulin resistance at puberty may limit hyperandrogenism and weight gain and prevent or reduce severity of PCOS.

Project Lead: Professor Roger Hart

Improved androgen assays

Current androgen assays, based on direct (un extracted) serum samples, are imprecise and little better than chance, with poorly based reference ranges varying between laboratories. CI David Handelsman leads the field in androgen physiology, pharmacology, and steroid measurement, with a track record of optimising androgen measurement. His clinical research drives the recently announced requirement for mass spectrometry (MS) sex steroid assays. Handelsman joins this CRE (and clinical PCOS research), providing access to state-of-the-art steroid assay technologies based on MS to establish reference ranges by age and ethnicity. This project will work with the pathology industry and College of Pathologists to improve measurement and reporting of androgens, informed by our results.

Project Lead: Project Lead: Professor David Handelsman

Standards for PCOS on ultrasound

Detection of polycystic ovaries (PCO) on vaginal and abdominal ultrasound does not by itself define PCOS; it is difficult to standardise, has changed with the evolution of imaging equipment, is costly, and is often unacceptable for young women. PCO defining and reporting standards differ internationally. The CRE will extend its use of databases from Australia (CI Roger Hart), Netherlands (AI Bart Fauser), and France (AI Didier Dewailly) to define normal and abnormal morphology, and standardise measurement and reporting for accuracy. We will address impacts of age, ethnicity, and evolution of imaging equipment. With the imaging collaborators, and leading subspecialists in gynaecological ultrasound and relevant colleges, this project will promote uniform assessment in practice.

Project Lead: Professor Robert Norman

AMH serum assays to simplify diagnosis

This project will investigate alternatives to ultrasound including serum anti-mullerian hormone (AMH), unique to ovarian follicular cells and elevated in PCOS. The project has so far applied AMH as a diagnostic replacement to ultrasound in Indigenous women and in ovulation prediction; but optimal assays and diagnostic ranges must be established. The CRE we will collaborate with international leaders in AMH, using new more accurate assays, to establish normal and diagnostic ranges for PCOS across the lifespan using the Raine and Lucina cohorts and in pooled data from the clinical trials.

Project Lead: Professor Roger Hart