The Origins of The Polycystic Ovary Syndrome

The Polycystic Ovary Syndrome (PCOS) affects up to 10% of women of reproductive age, which translates into around 350,000 women in Australia. It is the most common hormonal disorder in women.

The syndrome has far-reaching adverse implications for general and reproductive health, including menstrual disorder, obesity, infertility, miscarriage, pregnancy complications, increased risk of diabetes and possibly heart disease. PCOS also commonly causes cosmetic problems such as excess body hair and acne. 

The underlying causes of PCOS are not known but are thought to arise during intrauterine (fetal) life and to be modified by aspects of childhood health, in particular being overweight and obese. However, it has not previously been possible to investigate this sequence of events.

Using a large and unique cohort of adolescents followed up since fetal life and throughout childhood, and currently aged 13-15 years old (the Raine cohort), we will investigate for the first time the intrauterine and early childhood causes of PCOS. 

Understanding the causes of PCOS will lead to improvements in key areas of health for women internationally including reproductive health, diabetes and heart disease.

Mechanisms of Irregular Bleeding with Contraceptives and HRT

Irregular bleeding is the most common reason for women to discontinue hormonal contraception and in postmenopausal women using HRT irregular bleeding commonly leads to investigations to exclude cancer. In most cases no cause is found, and the bleeding appears to be due to the hormonal treatment.

Very little is known about the reasons for this bleeding and there are no effective therapies to prevent or stop the bleeding. Our research has focussed on improving understanding of the mechanisms underlying irregular bleeding. New and exciting data from the Women and Infants Research Foundation Laboratories have indicated changes in the uterine blood vessels causes by HRT use that may explain the bleeding. Future research will be aimed at finding effective therapies.

A Randomized Trial of Stripping Versus Ablation of Ovarian Endometriomas on Ovarian Function
 
Recruitment to this study has been slow as finding patients meeting the inclusion criteria has been difficult and unfortunately patients appear to be very reluctant to be involved in the study. Consequently the study has been adapted to allow investigation of a new marker of ovarian function.

Anti Mullerian Hormone (AMH) or Mullerian Inhibiting Substance (MIS) has become recognised as test of the reserve of the ovary. In addition, the protocol of the study has now been amended to that of a prospective observational study of women undergoing surgery for ovarian endometrioma, as the surgical excision of endometriomas has been demonstrated conclusively to be the most effective way to manage these ovarian cysts. This evidence is derived from the Cochrane Review researched on the subject by staff of the School of Women’s and Infants’ Health and KEMH.