Polycystic ovary syndrome (PCOS) is the leading cause of female infertility. Not only is the disorder greatly understudied, but the process of diagnosis can take years. The extensive symptoms of PCOS are often life-altering, and include menstrual cycle irregularities, male pattern hair loss, obesity, an increased risk of cardiovascular disease, fatty liver disease, type 2 diabetes, depression and eating disorders. Despite the severity of PCOS, there are no FDA-approved medications and the limited treatment options have not changed significantly over the last 30 years. 

“In some women, the diagnostic process is pretty horrific on the part of the patient. It takes between two and four years to get an accurate diagnosis,” said Melanie Cree, MD, PhD, associate professor of pediatrics and Ludeman Center researcher. This delay in care is significant because PCOS impacts nearly every system in a person’s body. Through clinics founded by Ludeman Center researchers at both Children’s Hospital Colorado and UCHealth, the wait time for a diagnosis is slowly being reduced and care is greatly improved. “A unique aspect of our pediatric clinic is that we are helping patients diagnose their PCOS earlier to intervene and stop that trajectory so these young women can live healthy and productive lives,” says Stacey Simon, PhD, associate professor of pediatrics and Ludeman Center researcher. 

PCOS has a major impact on patients' lives and efforts led by Noy Phimphasone-Brady, PhD, assistant professor of psychiatry and Ludeman Center researcher, Dr. Cree and Dr. Simon to develop multi-disciplinary clinics at Children’s Hospital Colorado and UCHealth to treat PCOS are changing the standard of care for patients.  

The Multidisciplinary PCOS Clinic at Children’s Hospital 

The PCOS Clinic at Children’s Hospital Colorado was founded by Dr. Cree, who is one of the few researchers in the country focusing on PCOS in adolescent girls. In addition to receiving a Building Interdisciplinary Research Careers in Women’s Health NIH K-12 (BIRCWH) award, she has received grant funding from the American Heart Association to study PCOS, received a Boettcher Foundation’s Webb-Waring Biomedical Research Award, a grant from the Doris Duke Foundation, and two R01 projects funded by the National Institutes of Health. Her research looks at metabolic disease in girls with PCOS, with a focus on pre-diabetes and fatty liver disease and has found that these Denver adolescents had an 18-fold increased risk of type 2 diabetes while 40 to 50% of them had fatty liver disease. Dr. Cree created the multidisciplinary clinic at Children’s Hospital Colorado to provide one place where patients could receive multidisciplinary care related to PCOS and address all aspects of the condition. 

“Our clinic is currently the most comprehensive PCOS adolescent clinic in the country, if not the world,” says Dr. Cree. “Our unique approach to supporting our patients includes the study of endocrinology, gynecology, dermatology, nutrition and specialized nursing all in one place and with consideration to the whole lifespan.” 

The Ludeman Center is a unifying program for these researchers. Over the last 10 years, Dr. Cree, Dr. Simon and Dr. Phimphasone-Brady’s paths crossed while pursuing research projects as BIRCWH scholars. When Dr. Simon joined CU Anschutz, she was immediately drawn to the work happening at the adolescent PCOS clinic. She brought sleep health research to the clinic, a critical element of improving the health of patients with PCOS. 

“We have found that adolescents with PCOS have poor sleep health,” says Dr. Simon. “This is because they are not getting sufficient sleep or are going to bed very late, which can cause them to have poor insulin sensitivity, higher testosterone levels, and other symptoms of metabolic syndrome that together increase the risk of heart disease and diabetes.” 

Prioritizing Transition of Care for PCOS Patients  
Several years ago, Dr. Cree began working with Dr. Phimphasone-Brady and Kathryn McKenney, MD, MPH, assistant professor of obstetrics and gynecology, to start their own adult multidisciplinary PCOS clinic to support adult patients. Funded by the Office on Women’s Health in the U.S. Department of Health and Human Services, this clinic aims to reduce the barriers to receiving continued care when transitioning to an adult clinic which include gynecology, health psychology, nutrition services and patient navigation. Despite the challenge of communicating across two health systems, they are accelerating appointment times and offering care that is aligned across both Children’s Hospital and UCHhealth. Their collaborative approach to patient care and research offers patients the best strategies to help them manage their PCOS across their lifespan. 

“We were all involved in writing a paper describing the transition from pediatric to adult care,” said Dr. Simon. “Our collaboration is strengthened by having care from pediatrics through adulthood. At some point, patients need to transition to adult care because of their age. Having us be a cohesive team is really valuable for our patients, so we can help them as they continue through development and across the lifespan.” 

Dr. Phimphasone-Brady's clinical and research focus is at the intersection of mental and physical health. During her graduate training, she had a young adult patient in college who had a family history of bipolar disorder and had been diagnosed with PCOS. Fascinated by these intersecting factors that were shaping the trajectory of this young person’s life, she began working with patients diagnosed with PCOS, which eventually led her to the Ludeman Center. 

Mental health is a leading concern for patients with PCOS as they face a lengthy and difficult to treat condition that is compounded by PCOS symptoms – like weight gain, facial hair and skin discoloration – that can create body image concerns. The impact of infertility is extremely stressful, especially when adolescent girls and women are dealing with fertility concerns very early on in their lives.  

Dr. Phimphasone-Brady, PhD, noted, “research indicates that people diagnosed with PCOS are up to two times more likely to be diagnosed with a major depressive or anxiety disorder. They are three times more likely to develop an eating disorder because of the increased weight and metabolic concerns and are also more likely to be diagnosed with bipolar disorder.” 

Together, these researchers are addressing all aspects of PCOS, from metabolic to psychiatric concerns. Combining their skills and their passion, the goal is to improve diagnosis and screening for PCOS and improve health for these women.  

Ludeman Center as a Place for Collaboration 

The Ludeman Center prioritizes collaboration. “You simply cannot do science in isolation anymore, "says Dr. Cree. “When you have a condition that hits multiple body systems, you need experts in each one of those areas to provide top-notch patient care, and the Ludeman Center has brought us all together to make this possible.” 

By combining research funding and mentorship, the Ludeman Center is fueling innovative research that is transforming women’s health in our community. “What the Ludeman Center has created for early-career researchers feels unmatched,” said Dr. Phimphasone-Brady.