Marla Lujan (center) works with students in anatomy lab. She has studied ovarian morphology for 15 years and her research aims to improve diagnosis and treatment for people with PCOS. Photo by Darcy Rose.
What
PCOS is a common hormonal disorder in reproductive-age women, characterized by irregular periods, excess androgens (male hormones) and enlarged ovaries with tiny ovarian cysts. It can lead to symptoms like infertility, weight gain and excess hair growth.
Lujan recently received an R01 award from the National Institutes of Health (NIH) to fund a five-year, multi-center study that will define the trajectory of PCOS symptoms during early adolescence. Lujan and her team aim to identify divergences in ovarian morphology, androgen concentrations and menstrual cyclicity between adolescents who develop PCOS and those with regular menstrual cycles, with the goal of developing a framework for the earliest detection and mitigation of the disorder. The grant builds on her earlier pilot study tracking the pubertal development of young women two years post-menarche.
“What’s cool here is that we don’t know what pubertal development looks like in PCOS,” said Lujan. “We have no domestic data in this area, yet we know that pubertal development is accelerating at-large. The number of girls who have their menarche — their first menstrual period — before age 11 has nearly doubled.”
Next year, Lujan’s team will publish pubertal data across populations. This new grant will help them develop diagnostic criteria for PCOS in adolescence and quantify differences in how it manifests in young people compared to adults to improve detection and treatment.
She also received a pilot grant to use artificial intelligence to automate detection of PCOS. Working with multiple collaborators, the team will analyze Lujan’s robust archive of sonograms from individuals across the reproductive spectrum to generate a novel imaging-based model for detecting PCOS on ultrasound.
“Clinicians can’t agree on whether ovarian morphology is part of PCOS,” said Lujan. “Endocrinologists prefer to focus on serum-based markers, while OB-GYNs depend on ultrasound to understand likelihood of response to ovarian stimulation for assisting individuals with fertility issues.” This lack of agreement delays diagnosis and the delivery of evidence-based care.
“If we can help resolve this debate by building working models that leverage our data, then we can help women,” she added.
Why
At any medical visit, clinicians typically check your pulse, temperature, breathing rate and blood pressure. These are called vital signs because they offer clues about your body’s overall health. A growing number of experts believe that a regular menstrual cycle should also be considered a vital sign, and Lujan agrees.
“I research women’s reproductive health from a variety of perspectives,” said Lujan. “Ovarian health reflects overall health, which we are not teaching early enough.”
Ovaries will naturally stop working in people who are malnourished. Menstrual disruptions are also documented in individuals who are in the military, traveling long distances or experiencing profound stress. This is a natural protective mechanism: the body halts reproduction when nutrients are insufficient or when stress responses dominate. Lujan’s team has discovered that in cases of obesity and inflammation, ovaries shut down for similar protective reasons.
“If you are not having regular ovulatory cycles, then something else is at play,” said Lujan. “It’s about overall health and not just fertility. Heavy bleeding is also not normal and is another indicator that something in the body is not right. Regular ovulation confers health benefits.”