Editing Anovulation (section)

===Classification and testing===
The [[World Health Organization]] criteria for classification of anovulation include the determination of [[oligomenorrhea]] (menstrual cycle >35 days) or [[amenorrea]] (menstrual cycle >6 months) in combination with concentration of [[prolactin]], [[follicle stimulating hormone]] (FSH) and [[estradiol]] (E2). The patients are classified as WHO1 (15%)—hypo-gonadotropic, hypo-estrogenic, WHO2 (80%)—normo-gonadotropic, normo-estrogenic, and WHO3 (5%)—hyper-gonadotropic, hypo-estrogenic. The vast majority of anovulation patients belong to the WHO2 group and demonstrate very heterogeneous symptoms ranging from anovulation, [[obesity]], biochemical or clinical hyperandrogenism and [[insulin resistance]].<ref name="FARIDDiamanti-Kandarakis2009">{{Cite journal|last1=Unuane|first1=David|last2=Tournaye|first2=Herman|last3=Velkeniers|first3=Brigitte|last4=Poppe|first4=Kris|date=December 2011|title=Endocrine disorders & female infertility|url=https://pubmed.ncbi.nlm.nih.gov/22115162|journal=Best Practice & Research. Clinical Endocrinology & Metabolism|volume=25|issue=6|pages=861–873|doi=10.1016/j.beem.2011.08.001|issn=1878-1594|pmid=22115162}}</ref> This classification system does not include a separate category for anovulation caused by [[Hyperprolactinaemia|hyperprolactinemia]], and experts do not consistently use this system.

Diagnosis of anovulation cause involves hormone level tests, in conjunction with an assessment of associated symptoms. A patient history and physical exam should include history of onset and pattern of [[oligomenorrhea]] or [[amenorrhea]], signs of [[Polycystic ovary syndrome|PCOS]] such as [[hyperandrogenism]] and [[obesity]], eating disorders, causes of excessive physical or mental stress, and breast secretions.<ref name=":3">{{Cite journal|last1=Teede|first1=Helena J.|last2=Misso|first2=Marie L.|last3=Costello|first3=Michael F.|last4=Dokras|first4=Anuja|last5=Laven|first5=Joop|last6=Moran|first6=Lisa|last7=Piltonen|first7=Terhi|last8=Norman|first8=Robert. J.|date=August 2018|title=Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome|journal=Fertility and Sterility|volume=110|issue=3|pages=364–379|doi=10.1016/j.fertnstert.2018.05.004|issn=0015-0282|pmc=6939856|pmid=30033227}}</ref><ref name=":4">{{Cite journal|last=Gordon|first=Catherine M.|date=2010-07-16|title=Functional Hypothalamic Amenorrhea|journal=New England Journal of Medicine|url=https://www.nejm.org/doi/10.1056/NEJMcp0912024|access-date=|volume=363|issue=4|pages=365–371|language=EN|doi=10.1056/nejmcp0912024|pmid=20660404|url-access=subscription}}</ref><ref name=":5">{{Cite journal|last1=Casanueva|first1=Felipe F.|last2=Molitch|first2=Mark E.|last3=Schlechte|first3=Janet A.|last4=Abs|first4=Roger|last5=Bonert|first5=Vivien|last6=Bronstein|first6=Marcello D.|last7=Brue|first7=Thierry|last8=Cappabianca|first8=Paolo|last9=Colao|first9=Annamaria|last10=Fahlbusch|first10=Rudolf|last11=Fideleff|first11=Hugo|date=2006|title=Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas|journal=Clinical Endocrinology|language=en|volume=65|issue=2|pages=265–273|doi=10.1111/j.1365-2265.2006.02562.x|pmid=16886971|s2cid=16048818|issn=1365-2265|doi-access=free}}</ref> Patients with symptoms of hyperandrogenism, such as hirsutism, can be tested for serum androgen levels as well as serum total testosterone levels.<ref name=":3" /> A 17-hydroprogesterone test may also be conducted if [[congenital adrenal hyperplasia]] is suspected. If the differential is broad, hormone serum levels of [[estradiol]], follicle-stimulating hormone ([[Follicle-stimulating hormone|FSH]]), gonadotropin-releasing hormone ([[Gonadotropin-releasing hormone|GnRH]]), [[anti-Müllerian hormone]] (AMH), [[thyroid-stimulating hormone]] (TSH), and [[prolactin]] can be diagnostic since most causes of anovulation are hormonal imbalances.<ref name=":4" /><ref name=":5" /><ref>{{Cite journal|last1=Laufer|first1=Marc R.|last2=Floor|first2=Amy E.|last3=Parsons|first3=Katherine E.|last4=Kuntz|first4=Karen M.|last5=Barbieri|first5=Robert L.|date=1995|title=Hormone Testing in Women with Adult-Onset Amenorrhea|url=https://www.karger.com/Article/FullText/292335|journal=Gynecologic and Obstetric Investigation|language=english|volume=40|issue=3|pages=200–203|doi=10.1159/000292335|issn=0378-7346|pmid=8529955|url-access=subscription}}</ref> Transvaginal ultrasound may also be used to visualize polycystic ovaries.<ref name=":3" />