Fertility awareness and LH measurement Symptoms-based methods of fertility awareness may be used to detect ovulation or to determine that cycles are anovulatory. Charting of the menstrual cycle may be done by hand, or with the aid of various fertility monitors. Records of one of the primary fertility awareness signs—basal body temperature—can detect ovulation by identifying the shift in temperature which takes place after ovulation. It is said to be the most reliable way of confirming whether ovulation has occurred. Women may also use ovulation predictor kits (OPKs) which detect the increase in luteinizing hormone (LH) levels that usually indicates imminent ovulation. For some women, these devices do not detect the LH surge, or high levels of LH are a poor predictor of ovulation; this is particularly common in women with PCOS. In such cases, OPKs and those fertility monitors which are based on LH may show false results, with an increased number of false positives or false negatives. Dr. Freundl from the University of Heidelberg suggests that tests which use LH as a reference often lack sensitivity and specificity. Classification and testing The World Health Organization criteria for classification of<unk>  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<unk>  patients belong to the WHO2 group and demonstrate very heterogeneous symptoms ranging from<unk> , obesity, biochemical or clinical hyperandrogenism and insulin resistance. This classification system does not include a separate category for<unk>  caused by hyperprolactinemia, and experts do not consistently use this system. Diagnosis of<unk>  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 PCOS such as hyperandrogenism and obesity, eating disorders, causes of excessive physical or mental stress, and breast secretions. Patients with symptoms of hyperandrogenism, such as hirsutism, can be tested for serum androgen levels as well as serum total testosterone levels. 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 (FSH), gonadotropin-releasing hormone (GnRH), anti-mullerian hormone (AMH), thyroid-stimulating hormone (TSH), and prolactin can be diagnostic since most causes of<unk>  are hormonal imbalances. Transvaginal ultrasound may also be used to visualize polycystic ovaries.
Anovulation
Anovulatory cycle
Gonadotropin-resistant ovary syndrome
Lactational amenorrhea
Polycystic ovary syndrome
Exercise amenorrhoea
Progestin-induced virilization
Primary ovarian insufficiency