WHO type 1 anovulation: an update on diagnosis, management and implications for long‐term health

Key content The World Health Organization (WHO) type 1 anovulatory disorders include hypogonadotrophic hypogonadism, hypothalamic amenorrhoea and hypopituitarism. These conditions are encountered primarily in endocrine, gynaecology and reproductive medicine clinics, and can result in amenorrhoea/oligomenorrhoea, subfertility or pregnancy loss. These conditions are associated with estrogen deficiency and therefore have implications for long‐term bone and cardiovascular health. There is an apparent lack of clarity on diagnostic criteria (including utility of new biomarkers such as anti‐müllerian hormone) and management strategies for these conditions. Evidence suggests that multidisciplinary care with timely induction of puberty, appropriate hormone replacement, lifestyle modification, counselling and behavioural therapies, and ovulation induction with gonadotrophins/gonadotrophin‐releasing hormone is associated with improved reproductive and other health outcomes in women with these conditions. Learning objectives To appreciate the role of the hypothalamo–pituitary–ovarian axis in normal reproductive health and understand the impact of its dysfunction on reproductive and other health outcomes. To subclassify WHO type 1 anovulation and understand the aetiology, pathogenesis and prognosis of different conditions. To offer appropriate evaluation and management options to women with WHO type 1 anovulation.