Zyklusstörungen systematisch diagnostizieren: von der WHO- zur neuen FIGO-Klassifikation

Cycle abnormalities are frequent and require a systematic evaluation prior to initiation of a targeted treatment. The Fédération Internationale de Gynécologie et dʼObstétrique (FIGO) describes deviations from a normal cycle pattern in frequency, variability or severity as abnormal uterine bleeding (AUB). It subdivides these into structural (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, PALM) and nonstructural (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, COEIN) causes. For the subclassification of ovulatory dysfunction a proposal was recently submitted by FIGO. The hypothalamus, pituitary, ovary-polycystic ovary syndrome (HyPO-P) scheme is intended to replace the previously used World Health Organization (WHO) classification and is based on the assignment of the disorder to the levels of the hypothalamic-pituitary-ovarian axis with subsequent classification according to genetic, autoimmune, iatrogenic, neoplasm; functional, infectious and inflammatory, trauma and vascular; physiological, idiopathic, endocrine (GAIN-FIT-PIE). The polycystic ovary syndrome (PCOS), as the most common cycle disorder, forms an additional category with an as yet unexplained pathophysiology. As before, hormonal diagnostics with assessment of ovarian function and regulation as well as hormonal aberrations are required for classification. This proposal highlights cycle dysfunction as a continuum of follicular maturation dysfunction with the complete spectrum from episodic occurrence up to the full picture of amenorrhea. The intended use of the new classification from FIGO to provide a comprehensive and internationally standardized diagnostics of cycle disorders not only for research and teaching but also in daily practice, can only be assessed through practical application and discussion.