The Ovulatory Disorders Classification System

Posted March 21, 2023

Providing international standardization on ovulatory disorders was the main objective of a study conducted by the INCT Hormona team at Universidade de São Paulo – Campus Ribeirão Preto (USP/RP).

According to the INCT deputy general coordinator and coordinator of the INCT Hormona Center at USP/RP, Dr. Rui Alberto Ferriani, the study proposes a broad and comprehensive standardization as well as updated classification of ovulatory disorders, since the system used until then, attributed to the World Health Organization (WHO), was developed more than 30 years ago. “Since the first iterations of the WHO classification, there have been significant advances in understanding the control of ovulation and the pathophysiology of ovulatory disorders, together with improvements in assay technology and genomics,” says the expert.

According to the expert, a classification system for abnormal uterine bleeding had already been proposed by the International Federation of Gynecology and Obstetrics (FIGO), known as PALM-COEIN. The group has now proposed a new classification of ovulatory disorders also using an acronym to facilitate memory recall (HyPO-P GAIN-FIT-PIE).

The article explains that the system is applied after a preliminary assessment has identified the presence of an ovulatory disorder. “The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P.”

Also, each anatomic category should be stratified in the second layer of the system to provide granularity for investigators, clinicians, and trainees using the ‘GAIN-FIT-PIE’ mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and Vascular; Physiological, Idiopathic, Endocrine). The tertiary level, according to the article, allows for specific diagnostic entities.

For Dr. Rui Ferriani, if widely adopted, this system will facilitate education, clinical care, and the design and interpretation of research in a fashion that better informs progress in this field. The FIGO Ovulatory Disorders Classification System study can be read in full at: