Anovulation Clinical Presentation

Updated: Jan 06, 2023
  • Author: Armando E Hernandez-Rey, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Past medical and surgical history

Obtain information about infections, history of pelvic surgery, anatomic anomalies, previous diagnosis of chromosomal abnormalities, past history of dilatation and curettage (history of postsurgical changes in menstrual flow, including amenorrhea and Asherman syndrome).

Past family history

Does/did the mother and/or sisters have similar symptoms?

History of pubertal development

When was the onset of menarche, pubarche, and growth spurt?

Detailed history of the menses

What is the current frequency, regularity or irregularity, length, and quantity of uterine bleeding?

Past reproductive history

Obtain information about pregnancy losses; antepartum, intrapartum, and postpartum complications, including dilatation and curettage, because of retained products of conception after an early pregnancy loss and after a normal vaginal delivery.

Past and current sexual activity

Obtain information about the number of partners, as well as a history of sexually transmitted diseases, painful intercourse, and vaginal symptoms (eg, burning, postcoital bleeding).


What are the methods of contraception and duration of use, such as type of oral contraceptives and intrauterine devices (IUDs), including progestin-IUDs?

Dietary history

Has there been any recent weight gain or weight loss?


Obtain information about past and present medication use.

Psychologic history

Is there/has there been a history of depression, emotional lability, anxiety, and/or stress (including status of current relationships)?

History of previous malignancies

Obtain information about previous malignancies (eg, craniopharyngioma, leukemia, Hodgkin disease) and treatments received (eg, radiation, alkylating chemotherapeutic agents).

Review of symptoms

Has the patient experienced any of the following:

  • Headaches

  • Visual disturbances

  • Changes in hair distribution or appearance

  • Deepening of voice

  • Breast secretions (unilateral, bilateral)


Physical Examination

Obtain and document the patient's vital signs.


Evaluate the patient's voice, affect, and presentation (eg, disheveled, well-groomed).


Does the patient have facial acne (cystic), acanthosis nigricans (velvety dark patches usually found on the lateral aspects of the neck, axillae, and inner aspects of the thighs), stigmata of hepatic disease (telangiectasia, caput medusae), and/or violaceous striae usually in the flanks (Cushing syndrome)?

Head, eyes, ears, nose, and throat

Assess the following:

  • Head - Hair distribution (male pattern baldness), facial hair, cushingoid facies

  • Eyes - Exophthalmos, visual acuity and visual fields (ruling out bitemporal hemianopsia)

  • Ears - Enlarged, disproportionate (acromegaly)

  • Nose - Enlarged (disproportionate to rest of face [acromegaly]), anosmia (scent of orange peels [Kallmann syndrome])

  • Throat - Webbing of neck (Turner syndrome [ie, remnants of cystic hygroma]), carotid bruits, thyromegaly


Evaluate the patient's Marshall-Tanner staging, areola (protuberance, pigmentation), secretions, shape of breasts (cylindrical as in exogenous estrogen exposure), decrease in breast size (androgen exposure), and/or presence of a shield chest (Turner syndrome).


Are murmurs present?


Assess for a linea alba, infraumbilical hair distribution, waist/hip ratio, and striae (as above).


Assess the mons pubis, Marshall-Tanner staging, male-female escutcheon, absence of pubic hair (androgen insensitivity syndrome), vulvar skin (hypoestrogenized), vulvovaginal mucosa (hypoestrogenized), and clitoris (clitoral index, >35 mm2). Perform a bimanual examination to exclude ovarian/adnexal masses, age-appropriateness of genitalia


Assess for the presence of lanugo (anorexia) versus male hair characteristics (hirsutism).