Occurs when the patient has never had a period
Should be investigated in:
- 14 year old girls with no breast development
- 15 year old girls
Often it is just due to late puberty (which is often familial), and you should reassure parents and patients that this is commonly the case.
Things to consider investigating
- Are the external genitalia normal?
- If so, are the internal genitalia normal?
Consider Genotypic karotyping for:
- Turner’s Syndrome
- Testicular feminization
- Emotional distress
- Weight loss
- Excessive Exercise
- Systemic disease
- Hyperthyroidism [link]
Other things to consider
- Early menopause occurs in about 1% of those with secondary amenorrhoea
- Polycystic ovary syndrome [link]
- Pituitary tumours
- Pituitary necrosis
- Early menopause occurs in about 1% of patients