Primary Amenorrhoea

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

Secondary Amenorrhoea

Common causes – the hypothalamic – pituitary – ovarian axis can be easily unbalanced by many things, including:

Other things to consider

Rare causes:

  • Pituitary tumours
  • Pituitary necrosis
  • Early menopause occurs in about 1% of patients