Primary Amenorrhea in Saudi Arabia: Aetiology, Clinical Manifestations, Management, and Prognosis: A 10-years multicentre retrospective study

Objective To investigate the causes, diagnostic approaches, management strategies, and outcomes of primary amenorrhea (PA) within the Saudi population. Design Retrospective study. Setting Tertiary and secondary-level hospitals in Riyadh, Saudi Arabia. Population or Sample A total of 72 patients diagnosed with PA between July 2013 and July 2023. Methods Descriptive and inferential statistics were used to analyze patient information, risk factors, investigations, management plans, and outcomes. Data were analyzed using IBM's SPSS software version 29, employing Fisher's exact tests and binary logistic regression to identify significant associations and predictors for different PA categories. Main Outcome Measures Etiolgies, diagnostic approaches, management strategies, and outcomes. Results The results indicate primary ovarian failure as the leading cause of PA (31.9%), followed by central hypogonadism (18.1%) and Turner's syndrome (16.7%). Diagnostic processes included comprehensive patient histories, physical examinations, hormonal assays, imaging, and karyotyping. Medical therapy was the primary treatment approach in 69.4% of cases, with conjugated estrogens being the most prescribed medication. Surgical interventions, including hymenectomy, were significantly associated with positive outcomes like withdrawal bleeding. The study also found specific associations between age, LH levels, and the likelihood of PA, particularly in cases of primary ovarian failure and Turner syndrome. Conclusions This study's findings provide a comprehensive overview and contribute to the limited literature on PA in Saudi Arabia, highlighting the need for increased awareness and research to improve clinical understanding and patient care.