Primary Amenorrhoea

The amenorrhoea is the normal physiological feature in prepubertal girls, failure to commence menstruation is primary amenorrhea. A normal uterovaginal anatomy and functional hypothalamic pituitary ovarian (HPO) axis is essential for menstruation. The detailed relevant medical and family history along with thorough physical examination adds in for requesting relevant investigations to find out the cause. In the absence of secondary sexual characteristics, hormonal disturbances are the most likely cause while anatomical problems are more common in the presence of secondary sexual characteristics, along with physiological delays and endocrinopathies. Investigate primary amenorrhoea without secondary sexual development at 13 years and with secondary sexual development at 15 years of age, consider early referral if suspicion of chromosomal abnormality, hyperandrogenemia, anatomical abnormalities or primary amenorrhoea persists for five years after thelarche. The multidisciplinary team approach, to support patient and parents with evidence base knowledge for decision-making is the corner stone. It is important to address patient and their family needs, individually for the best outcome.