Investigation and treatment of primary amenorrhoea

Primary amenorrhoea is defined as a failure to start menstruation by the age of 16 in the presence of normal secondary sexual characteristics or by the age of 14 in the absence of secondary sexual characteristics. It can be caused by genetic, endocrine or structural disorders during the development of reproductive organs or may be constitutional in nature. Adolescence is a time of enormous physical and emotional development, the diagnosis and management of primary amenorrhoea requires dedicated teams to manage the complexities of transitioning between the paediatric and adult age group. Investigations should be offered in stepwise manner with appropriate counselling, keeping the adolescent's psychological development in mind. It is important to recognize the spectrum of normalcy before deciding to investigate the abnormal. Treatment depends on the cause with emphasis on the immediate and long term wellbeing of the individual.