Primary amenorrhoea

Primary amenorrhoea is defined as the absence of menstruation by age 14 years in the absence of secondary sexual characteristics, or by age 16 years if secondary sexual characteristics are present. Regular menstruation is regarded as a sign of reproductive health thus absent menstruation causes a significant degree of stress and anxiety to the individuals involved. Puberty is governed by a complex neuro-hormonal system with input from multiple endogenous and exogenous factors, and pathology at various levels in this system can result in amenorrhoea. The causes range from genetic, anatomical, and endocrine to constitutional delay. A stepwise diagnostic approach is key to guiding appropriate investigations whilst minimising the physical and psychological impact on young adolescent women.