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CASE 1: PRIMARY AMENORRHEA
Preview AbstractA 16-year-old girl complains that she has yet to experience menstruation.
- Is this abnormal?
- What produces menstruation?
- What conditions may explain her complaint?
- What investigations should be performed on her?
The onset of puberty in girls is marked by the beginning of ovarian function in estrogen secretion followed by physical development of breast buds detectable as firm nodules directly beneath the nipples. This occurs between the ages of 10 and 11.5 years old and is known as thelarche. The first menstruation, or menarche, should occur within three years of thelarche. The mean age of menarche is 12.5 years old. Fewer than 10% of girls menstruate before 11 years old and 90% of girls are menstruating by 13.7 years old. Absence of menarche three years after thelarche or after 16 years old is an abnormal delay known as primary amenorrhea. The incidence of primary amenorrhea is less than 1%.