Primary Amenorrhoea



Primary Amenotthoea means that menstruation has failed to occur at or after puberty. In some women there is a familial tendency for menstruation to commence late, sometimes delayed up to the age of 16 years or even later. With the social implications of early sexual development in today’s society, it is common for doctors to see girls early who have not started to menstruate. Figures for the Western world show that there is a general trend with modern living for sexual development and menstruation to occur at younger ages. Frequently girls aged 10 or even nine have started. There are many reasons why menstruation does not occur when it should.

Sometimes an imperforate hymen may prevent the escape of blood. This is an obvious and readily curable cause; acute or chronic pelvic disorders may be another. Often psychological reasons may check release of gonadotrophins by the pituitary, so delaying the menses.



It may also be due to a symptom of a general lack of development of the pituitary or the thyroid, or a symptom of juvenile myxoedema. In some, other indications of endocrine deficiencies may be in evidence, such as dwarfism. About 25 per cent of patients with the symptom have a genetic anomaly, having inherited an extra chromosome. This is called Turner’s syndrome. In other cases there is simply no explanation, and the lack of menstruation together with a lack of sexual development simply occurs for reasons unknown.

Primary Amenorrhoea Symptoms

Symptoms are usually obvious. Ovulation does not take place, so normal hormones fail to be produced, and usual menstrual cycle simply does not eventuate. Secondary sexual characteristics do not develop either. Breasts, vulva, vagina and uterus remain rudimentary. Often the mental outlook is immature. The bones may show stunted growth, and dwarfism may occur. If it occurs in conjunction with other hormonal disorders, symptoms due to the primary cause may also be in evidence.



Primary Amenorrhoea Treatment

In most cases there is no correctable underlying cause. Giving sex hormones may at least produce mental and physical development, which many of these girls seek. It can also establish artificial menstruation, which is satisfactory to many. Pregnancy of course will not occur unless ovulation is taking place. The hormones contained in the contraceptive pill, usually a progestogen and an oestrogen, are available. These may be continued long-term.

If the basic cause is a thyroid disorder that may be corrected, then this may respond by allowing ovulation to proceed. The outlook is then good in terms of ovulation and fertility. If merely a late-occurring normal puberty was the reason, the outlook is likewise generally good, and after a few normal cycles, discontinuation of medication may be followed by the regular normal cycles. However, in many, infertility will continue if the cause is a not correctable one, and substitution therapy will be necessary until the change of life and parents.



The average baby will develop normally and naturally, irrespective of what you do to try to hasten this along. After all, baby humans are just another facet of nature. Cows and horses, dogs and cats manage to do quite well and generally develop in a normal healthy way without the need of textbooks and specialists or oral advice. Babies (with two legs) are not much different. Do not expect too much too soon.

There are enormous variables; one child will start to teethe early while another will start months later. The end point is identical. Maybe the late teether will have better teeth in the long run. Trying to force baby along these channels can breed problems, both for you and your child, take it gently. If there are any obvious problems looming, consult your doctor. If there is any major query, seek the expert opinion of a paediatrician.