Primary amenorrhea is defined as having:
No Menses, PLUS
- Being 13 years or older with no pubertal development (breast development, etc), OR
- Being 5 years after initial breast development, OR
- Being 15 years old with pubertal development (secondary sexual characteristics).
Primary amenorrhea is usually caused by chromosomal problems that lead to primary ovarian insufficiency or anatomic abnormalities.
A good way to look at it is that the label primary amenorrhea is really given at 15 years of age to a female who has normal growth and secondary sexual characteristics are present, however, they still don’t have periods. However, at age 13 years, if there a complete absence of secondary sexual characteristics such as breast development and the patient has no menses, evaluation for primary amenorrhea should begin.
Also, some girls with secondary sexual characteristics may present with cyclic pelvic pain and amenorrhea before the age of 15. Evaluate them for possible outflow tract obstruction.