For the majority of pubertal girls menstruation is the final result of a series of events, which result in sexual maturity. Maturation of the hypothalamus through several years of late childhood begins a cascade of events which finally result in the establishment of the normal menstrual cycle and menstruation. Amenorrhoea will result when there is a failure of function in any of the organs involved in this cascade. Management of patients with primary amenorrhoea therefore demands a knowledge and understanding of the embryology of female development and the endocrinology of puberty, but also an ability to assess an adolescent girl in her entirety. Details of embryology and normal pubertal development can be found in Chapter 34.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.