There is considerable difficulty in defining the term primary amenorrhoea, other than the obvious statement that it is the failure to establish menstruation. The difficulty of definition relates to the time frame in which this definition is applied. To look at primary amenorrhoea as an isolated event is misleading as it is part of the whole development of puberty. Of the five changes that occur at puberty, menstruation is but one and may normally occur any time between ages 10 and 18 years. However, it occurs in conjunction with the development of other secondary sexual characteristics. It is therefore more useful to look upon secondary sexual development as the criteria for investigation and management in association with primary amenorrhoea. As a general rule, therefore, failure of the development of any secondary sexual characteristic by the age of 14 years should be investigated. In the presence of secondary sexual characteristics, menstruation ought to occur within 2 years of the establishment of this development. Failure to do so would warrant investigation. However, any child brought by its mother at any stage because of concern over the failure to establish either secondary sexual characteristics or menstruation should be investigated at that time. There are usually very good reasons why a mother will bring her daughter for investigation. This often relates to the fact that a sibling completed her pubertal development at an earlier age than the patient. While investigations may not lead to a diagnosis of abnormality, the proof of normality is also extremely important (Figs 38.1 and 38.2). It can be seen therefore that the term primary amenorrhoea is really not very meaningful in terms of definition, and a more useful term would be delayed puberty. This term encompasses the completion of the processes involved in reaching sexual maturity and allows a much more pragmatic approach to the management.
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Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.