Primary amenorrhoea

Definition/Description

  • Absent menstrual periods by the age of 16 with normal secondary sexual characteristics
  • Absent menstrual periods by the age of 13 with no secondary sexual characteristics

Red Flag Symptoms

Exclude Red Flag Symptoms

  • Delayed puberty at 13 (amenorrhoea and no secondary sexual characteristics) should be referred to Paediatrics
  • Abnormal pain – investigate

Guidelines on Management

  • Confirm breast and hair development
  • Examine abdomen

Referral Criteria/Information

Indications for referral

Primary amenorrhoea – see definitions above – paediatric or Gynaecology referral
 

Investigations prior to referral

  • Blood tests, FSH/LH, TSH, Prolactin, testosterone, SHBG, Pelvic ultrasound
     

Information to include in referral letter

  • Confirm secondary sexual development
  • FH of delayed menarche
  • Relevant past medical / surgical history
  • Current regular medication
  • Height / weight / BMI growth chart 
  • Smoking status
     

Desirable information

  • Any FH of delayed menarche

 

Additional Resources & Reference

Patient information leaflet

Early or delayed puberty information

 

References:

  1. CKS – Clinical Knowledge Summary
     
  2. Amenorrhoea - NICE CKS

Associated Policies

There are no associated policies.

Specialties

Gynaecology York Paediatrics York

Places covered by

  • vale-of-york

Hospital Trusts

  • york-and-scarborough-teaching-hospitals
Author: Responsible GP – Dr Omnia Hefni, SRCCG / Responsible Consultant – Ms Louise Hayes, YTHFT / Responsible Pharmacist – Ms Rachel Ainger, SRCCG Medicines Mngt
Date created: 13/08/2025, 11:24
Last modified: 13/08/2025, 11:26
Date of review: 30/9/24