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Primary Amenorrhoea – Information for GPs

Definition

  • 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

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

Management

  • Confirm breast and hair development
  • Examine abdomen

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

Patient information leaflet

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