In my previous communications. I discussed regarding normal changes which occur at puberty and some aspect of sex education. Now I want to discuss an uncommon problem in the adolescents but which is very distressing i.e. Primary Amenorrhoea or failure of menses to begin or no menarche.

Definition: If by the age of 16 years menses do not begin than we call it a case of Primary Amenorrhoea and a gynaecologist needs to be consulted.

Common Causes:

Delayed Puberty: Some girls just take little more time to mature and get delayed onset of menses. It may be considered normal if the menses start upto 18years. Otherwise the body changes start appearing like growth spurt, breast development and genital hair. Sometime very low weight or dietary deficiencies are also responsible for such delay. Just waiting and improvement in general health status helps in starting the menstruation.

Hormonal Deficiency: It is a rare cause. The normal menstrual cycle is under the control of certain hormones i.e. LH & FSH which are secreted by the pituitary gland in the brain. A deficiency in these hormones because of some reason may sometime lead to Primary Amenorrhoea. These women are otherwise normal and capable of normal married life. They can get menses only with medicines. They also have normal chances of pregnancy with hormonal treatment.

Hyperprolactinaemia: This is a condition where another pituitary hormone Prolactin is secreted in excess due to the presence of a tumour. With regular medicine intake this condition can be treated completely. Both menses and reproductive function are restored completely.

Failure of Ovaries to develop: In some cases ovaries do not develop properly. This may happen due to some genetic defect, some environmental influences during development or due to certain unexplained reasons. These girls have normal married life. They can get menses with hormones. Since their uterus is normal these women can also conceive with the help of IVF ? ET (Test tube baby technique) by borrowing eggs from some other lady.

Failure of pessages to develop: These are called congenital malformations. These may also happen due to genetic defects and or environmental effects. Some medicines given by quacks for changing the sex of the fetus can have effect on the development of sex organs. These girls may need operations to correct the pessages for a normal sex life. In rare cases there may be obstruction to the outflow of menstrual blood from the uterus. These cases will also require operation for the correction of the problem. 

Other rare causes: Other rare causes include general illness like thyroid disease, diabetes, tuberculosis etc. which may occur at young age usually and affect onset of menses. Treatment of primary disease results in solving menstrual problem also.

To conclude Primary Amenorrhoea is an uncommon condition. It requires proper investigations, hormonal evaluation, ultrasound and proper treatment of the underlying cause. Even if treatment is not possible the patient and family should know the exact problem and its implications.