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Primary amenorrhoea — DRCOG MCQ

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HardGynaecologyPrimary amenorrhoeaDRCOG

A 16-year-old girl has never had a period. She has no breast development and is significantly shorter than her peers. Pregnancy test is negative. When should this patient be referred?

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Correct answer: A — Refer for specialist assessment of delayed puberty and primary amenorrhoea

Primary amenorrhoea with absent secondary sexual characteristics warrants specialist assessment for delayed puberty, gonadal dysgenesis, hypothalamic or pituitary causes. Waiting until 21 would delay diagnosis and treatment. Combined pill may induce bleeding but should not be started without evaluation. PCOS usually presents after pubertal development with oligomenorrhoea and hyperandrogenism.

Reference: NICE CKS amenorrhoea; British Society for Paediatric Endocrinology guidance