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Amenorrhea: Primary and Secondary

Feb 23, 2023


Primary amenorrhea refers to the absence of menstruation by the age of 16 years in the presence of normal growth and development of secondary sexual characteristics or the absence of menstruation by the age of 14 years in the absence of secondary sexual characteristics. Secondary amenorrhea refers to the cessation of menstruation for more than 6 months in women who have previously had regular menstrual cycles.

These conditions can have a wide range of causes, including genetic disorders, hormonal imbalances, anatomical abnormalities, and psychological factors. Therefore, it is essential for medical professionals to have a thorough understanding of the underlying pathophysiology, clinical presentation, and management options for primary and secondary amenorrhea.

Read this blog further for a quick overview of this important OBGYN topic for NEET PG exam preparation.

ENT Residency



  • Primary Amenorrhea: No periods ever
  • Secondary Amenorrhea: No periods x 3 cycles (3 months)/ 6 months 

Puberty: Normal 10-12 yrs
Delayed Puberty

  • No periods till 13 yrs
    • Secondary sexual characters absent 
  • Secondary sexual characters present
    • No periods till 15 yrs


  • Pregnancy test negative
  • O/E
    • Breast examination
    • Axillary, pubic hair
    • Vagina 
  • P/V: Uterus examination 
  • Tests including: LH, FSH, TSH, PRL, karyotype

Primary Amenorrhea

secondary sexual characters


Absent uterus

Present uterus

MRKH Syndrome
  • Imperforate hymen
  • Transverse vaginal septum
  • Cervical atresia 
  1.  Hypothyroidism, Hyperprolactinemia
  2. ↑ LH, ↑ FSH (pure gonadal dys genesis)
  3. ↓ LH, ↓ FSH
    • Malnourishment
    • Chronic illness
    • Anorexia
  • Secondary sexual characters Asynchronous
    • Androgen Insensitivity syndrome

Secondary Sexual characters


 (LH/ FSH)


  • Primary ovarian failure
  • Gonadal dysgenesis
    (eg. Turners)
  • FSH, LH receptor defect
  • Galactossemia 


  • Physiological delay
  • Kallman syndrome
  • CNS Tumors 

Previous year question

  1. Question: 14-year-old girl presented with primary amenorrhea. on examination, secondary sexual characters are seen. Uterus and ovaries were seen to be normal on USG. What is the next step in management? (FMGE 2020)
    1. Reassurance
    2. UPT
    3. Karyotyping
    4. LH, FSH, TSH
  2. Question: 19 year old girl presents with primary amenorrhea with normal secondary sexual characteristics. What is the next investigation to be done? (FMGE 2020, 2019)
    1. USG
    2. LH and FSH
    3. Estradiol estimation
    4. Karyotyping

Secondary Amenorrhea

Secondary Amenorrhea

(pregnancy Test -ve)

 Rule out Hypothyroidism


PR challenge

Periods occur

No periods


(Periods occur in Estrogen primed endometrium)

ER + PR challenge

No periods

Periods occur

Asherman syndrome

↑ LH, ↑ FSH

  • Premature ovarian failure
  • Ovarian injury
    • Radiotherapy
    • Chemotherapy
  • Oophorectomy

↓ LH, ↓ FSH

  • CNS tumors
  • Chronic illness
  • Sheehan syndrome

Previous year question

  1. Question: 19 year old girl presented with weight loss, secondary amenorrhea and a constant fear of gaining weight. Alteration in which of the following is responsible for such presentation? (FMGE 2020)
    1. GnRH
    2. HCG
    3. Estrogen
    4. Progesterone

  2. Question: A 52 year old woman came with 16 months of amenorrhea. The test results that you would expect are? (FMGE 2020)
    1. High LH and High FSH
    2. Low FSH and High LH
    3. Low FSH and normal LH
    4. High FSH and low LH

  3. Question: 32 year old unmarried woman came with secondary amenorrhea. she was having regular normal flow periods until now. No other associated complains, pelvic examination was normal. Nest step is? (FMGE 2020)
    1. LH/ FSH testing
    2. Estrogen level
    3. USG
    4. Urine HCG


  • Pregnancy
  • Hypothyroid/ Pituitary tumors
  • Chronic illness
  • Hyperprolactinemia
  • Empty sella syndrome
  • Thyroid disease
  • POI
  • Cushing syndrome 

Explore more about this important OBGYN topic on the PrepLadder app. Learn from conceptual video lectures and self-explanatory NEET PG study material along with related MCQs for evaluating your understanding of the topic.

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