Current evaluation of amenorrhea

Amenorrhea is the absence or abnormal cessation of the menses (1). Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. The majority of the causes of primary and secondary amenorrhea are similar. Timing of the evaluation of primary amenorrhea recognizes the trend to earlier age at menarche and is therefore indicated when there has been a failure to menstruate by age 15 in the presence of normal secondary sexual development (two standard deviations above the mean of 13 years), or within five years after breast development if that occurs before age 10 (2). Failure to initiate breast development by age 13 (two standard deviations above the mean of 10 years) also requires investigation (2). In women with regular menstrual cycles, a delay of menses for as little as one week may require the exclusion of pregnancy; secondary amenorrhea lasting three months and oligomenorrhea involving less than nine cycles a year require investigation.