What is the evaluation for a child with primary amenorrhea (absence of menstruation) after menarche (first menstrual period) at age 10 years and 6 months?

From the Guidelines

A child who had their first period at age 10 and 6 months and then no further periods for three months should be evaluated by a pediatrician or adolescent gynecologist to rule out any underlying conditions that may be affecting her menstrual cycle. This pattern is likely normal, as irregular menstrual cycles are common in the first 2-3 years after menarche (first period) 1. The evaluation should include a detailed medical history, including growth patterns, other pubertal changes, family history, and any symptoms like abdominal pain, weight changes, or excessive exercise.

Key Components of Evaluation

• A physical examination should assess pubertal development using Tanner staging and check for signs of hormonal imbalances.
• Basic laboratory tests may include a pregnancy test, complete blood count, thyroid function tests, and possibly prolactin levels.
• The current evidence does not support the use of anti-mullerian hormone (AMH) as a marker of ovarian reserve in young women under 25 years old, as AMH levels can fluctuate throughout the menstrual cycle 1. In most cases, no treatment is needed as the menstrual cycle naturally becomes more regular over time. However, if there are concerning findings such as signs of polycystic ovary syndrome, thyroid dysfunction, or other hormonal issues, specific treatments may be recommended.

Reassurance and Follow-up

• Parents and the child should be reassured that irregular periods are normal during early adolescence as the hypothalamic-pituitary-ovarian axis matures, and regular cycles typically establish within 2-3 years after menarche.
• Follow-up appointments should be scheduled to monitor the child's menstrual cycle and overall health.

From the Research

Evaluation Approach

• A systematic evaluation including a detailed history, physical examination, and laboratory assessment of selected serum hormone levels can usually identify the underlying cause of amenorrhea 2
• Initial workup of secondary amenorrhea includes a pregnancy test and serum levels of luteinizing hormone, follicle-stimulating hormone, prolactin, and thyroid-stimulating hormone 2

Potential Causes

• Secondary amenorrhea can be attributed to polycystic ovary syndrome, hypothalamic amenorrhea, hyperprolactinemia, or primary ovarian insufficiency 2
• Pregnancy should be excluded in all cases of amenorrhea 2
• Thyroid function test abnormalities may be associated with thyroid antibody positivity, iodine deficiency, or excess 3

Laboratory Tests

• Serum levels of luteinizing hormone, follicle-stimulating hormone, prolactin, and thyroid-stimulating hormone should be assessed 2
• Thyroid function tests may be necessary to evaluate for thyroid function test abnormalities 3

Considerations

• Patients with primary ovarian insufficiency can maintain unpredictable ovarian function and should not be presumed infertile 2
• Patients with hypothalamic amenorrhea should be evaluated for eating disorders and are at risk for decreased bone density 2
• Patients with polycystic ovary syndrome are at risk for glucose intolerance, dyslipidemia, and other aspects of metabolic syndrome 2