DDx

Question 1

primary amenorrhoea

Answer 1

Constitutional delay i.e. a late bloomer, has secondary sexual characteristics

Anatomical i.e. mullerian agenesis (patient develops secondary sexual characteristics and has variable absence of female sexual organs)

Imperforate hymen (characterised by cyclical pain and the classic bluish bulging membrane on physical examination)

Transverse vaginal septae (characterised by cyclical pain and retrograde menstruation)

Turner syndrome (XO chromosome)
Testicular feminisation syndrome (XY genotype, no internal female organs)
Kallmann syndrome (failure to secrete GNRH)

Question 2

primary amenorrhoea

Answer 2

Constitutional delay i.e. a late bloomer, has secondary sexual characteristics

Anatomical i.e. mullerian agenesis (patient develops secondary sexual characteristics and has variable absence of female sexual organs)

Imperforate hymen (characterised by cyclical pain and the classic bluish bulging membrane on physical examination)

Transverse vaginal septae (characterised by cyclical pain and retrograde menstruation)

Turner syndrome (XO chromosome)
Testicular feminisation syndrome (XY genotype, no internal female organs)
Kallmann syndrome (failure to secrete GNRH)

Question 3

Secondary amenorrhoea

Answer 3

Pregnancy

Patient is using contraception

Menopause

Lactational amenorrhoea

Hypothalamic amenorrhoea (suppression of GnRH due to stress, excessive exercise, eating disorder)

Endocrinological (hyperthyroidism, polycystic ovary disease, Cushing’s syndrome, hyperprolactinaemia, hypopituitarism)

Premature ovarian failure (autoimmune, chemotherapy, radiation therapy)

Asherman’s syndrome (iatrogenic intrauterine adhesions/cervical stenosis)

Question 4

Secondary amenorrhoea

Answer 4

Pregnancy

Patient is using contraception

Menopause

Lactational amenorrhoea

Hypothalamic amenorrhoea (suppression of GnRH due to stress, excessive exercise, eating disorder)

Endocrinological (hyperthyroidism, polycystic ovary disease, Cushing’s syndrome, hyperprolactinaemia, hypopituitarism)

Premature ovarian failure (autoimmune, chemotherapy, radiation therapy)

Asherman’s syndrome (iatrogenic intrauterine adhesions/cervical stenosis)