primary amenorrhoea

Question 1

task

Answer 1

You are working in a general practice. Your next patient is an 18-year-old woman who is
concerned because she has never had a menstrual period.
YOUR TASKS ARE TO:
* Take any further relevant history you require.
* Ask the examiner for relevant findings you wish to ascertain on general and gynaecologic
examination.
* Advise the examiner of investigations you wish to order and your provisional diagnosis.
* Counsel the patient appropriately.

Question 2

HX

Answer 2

1.PUBERTAL CHANGES
-expereince a growth spurt
-changes in breast
-pubic hair
-height comparison with peers
2.hx of abdominal pelvic pain
3. when did mom have her first period
,sister no breast development yet
4. no sx or any other medical illness
5.have you been sexually active? no

Question 3

examination findings

Answer 3

-tanner stage breast and axillary pubic hair stage
-weight and height
-vulval inspection : normal appearance, hymen intact, perforate, lower vagina above hymen normal
-blood pressure
PELVIC EXAM PER VAGINUM SHOULD NOT BE DONE

Question 4

IX

Answer 4

-abdominal USS : check uterus and vagina to see if normal
-Hormorne test : FSH, LH, PRL, oestradiol levels
-chromosome analysis not needed if above two normal

Question 5

advice

Answer 5

-reassure likely physiological delay as ix and exam normal
-The first period usually occurs
two years after the first breast development, but can be delayed for three years or longer as normal variation.
-r/v after ix have been normal and again in 12 months
-if not occurred>repeat oestrodiol again