OBJECTIVE: To determine the frequency of primary amenorrhea and to enlist etiological factors
and outcome of treatment of primary amenorrhea.
DESIGN: A descriptive case series.
SETTING: Department of Obstetrics and Gynaecology (Unit-II) Liaquat University Hospital Hyderabad,
Sindh – Pakistan, from January 2006 to December 2007.
METHODS: All patients presenting with primary amenorrhea were included in the study and patients
having secondary amenorrhea including pregnancy were excluded. All the data collected
by history, examination and investigations were recorded on a proforma. Data were analyzed
using SPSS version 10.0.
RESULTS: Total number of patients admitted was 2,505. Frequency of primary amenorrhea was
0.75%. Imperforate hymen was found in 21.05% cases, pure gonadal dysgenesis in 15.7%, constitutionally
delayed puberty in 10.52%, hyperprolactinemia in 10.52%, polycystic ovaries in
5.26%, Turner’s syndrome in 10.52% and testicular feminization in 10.52% cases. Patients with
constitutionally delayed puberty had spontaneous onset of menstruation. Outcome was good in
all patients with cryptomenorrhea. Two of them got married and conceived successfully. The
patients with primary amenorrhea due to polycystic ovaries and hyperprolactinemia had resumption
of normal menstruation after medical therapy. In patients with testicular feminization,
testicular tissue was removed and estorgenprogestogen therapy was given.
CONCLUSION: Primary amenorrhea is one of the important reasons for distress of family and
patient herself. Literature review has shown that low frequency and fear of exposure of defect
may be the reason for not seeking medical advice. In our setup too, these observations were
found. Patient awareness and the proper counseling of parents regarding the treatment options
available and need for follow up can help in deciding the sex of rearing and even restoring the
fertility in many of these women.
Primary amenorrhea. Frequency. Causes. Follow up. Outcome.