What are primary and secondary amenorrhoea?
Amenorrhoea can be primary, indicating that periods have never occurred, or secondary if periods have occurred and then stopped. The commonest cause of false primary amenorrhoea is an imperforate hymen. The teenager will have monthly pelvic symptoms but no bleeding. When she is examined, blood can be seen behind the hymen. Under a general anaesthetic, the hymen is opened and the problem is solved. The commonest (but not common) cause of secondary false amenorrhoea is cervical stenosis. Typically the periods stop some time after an operation such as a cone biopsy of the cervix. The resulting scar tissue tightens (stenoses) the canal within the cervix. Monthly symptoms occur but periods cease. I have not seen this happen for more than twenty years. This problem is usually resolved by dilating the cervix under anaesthetic. Primary amenorrhoea: When to seek advice? Investigation is to be recommended if periods have not begun by the age of 16 or if secondary sexual development, and in parti
