Primary Amenorrhea: Causes, Symptoms, and Diagnosis

A 14 year old woman presents to clinic with some frustration over never having a menstrual period. She is short in stature and has Tanner stage 2 breast development. As you begin a gynecological exam, you realize that you cannot pass a speculum into the vagina. Which of the following is the most likely diagnosis?A. DUBB. Primary amenorrheaC. Secondary dysmenorrheaD. Sheehan’s syndrome

B.

The most likely diagnosis for this patient is primary amenorrhea. Primary amenorrhea is defined as the absence of menarche (first period) by the age of 16, or by age 14 if secondary sexual characteristics are absent. In this case, the patient is 14 years old with only Tanner stage 2 breast development, indicating that puberty has started but is not fully developed. The inability to pass a speculum into the vagina could indicate vaginal agenesis or a hymen that is imperforate or too small, which are common causes of primary amenorrhea.

DUB (dysfunctional uterine bleeding) refers to abnormal uterine bleeding without a specific organic cause. Secondary dysmenorrhea refers to painful menstruation that develops later in life, typically after menarche and may be associated with an underlying medical condition. Sheehan’s syndrome occurs when there is pituitary gland damage as a result of postpartum hemorrhage leading to hormonal deficiencies and subsequent amenorrhea. These diagnoses are less likely given the patient’s presentation and age.

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