A 16-year-old girl has not yet attained menarche. Breast budding began at 13 years and breast development is now Tanner stage III. There is no history of chronic illness, excessive exercise or weight loss, and examination is otherwise normal. What is the correct classification of her presentation?

• A Primary amenorrhoea requiring full evaluation now
• B Hypergonadotropic hypogonadism until proven otherwise
• C Constitutional delay requiring growth hormone
• D Physiological delay of menarche, review in 6 months ✓

Explanation

Menarche normally occurs within about 2 to 3 years of thelarche, usually by Tanner stage IV breast development. This girl has progressing puberty without any red flags, so physiological variation is likely and observation with review is appropriate. Full evaluation for primary amenorrhoea is indicated if there are no secondary sexual characteristics by 13 to 14 years, or if menarche has not occurred within 3 years of thelarche or by 15 to 16 years.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.