Management of Primary
Investigations for the cause must begin if
• No menstruation occurs till 13 years of age and
there is the absence female secondary sexual
• At 15 years of age if there are female secondary
sexual characters but menstruation does not
Objectives of Management
To initiate the menstrual cycle if possible
To promote the development of female
secondary sexual characters if it hasn’t been
To enable the female to beget a child.
• The treatment or management is mainly
based on the cause.
• The scope of the therapeutic success is very
limited. Thus, counseling is very important.
Disease and Malnourished States
• Diabetes mellitus and tuberculosis must be
• Improvement of the nutritional state is vital.
• Correction of malabsorption and weight loss.
• The weight is brought back to normal first.
• This should initiate menstruation.
• Clomiphene therapy can be used to induce
ovulation if needed.
Hypergonadotropic Primary Amenorrhea
Women with streak ovaries
- To promote female secondary sexual
characters, cyclic estrogen and progesterone is
- The women can bear children with donated
Testicular feminizing syndrome
- Gonadectomy followed by estrogen therapy.
- Short term estrogen and progesterone
Resistant Ovarian Syndrome and Savage
Syndrome has no treatment.
• For Turner syndrome and other ovarian
Low dose estrogen (0.625 mg) orally for 25
Progestin (medroxy progesterone acetate 5
mg daily) for the last 10 days after 13 years of
Eugonadotropic Primary Amenorrhoea
• Roki Tansky Syndrome
– Creation of a functional vagina for coital
Can bear children through surrogacy.
• Cryptomenorrhoea with Amenorrhoea
- Simple cruciate incision of the hymen if the cause
is intact hymen.
- Excision and vaginoplasty if the vaginal septum is
Hypogonadotropic Primary Amenorrhoea
-Pulsatile administration of estrogen and
Hypothalamic-pituitary tumors require