Hello and welcome to the Zero to Finals podcast.

My name is Tom and in this episode I'm going to be talking to you about Primary Amenorrhea.

And you can find written notes on this topic at zero tofinals.com slash primary amenorrhea

or in the gynecology section of the Zero toinals obstetrics and gynecology book. So let's get

straight into it. Primary amenerea is defined as not starting menstruation by 13 years of age when

there's no other evidence of pubertal development or by 15 years of age where there's no other evidence of puberal development, or by 15 years of age, where there are

other signs of puberty, such as breastbud development. Normally, puberty starts aged 8 to 14 in

girls and 9 to 15 in boys. It takes about four years from start to finish.

Girls have their pubertal growth spurt

earlier in puberty than boys,

and in girls puberty starts with a development of the breast buds,

then the pubic care,

and finally the menstrual periods,

about two years from the start of puberty.

We need to talk about something called hypogonadism.

And hypogonadism refers to a lack of the sex hormones, estrogen and testosterone,

that normally rise before and during puberty.

A lack of these hormones causes a delay in puberty.

The lack of hormones is fundamentally due to one of two reasons.

And this is hypogonadotropic hypogonadism,

where there's a deficiency of the gonadotrophins, which are LH and FSAH.

And the other reason is hypergonadotropic hypogonadism, where there's a lack of response to normal levels of LH and FSAH by the gonads, the testes and the ovaries.

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