Pubertal development and primary amenorrhoea

Puberty is the physical, emotional and sexual transition from childhood to adulthood. It involves five changes: breast, pubic hair, axillary hair development, the growth spurt and the onset of menstruation. In girls, pubertal development commences at around 8–9 years of age and lasts for 4–5 years. This review looks at the investigation into the absence of periods (primary amenorrhoea) if there is a failure to establish menstruation by the age of 14 years in girls without signs of secondary sexual development or by the age of 16 in the presence of normal secondary sexual characteristics. Primary amenorrhoea can be classified according to the presence or absence of secondary sexual characteristics. The onset of menstruation should usually occur within 2 years of the onset of breast development, pubic and axillary hair development and the growth spurt.