Amenorrhoea in Adolescents: A Guide to Management

ABSTRACT Key Content Amenorrhoea is defined as absence or cessation of menses. It is broadly classified into primary and secondary amenorrhoea. A normal menstrual cycle requires an optimally functioning hypothalamic–pituitary–ovarian (HPO) axis and a patent outflow tract. Any dysfunction in these areas can result in amenorrhoea. Managing amenorrhoea can be challenging, especially for those not specifically trained in this area. Since the majority of patients are primarily seen by general practitioners (GP) or general gynaecologists, rather than Paediatric and Adolescent Gynaecologist (PAG), clear and simple guidance on its management is important. This review aims to summarise the latest evidence and provide a comprehensive guide to management of amenorrhoea in adolescents. Learning Objectives To understand how to clinically evaluate primary and secondary amenorrhoea. To understand the different treatment options for primary and secondary amenorrhoea. To understand the role of the multidisciplinary team (MDT) in primary and secondary amenorrhoea. Ethical Issues Management of adolescent amenorrhoea requires a developmentally appropriate, patient‐centred approach that upholds autonomy, beneficence, non‐maleficence and justice. Assessment of decision‐making capacity and consent is essential, alongside maintaining confidentiality and appropriate parental or caregiver involvement. Additional ethical considerations may arise in conditions such as eating disorders, differences of sex development (DSD) and complex Mullerian anomalies, particularly in relation to body image, identity and future fertility. Fertility implications and preservation options should be discussed early when relevant, in an age‐appropriate manner. A multidisciplinary approach is often required to address psychological, social and cultural factors, ensuring holistic care while safeguarding the adolescent's best interests.