Amenorrhea is described as either primary or secondary in nature. Primary amenorrhea is the absence of menses by age 16 in the presence of normal secondary sexual development or the absence of menses by age 14 in the absence of normal secondary sexual development. Secondary amenorrhea is the absence of menses for three cycles or 6 months in a previously menstruating woman. However, in clinical practice, there is a significant amount of overlap. The initial evaluation of amenorrhea is often the same regardless of age of onset, except in unusual clinical situations.1

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