Samad Ambareen, Bangash Arzoo Gul, Naz Talat
Dr. Ambareen Samad, MBBS, FCPS Assistant Professor, Department of Obstetrics & Gynaecology, Khyber Teaching Hospital, Peshawar, Pakistan.
Dr. Arzoo Gul Bangash, MBBS, FCPS Assistant Professor, Department of Obstetrics & Gynaecology, Khyber Teaching Hospital, Peshawar, Pakistan.
Pak J Med Sci. 2025 Mar;41(3):872-875. doi: 10.12669/pjms.41.3.11199.
BACKGROUND & OBJECTIVES: The onset of menstruation heralds the beginning of feminism and fecundity. Primary amenorrhea is a distressing symptom and is often associated with late diagnosis and appropriate management. Our study aimed to find the frequency of primary amenorrhea along with its causes and subsequent management by a multidisciplinary team.
In our descriptive case series patients presenting with primary amenorrhea to the Department of Gynaecology, Khyber Teaching Hospital Peshawar from January 2018 to December 2022, were included. Gynecologist initially analyzed the cases based on history, clinical examination (secondary sexual characteristics, Body mass index) and relevant investigations including hormonal profile, pelvic ultrasound, MRI and karyotype. After final diagnosis, a multidisciplinary team comprising of plastic surgeon, endocrinologist and psychiatrist advised treatment based on cause. Relevant information was recorded on predesigned proforma. Data was analyzed using SPSS 23.
The frequency of primary amenorrhea was 0.3% out of 18,504 patients seen in Gynaecology clinic. Forty-six (82%) patients were in the age group of 14-20 years. The mean body mass index was 22.8±2.4. Mullerian agenesis was seen in 22(39%) of patients, 20(35.7%) had outflow tract abnormality which were treated by vaginoplasty or hymenectomy/ resection of vaginal septum depending on cause. Ten (17.8%) patients diagnosed with gonadal dysgenesis. Four(7.1%) patients with constitutionally delayed menarche had spontaneous onset of menstruation.
Disorders related to Mullerian agenesis are the most common cause of primary amenorrhea. Timely diagnosis by attending gynecologist and subsequent multi-modal approach, including psychological counseling, hormonal therapy, and tailored surgical interventions like neovagina creation by vaginoplasty, hymenectomy and laparoscopic gonadectomy can ensure appropriate management of this distressing condition in young girls.
月经初潮标志着女性特征和生育能力的开始。原发性闭经是一种令人苦恼的症状，常与诊断延迟及恰当治疗相关。我们的研究旨在找出原发性闭经的发生率、病因以及多学科团队随后的治疗情况。
纳入2018年1月至2022年12月在白沙瓦开伯尔教学医院妇科就诊的原发性闭经患者的描述性病例系列。妇科医生最初根据病史、临床检查（第二性征、体重指数）以及相关检查（包括激素水平检测、盆腔超声、磁共振成像和核型分析）对病例进行分析。最终诊断后，由整形外科医生、内分泌学家和精神科医生组成的多学科团队根据病因给出治疗建议。相关信息记录在预先设计的表格上。使用SPSS 23软件进行数据分析。
在妇科门诊就诊的18504例患者中，原发性闭经的发生率为0.3%。46例（82%）患者年龄在14至20岁之间。平均体重指数为22.8±2.4。22例（39%）患者存在苗勒管发育不全，20例（35.7%）有生殖道异常，根据病因分别通过阴道成形术或处女膜切开术/阴道纵隔切除术进行治疗。10例（17.8%）患者被诊断为性腺发育不全。4例（7.1%）体质性月经初潮延迟的患者月经自然来潮。
与苗勒管发育不全相关的疾病是原发性闭经最常见的原因。妇科医生及时诊断并随后采用多模式方法，包括心理咨询、激素治疗以及如通过阴道成形术创建新阴道、处女膜切开术和腹腔镜性腺切除术等量身定制的手术干预措施，可确保对年轻女孩这种令人苦恼的疾病进行恰当治疗。
