Amenorrhea, or the absence of menses, is common during adolescence. Finding the underlying cause presents a diagnostic challenge and requires an understanding of normal menstrual function during the pubertal years. The differential diagnosis is broad, ranging from endocrine and genetic disorders to environmental and psychologic stresses to structural anomalies of the genital tract. Most importantly, any disturbance of menstruation should alert clinicians to the possibility of pregnancy.

Clinical evaluation begins with the completion of a thorough history and physical examination. Because amenorrhea and underlying pathologies can cause considerable physical and emotional morbidity, evaluation should begin promptly and proceed in a logical, stepwise manner. The most common causes of amenorrhea do not require referral and can be managed by primary care providers.