Primary amenorrhea is absence of menstrual period by the age of 16 years and affects approximately 1 percent of girls. The causes of primary amenorrhea includes chromosomal abnormalities, diseases in hypothalamus, diseases in pituitary, lack of or absence of reproductive organs, anatomical abnormalities in vagina etc.

Chromosomal abnormalities:

Some chromosomal abnormalities can cause depletion of ova and destruction of follicles responsible for menstruation and ovulation (maturation of ova).

Diseases in hypothalamus:

Menstrual cycle is regulated by hypothalamus and any functional abnormality in hypothalamus can result in amenorrhea. Several factors such as eating disorders (anorexia nervosa), excess physical exercise (as sometimes seen among female athletes), physical stress, psychological stress etc. can contribute to abnormal functioning of hypothalamus and result in primary (as well as secondary) amenorrhea. Tumor in hypothalamus can also contribute to abnormal functioning of hypothalamus and result in amenorrhea.

Diseases of Pituitary:

Pituitary gland is also involved in regulation of menstrual cycle in females. Any disease such as a tumor in pituitary gland can be responsible for disruption of control of menstrual cycle by pituitary and result in amenorrhea.

Lack of or absence of reproductive organs:

In absence of reproductive organs there will be no menstrual period. Some girls are born without some important organs (including reproductive organs) such as cervix, vagina, uterus etc. and in absence of reproductive organs menstruation does not begin.

Anatomical abnormality in vagina:

In case of anatomical abnormality in vagina such as obstruction of vagina by a membrane may not allow the menstrual blood to be seen as the membrane blocks the outflow of menstrual blood from uterus and cervix. Surgical removal of the membrane will establish normal menstruation in this case.

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