Abstract
Background: Amenorrhea is the sixth major cause of female infertility affecting 2–5% of women in reproductive age. Primary amenorrhea affects 2–5% of adolescent girls. Early diagnosis and treatment is necessary to prevent complications and social consequences. Imaging plays a vital role in etiology of primary amenorrhea. Ultrasound is the first line investigation while Magnetic resonance imaging is important for accurate diagnosis and surgical planning.
 Aim and Objective: Determine etiology of primary amenorrhea in Kashmiri tertiary care centre and assess role of imaging (USG, CT, MRI) in determining its etiology.
 Materials and Methods: This was a hospital based prospective study done by departments of Gynaecology and Obstetrics and Radiodiagnosis and Imaging done in SKIMS hospital from Febuary to December 2019. 46 adolescent girls with primary complain of primary amenorrhea visited hospital’s out patient department.
 Results: Eugonadism was the most common cause of primary amenorrhea in our study accounting for 60.8% cases followed by Hypogonadotropic hypogonadism in 28.2% cases and hypergonadotropic hypogonadism in 10.8% cases. Mayer-Rokitansky-Kuster-Hauser syndrome was the most common cause of primary amenorrhea accounting for 21.7% cases followed by constitutional delay in 17.3% cases and polycystic ovarian disease in 13% cases.
 Radiological investigations primarily ultrasound and magnetic resonance imaging were directly or indirectly involved in diagnosing 65.5% cases of primary amenorrhea. Radiological Imaging was least useful in patients with constitutional delay.
 Conclusion: Radiology should be the first referral department in primary amenorrhea patients. Imaging is helpful in identifying cause of primary amenorrhea in majority of patients. Other modalities like karyotyping, laboratory investigations, clinical examination etc are helpful as well in addition to imaging.
 Keywords: Primary Amenorrhea, ultrasound(USG), Magnetic resonance Imaging(MRI), Computerized tomography(CT), Mayer-Rokitansky-Kuster-Hauser (MRKH).
Highlights
Absence of menarche by 14 years of age in the absence of secondary sexual characteristics or absence of menses by 16 years in the presence of normal growth and secondary sexual characteristics is termed as primary amenorrhea [1]
Eugonadism was the most common cause of primary amenorrhea in our study accounting for 60.8% cases followed by Hypogonadotropic hypogonadism in 28.2% cases and hypergonadotropic hypogonadism in 10.8% cases
MayerRokitansky-Kuster-Hauser syndrome was the most common cause of primary amenorrhea accounting for 21.7% cases followed by constitutional delay in 17.3% cases and polycystic ovarian disease in 13% cases
Summary
Absence of menarche by 14 years of age in the absence of secondary sexual characteristics or absence of menses by 16 years in the presence of normal growth and secondary sexual characteristics is termed as primary amenorrhea [1]. Primary amenorrhea affects physical and psychological wellbeing of the patient. Primary amenorrhea affects 2–5% of adolescent girls. Results: Eugonadism was the most common cause of primary amenorrhea in our study accounting for 60.8% cases followed by Hypogonadotropic hypogonadism in 28.2% cases and hypergonadotropic hypogonadism in 10.8% cases. MayerRokitansky-Kuster-Hauser syndrome was the most common cause of primary amenorrhea accounting for 21.7% cases followed by constitutional delay in 17.3% cases and polycystic ovarian disease in 13% cases. Radiological investigations primarily ultrasound and magnetic resonance imaging were directly or indirectly involved in diagnosing 65.5% cases of primary amenorrhea. Conclusion: Radiology should be the first referral department in primary amenorrhea patients. Imaging is helpful in identifying cause of primary amenorrhea in majority of patients.
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