Spurious primary amenorrhoea: a case report

An unusual case of 'primary amenorrhoea' is described, in which clinical, cytogenetic, biochemical and hormonal features were all normal. Failure to obtain withdrawal uterine bleeding after therapy with a combined oestrogen/progestagen preparation, together with the finding of normal cyclical oestrogen and progesterone secretion, the latter reaching normal luteal phase levels, strongly suggested end-organ (endometrial) failure. However, 6 weeks after a searching interview by one of us (H.C.), during which sufficient evidence was uncovered to implicate major emotional factors as contributing to her state of amenorrhoea, the patient began menstruating and has menstruated regularly ever since. It is likely that the patient denied the existence of her menstrua and that the term 'spurious' primary amenorrhoea would most appropriately described this condition.