History of present illness includes whether menses have ever occurred (to distinguish primary from secondary amenorrhea) and, if so, how old patients were at menarche, whether periods have ever been regular, and when the last normal menstrual period occurred. History should also include duration and flow of menses; presence or absence of cyclic breast tenderness and mood changes.
Young athletes are particularly vulnerable, although normal menses usually return with healthy body weight. Causes of secondary amenorrhea can also result in primary amenorrhea, especially if present before onset of menarche.Treatments vary based on the underlying condition. Key issues are problems of surgical correction if appropriate and oestrogen therapy if oestrogen levels are low.
In preindustrial societies, menarche typically occurred later than in current industrial societies. After menarche, menstruation was suppressed during much of a woman's reproductive life by either pregnancy or nursing. Reductions in age of menarche and lower fertility rate.