A patient presents with amenorrhea, the cessation or interruption of regular menstrual cycle.  Two key questions arise: Is there an age so young where pregnancy testing would not be appropriate, and is there an age so old that pregnancy testing would not be appropriate?  And, of course, what is the rationale for both answers?

Primary amenorrhea can  result from a variety of causes including: vigorous exercise, Turner’s syndrome, Mullerian agenesis together account for about 15% of all cases (Schub & Clausulli, 2011).  Secondary amenorrhea can result from pregnancy, but also from a variety of other underlying conditions, including ovarian diseases, hypothalamic disorders, and extreme lack of body fat.  The most common cause of amenorrhea is pregnancy (about 40% of all cases) (Schub & Clausulli 2011). The Practice Committee of the American  Society for Reproductive Medicine states that pregnancy, lactation, and  menopause together account for 96-97% of all cases of amenorrhea (American Society for Reproductive Medicine, 2006).

In terms of the lower age limit for pregnancy testing, there is none.  If a female patient has been experiencing periods (which is implied if the complaint is an interruption in her menstrual cycle), pregnancy is always an option, no matter how young the female patient.  In fact, this is particularly important in very young women, due to the potential for hidden sexual abuse of the girl.  Thus, no matter how young the girl, if there is a complaint of an interruption of her menstrual cycle, pregnancy testing must be done.

In terms of an upper age limit for pregnancy testing, if this is a new complaint (i.e., the woman has not been previously diagnosed with menopause or other condition that would interrupt menstrual cycles), again, it would be important to do pregnancy testing no matter what her age.  Moreover, treatment for other causes of amenorrhea may impact the safety of any fetus if the woman is pregnant. Thus, it is important to be sure no such fetus exists before beginning any treatment for another cause that would interrupt menstrual cycles.

The bottom-line answer is that there is no age so young, nor any age so old that an initial complaint of amenorrhea should not generate a pregnancy test, if only to rule out the most common cause of interruptions in a woman’s menstrual cycle.