What exactly can be the causes of the primary amenorrhea?

Primary amenorrhea. Primary amenorrhea is diagnosed when someone reaches age 14 with no secondary sexual development or 16 with no periods + some sexual development. The evaluation is complex but should start with an fsh, lh test to see what the pituitary gland is doing. An exam is done to confirm normal genital/pelvic anatomy and sonogram is done to confirm the ovaries are present.