A clinician explains how breast development and uterine presence help classify primary amenorrhoea. Which single inference is correct?

Answer: D. Breast development indicates oestrogen exposure, and uterine presence/absence narrows the cause

Breasts and uterus in primary amenorrhoea

Two simple findings structure the differential.

Breast development

• Indicates oestrogen exposure (so the ovaries have produced oestrogen, or there is peripheral aromatisation as in AIS).
• Absent breasts suggest low oestrogen (gonadal failure or hypogonadotrophic states).

Uterus present or absent

• Breasts present + uterus absent -> MRKH (46,XX) or AIS (46,XY).
• Breasts + uterus present -> consider outflow obstruction (imperforate hymen, transverse septum).

Why useful

• Combined with FSH/LH and karyotype, this rapidly narrows the cause.

So breasts indicate oestrogen exposure and the uterus narrows the cause.