The patient should be considered for evaluation if menarche:
(1) has not started within 3 years of thelarche (onset of breast development)
(2) has not started by age 13 AND there are no signs of pubertal development
(3) has not started by age 14 AND there are signs of hirsutism
(4) has not started by age 14 AND there are signs of excessive exercise
(5) has not started by age 14 AND there are signs of an eating disorder
(6) has not started by age 14 AND there are signs of a genital outflow anomaly or obstruction
(7) has not started by age 15
where:
• Signs of genital outflow anomaly or obstruction would warrant an evaluation regardless of menstrual status.
The patient should be considered for evaluation if periods:
(1) are now markedly irregular BUT previously were regular every month
(2) occur more frequently than every 21 days (interval < 21 days)
(3) occur less frequently than every 45 days (interval > 45 days)
(4) ever have occurred >= 90 days apart
The patient should be considered for evaluation if menstrual blood flow:
(1) last > 7 days
(2) require frequent tampon or pad changes (soak completely within 1-2 hours)
