development of breasts and genitalia should be checked If a history of galactorrhea is suspected, attempt to express fluid manually from the patient’s breasts The completed examination will separate the majority of patients who have no notable abnormalities from a minority that may point to a specific medical cause Pregnancy Pregnancy is the first diagnosis to consider when evaluating an adolescent with one or several missed menstrual periods ( Fig 51.1 ) Prompt diagnosis and exclusion of a life-threatening ectopic pregnancy is critical Referral is then important; early and regular prenatal care is associated with reduced morbidity and mortality among pregnant teenagers and their offspring; early diagnosis also affords the pregnant adolescent time to consider all options including therapeutic abortion If the patient is not pregnant, evaluation can proceed at a more deliberate pace