Reasons you don’t have your period yet

Primary amenorrhoea is the failure of your first menstrual period (menarche) to arrive. It is normal for girls to start their periods between ages nine and 12.

When menstruation doesn’t arrive at the same time as everyone else, it might mean something isn’t quite right – but there’s no need to panic before seeing a doctor for assessment. Typically there is no need to worry before age 15-16 – some of us are just a little later to the party (some might say fashionably late!).

Sometimes other signs of puberty may be missing as well (underarm hair, pubic hair, growth of labia, etc.), in which case this should be discussed with a doctor sooner. The absence of puberty may mean something more serious is occurring.

The absence of a menstrual period after age 15-16 means something may also be going wrong somewhere along the line. Sometimes these things can be serious, like a missing uterus, or they could be more manageable, like being underweight.

If you’re concerned, talk to your healthcare provider.

Reasons your period may not arrive

There are a handful of causes, and they all have quite different implications.

  1. Low body fat – those with low body fat don’t have the required percentage of fat cells required for sufficient oestrogenic hormone production
  2. Over-exercising
  3. The hymen completely covers the vaginal opening so no blood can exit the vagina (an imperforate hymen)
  4. A blockage or narrowing of the cervix (cervical stenosis), causing blood to back up in the uterus
  5. A transverse vaginal septum that blocks flow of blood out of the vagina
  6. The vagina, uterus or cervix are missing (vaginal agenesis, uterine/Mullerian agenesis, cervical agenesis)
  7. The vagina, uterus, or cervix are not properly formed (vaginal hypoplasia, uterine hypoplasia, cervical hypoplasia)
  8. The ovaries aren’t functioning correctly – possibly due to tumours or hormone dysregulation – no ovulation generally means no period
  9. The areas that deal with hormones are not functioning optimally (hypothalamus, pituitary, thyroid, adrenals) – dysfunctional hormones means no ovulation/disrupted hormone cascade
  10. Unknown causes
  11. Pregnancy
  12. Genetic conditions such as Kallmann syndrome or anatomical abnormalities caused by genetic defects

As you can see, there is quite a range of reasons why you might not have your period yet. So next is an appointment with your doctor to find out why.

Also check out secondary amenorrhoea, since some of these like over-exercising and low weight are covered in more detail there.

What the doctor might discover

  • Underlying illness – cystic fibrosis, heart problems, chronic illness
  • A genetic blip that has resulted in you growing differently in the womb (see DSD for more information)
  • Poor nutrition and low weight (possibly linked with disordered eating or illness)
  • Tumours

A physical examination will be done, with questions regarding your medical history. A pregnancy test will be done.

Blood tests may include a range of hormone tests, including oestrogen and thyroid hormones. Imaging scans may be taken to establish what lies beneath your flesh in your pelvis – if you are missing organs or even have duplicates.

Treatment and management of primary amenorrhoea

Treatment depends entirely on why the cause, so see the separate sections for each topic for more information. Seek advice from your healthcare practitioner.

References​1–9​

  1. 1.
    Lord M, Sahni M. statpearls. Published online July 18, 2022. http://www.ncbi.nlm.nih.gov/books/NBK431055/
  2. 2.
    Current evaluation of amenorrhea. Fertility and Sterility. Published online November 2008:S219-S225. doi:10.1016/j.fertnstert.2008.08.038
  3. 3.
    Gordon CM, Nelson LM. Amenorrhea and bone health in adolescents and young women. Current Opinion in Obstetrics and Gynecology. Published online October 2003:377-384. doi:10.1097/00001703-200310000-00005
  4. 4.
    Klein D, Paradise S, Reeder R. Amenorrhea: A Systematic Approach to Diagnosis and Management. Am Fam Physician. 2019;100(1):39-48. https://www.ncbi.nlm.nih.gov/pubmed/31259490
  5. 5.
    Master-Hunter T, Heiman D. Amenorrhea: evaluation and treatment. Am Fam Physician. 2006;73(8):1374-1382. https://www.ncbi.nlm.nih.gov/pubmed/16669559
  6. 6.
    He Q, Karlberg J. BMI in Childhood and Its Association with Height Gain, Timing of Puberty, and Final Height. Pediatr Res. Published online February 2001:244-251. doi:10.1203/00006450-200102000-00019
  7. 7.
    Committee Opinion No. 651. Obstetrics & Gynecology. Published online December 2015:e143-e146. doi:10.1097/aog.0000000000001215
  8. 8.
    Deligeoroglou E, Athanasopoulos N, Tsimaris P, Dimopoulos KD, Vrachnis N, Creatsas G. Evaluation and management of adolescent amenorrhea. Annals of the New York Academy of Sciences. Published online September 2010:23-32. doi:10.1111/j.1749-6632.2010.05669.x
  9. 9.
    Tavera G, Lazebnik R. Müllerian Agenesis Masquerading as Secondary Amenorrhea. Case Reports in Pediatrics. Published online July 19, 2018:1-3. doi:10.1155/2018/6912351


Sale!
Original price was: USD $9.99.Current price is: USD $0.00. ex GST/VAT/TAX
Sale!
Original price was: USD $9.95.Current price is: USD $0.00. ex GST/VAT/TAX
Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
SHARE YOUR CART