Why Have I Not Gotten My Period?

The Concern of a Missing Period: Sara’s Story

Sara, a teen in her late teens, had always experienced a regular period each month. Then, one month, it didn’t arrive. She initially dismissed it as stress. But when a second and then a third month passed with no period, she grew concerned. A visit to her doctor yielded little reassurance—she was simply told to wait. Feeling lost and uncertain, Sara came to us asking, “What should I do?”

What is Amenorrhea?

Amenorrhea, meaning “without menstruation,” is the medical term for the absence of a period. It falls into two main categories:

• Primary Amenorrhea: When a girl has not gotten her first period by age 14.
• Secondary Amenorrhea: The more common type, when a person who has previously had periods misses them for an extended time.

Understanding the root cause is essential for finding the right treatment and supporting your body’s health.

What Causes Primary Amenorrhea?

Primary amenorrhea is often related to structural issues or genetic conditions affecting the reproductive system. To understand these causes, it helps to know the basic anatomy involved in menstruation.

Each month, an ovary releases an egg, and the uterus builds up a tissue lining in preparation for pregnancy. If the egg isn’t fertilized, this lining is shed as a period, flowing from the uterus, through the cervix and vagina, and out of the body. A blockage or malformation in this pathway can prevent a period from occurring.

Structural Causes

• Imperforate Hymen: In about 0.05%-0.1% of women, the hymen completely covers the vaginal opening. While puberty progresses normally, menstrual blood cannot escape, often leading to painful, “hidden” periods.
• Transverse Vaginal Septum: A rare condition (occurring in about 0.05% of females) where a horizontal wall of tissue blocks the vagina, similarly trapping menstrual flow.
• Mullerian Agenesis: A very rare condition (seen in 0.01-0.025% of females) where the uterus and/or vagina do not develop fully before birth.

Is It Genetic?

Genetic conditions are responsible for 30-40% of primary amenorrhea cases. These involve abnormalities in the sex chromosomes, which can affect the development of reproductive organs. The most common are:

• Turner Syndrome: Where an individual is missing one sex chromosome.
• Swyer Syndrome: Where an individual cannot produce typical levels of sex hormones.

These conditions are usually identified through prenatal screenings, so you would likely know if you were affected.

How is Primary Amenorrhea Treated?

Treatment depends entirely on the cause:

• For genetic conditions, hormone replacement therapy (estrogen and cyclic progesterone) is typically used to induce normal puberty.
• For structural blockages, minor surgery can remove the obstructive tissue.
• For complex conditions like Mullerian agenesis, a comprehensive care team is needed to discuss treatment and fertility options.

Do I Have Secondary Amenorrhea?

This is the more common form of amenorrhea. The official diagnosis depends on your previous cycle history:

• If your periods were regular, it’s defined as missing three consecutive periods.
• If your periods were irregular, it’s defined as having no period for six months.

Secondary amenorrhea is often under-diagnosed, leaving many without proper care. It’s associated with conditions like PCOS and hypothalamic amenorrhea, each with unique root causes.

Is It Bad to Not Get Your Period?

Yes, going too long without a period can have serious long-term health consequences. A missing period is often a sign of low estrogen, a hormone vital for many bodily functions.

Without adequate estrogen, you may be at higher risk for:

• Low bone density (osteoporosis)
• Heart disease
• Accelerated memory loss

Your period is more than just a monthly bleed; it’s a vital sign that your body feels safe and your hormone levels are balanced. It’s the body’s way of cleansing and renewing the uterine lining each month.

For Sara, losing her period was a wake-up call that led her to understand and respect this process. She now feels empowered to take the next steps in her health journey.

If you’d like to learn more about the causes of missing periods, read our detailed blog post, Do I Have Secondary Amenorrhea? or explore all our Irregular Periods blogs here!

References

1. Marsh, C. A., & Grimstad, F. W. (2014). Primary amenorrhea: diagnosis and management. Obstetrical & Gynecological Survey, 69(10), 603–612.
2. Georgia EMS Academy. (n.d.). Reproductive System – Female. Georgia EMS Academy.
3. University of Rochester Medical Center. (n.d.). Exercise stress test.
4. Lee, K. H., Hong, J. S., Jung, H. J., et al. (2019). Imperforate Hymen: A Comprehensive Systematic Review. Journal of clinical medicine, 8(1), 56.