Anatomical Causes of Absent Periods

November 21, 2009

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Anatomical Causes of Absent Periods

by Marjorie Greenfield, M.D.
reviewed by Marjorie Greenfield, M.D.

For the majority of girls who don't get a period by the age of 15, there is a hormonal cause at the root of the problem--the pituitary gland isn't telling the ovaries what to do, or the ovaries simply are not working.

Some girls, though, don't get their periods because something is anatomically awry. Perhaps the menstrual flow is obstructed on its way out, or, in rare instances, there is no uterus to do the bleeding. Here is an overview of the different anatomical causes that may be responsible for the lack of a period.

Obstruction to the flow of menses

Imperforate hymen--The hymen is a membrane that encircles the opening of the vagina. With an imperforate hymen, the membrane stretches completely across the vaginal opening, so when the period starts, the blood gets trapped in the vagina. Over a few months' time, blood will back up and lead to pain and distension of the vagina.

This problem can be easily remedied as soon as it is diagnosed by making an incision (with anesthesia) in the hymen membrane to allow the blood to escape.

Transverse vaginal septum--A transverse vaginal septum is a thick or thin dividing wall that partly blocks off the vagina, thereby obstructing the blood from a period from making its way out. Treating this condition may require extensive, specialized surgery.

Absence of the uterus

Vaginal agenesis--This condition, which affects 1 in 4,000 girls, goes by many names, including uterine agenesis, mullerian agenesis, Rokitansky syndrome and Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome.

The problem comes about when the uterus and upper vagina of a female fetus do not develop properly. A girl with vaginal agenesis usually experiences normal puberty--that is, she develops breasts, sprouts pubic hair, and undergoes a growth spurt. But she won't get a period.

A doctor who has been consulted about the girl's lack of periods typically will find, upon examination, that the external, visible genital area looks totally normal. On closer inspection, however, the doctor will note a very shallow vagina. Further exams eventually will determine that no cervix and uterus are present.

Androgen insensitivity syndrome (AIS)--Like those with vaginal agenesis, girls with androgen insensitivity syndrome often don't find out about the condition until they become teenagers and grow concerned because they haven't yet had a period. Most girls with the complete form of this condition (known as CAIS) have normal breast development and experience a normal growth spurt, although they probably will have little or no pubic and armpit hair. In girls with AIS, the uterus is absent.

More information
There is a terrific international support group for girls and women with androgen insensitivity syndrome and their families; it also offers support for those with related conditions such as vaginal agenesis. Its website is www.medhelp.org/www/ais.


RELATED INFORMATION

			Absence of Menstrual Periods
			Absence of the Uterus (Vaginal Agenesis)
			Menstruation

Created July 19, 2001
Reviewed August 05, 2004

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