I am 25 yrs old and have never had a menstral cycle, ever. I have been starting to worry about why this is. I guess I just want to know what could be wrong with me. Is it something serious, or just temporary?

Dr. Joshua’s Answer:

If you have never had menstruation, in medical terms you have primary amenorrhea. There are a large number of possible causes for primary amenorrhea, and in order to find out what is causing this, you will need to see a doctor. I cannot possibly begin to guess why you have never had a period, because I have practicall no information about you, or about other symptoms you may or may not have. A clinical examination is absolutely necessary. I will, however, give you some ideas and a general discussion of why have not had a menstrual cycle.

First, check out the excellent article in Widipedia to learn about the menstrual cycle and the physiology involved:
Menstrual Cycle - Widipedia

The most common cause of amenorrhea (lack of menstruation) is anovulation, which means that the egg cell is not released for some reason. There are so many possible reasons for this that I cannot go into detail within the context of this answer. The causes of anovulation include hormonal imbalances, hormonal medications, radiation, chemotherapy, autoimmune disease.

Other possible reasons of amenorrhea include:
-hypothyroidism (disorder of the thyroid gland)
-polycystic ovary syndrome, which also causes hirsutism (excess body hair) and obesity.
-hyperprolactinemia, (too much of the hormone prolactin), which can be caused by a pituitary (hypophysis, part of the brain) tumor, and psychiatric medications (such as Haldol)
-disorders of the thyroid gland
-absence or anatomic anomalies of the reproductive organs (womb, ovaries, tubes, vagina)
-chronic illness
-starvation or anorexia
-excessive exercise
-depression
-stress
-Turner syndrome
-various hormonal disturbances

These are just a few possible causes of not having periods. The diagnosis and treatment of amenorrhea requires a consultation with specialist physician.

Some of the most important lab tests and other tests include:
-pelvic ultrasound to check that all the reproductive organs are there
-TSH (hypothyroidism)
-Prolactin (hyperprolactinemia)
-sex hormone levels (FSH, LH), sometimes testosterone and other hormones are checked, too
-Head MRI (to rule out pituitary adenoma)
-karyotype (genetic) testing: Turner syndrome, mosaic etc.
-progestin challenge test

Of course, not all of these are necessarily needed, and some other tests may be needed. Talk to your GP, and he/she will be able to start the investigations and, if needed, refer you to the proper specialist.

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