Q I'm 22 and still haven't had my first period. Why does primary amenorrhea happen?
A Primary amenorrhea refers to never having started menstruating by age 16. In most cases it stems from delayed hormonal development of the hypothalamic-pituitary-ovarian axis, or, more rarely, from an anatomical abnormality. Regardless of pregnancy, the first priority is identifying the underlying cause.
Detailed Answer
Primary amenorrhea is defined as the absence of a first period by age 16, or no menstruation by age 14 in the absence of secondary sexual characteristics. Causes vary widely, including delayed development of the hypothalamic-pituitary-ovarian axis (functional hypothalamic amenorrhea), chromosomal disorders such as Turner syndrome, and congenital Mullerian anomalies (MRKH syndrome). Blood tests for FSH, LH, estradiol, prolactin, and TSH, along with pelvic ultrasound, help distinguish the cause.
Korean Medicine Clinic Perspective
In Korean medicine, the onset of menstruation requires that Kidney Essence (sinjeong) be sufficiently full and that Qi and Blood gather toward the uterus. When primary amenorrhea is rooted in a congenital Kidney deficiency (sinheo) or in nutritional insufficiency, treatment focuses on tonifying Kidney Essence and building up Qi and Blood, creating an internal environment in which the uterus can begin to function. That said, when an anatomical abnormality is present, conventional medical evaluation should come first.
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