When periods fail to start by the age of 16 or 17, a young woman has the condition that doctors call primary amenorrhea. For most of these girls, the problem is nothing more serious than an unusual delay. But for a few, there may be a more important underlying cause. Doctors divide young women with a significant problem into four groups.
Group 1: Girls in this group have flat enlarged breasts and an undeveloped uterus. Sometimes they have no uterus at all. Causes of their lack of menstruation range from low hormonal levels to diseases like tuberculosis, meningitis, and encephalitis. If the girl has some development of the uterus, treatment with gonadotrophic releasing hormone may make future pregnancy possible. If no pregnancy is desired, the doctor will prescribe estrogen to promote breast development. A few girls in this group are genetically male, and require other more specialized therapy.
Group 2: These young women have normal breast development but no uterus; and some may have testes (male sperm-producing organs). Although these girls can never have children, there are measures the doctor can take to correct other problems. If testes are present, they can be surgically removed after puberty and the doctor can prescribe estrogen. If the girl has a short vagina, it can be surgically lengthened to allow for intercourse.
Group 3: There are few girls with neither a uterus nor breast development. Available treatments are similar to those recommended for girls in Group 2. Estrogen is prescribed to promote breast development.
Group 4: If a girl has both breast development and a uterus, the failure to menstruate may be due to an imbalance in hormone secretion. Treatment is similar to that for amenorrhea developed later in life.