Greetings Masha.I am sorry that your question was unanswered for long.The causes of not starting a period is called as primary amenorrhea. Following are the causes;1) Congenital abnormalitiesa) Isolated GnRH deficiencyb) Forms of hypopituitarism c) Congenital central nervous system defects d) Constitutional delaye) Congenital absence of the uterus and vaginaf) Cervical atresiag) Intersex disorders include androgen insensitivityh) 17-ketoreductase deficiency2) Endocrine disorders (hormonal diseases)a) Congenital adrenal hyperplasia b) Cushing syndrome c) Pseudohypoparathyroidism d) Hyperprolactinemia
3) Systemic illness 4) Eating disorder
Thus a thorough investigations by a gynecologist would be recommendedMinimal fluid in cul de sac is likely due to infection. This is collection of inflammatory fluid at the base of uterus. This is not likely to be responsible for the absence of period.Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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You are very welcome,Masha.Since her hormones are perfect, she would need a CT scan of abdomen and other blood work to rule out any systemic illness or a subtle chronic infection, which usually does not give any symptoms and is detectable only by the further blood work. Following would be advised (some of them may have been done) for the evaluation of the cause;1) Thyroid-stimulating hormone (TSH), prolactin, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) measurements
2) testosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and 17-OH progesterone
3) erythrocyte sedimentation rate (ESR), liver function tests, blood urea nitrogen (BUN) determination, creatinine determination, and urinalysis.
4) Magnetic resonance imaging can detect hypothalamic/pituitary lesions.
5) Progesterone challenge test.
These tests would point the cause and direction for the treatment.It is privilege assisting you.Dr. Arun
Thank you !!!!
You are most welcome, Masha.Please rate the answer Excellent / Good, if this has been satisfactory. Only a positive rating gives us credit and payment for the work and expertize. You may ask the follow up questions even after rating.