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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 34694
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Hello, my daughter is 13 years old, she doesnt have a period

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Hello, my daughter is 13 years old, she doesn't have a period yet. Pelvic ultrasound was noted there is a minimal amount of free fluid was noted in the cul-de sac. Can you tell what this mean's?

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 abnormalities
a) Isolated GnRH deficiency
b) Forms of hypopituitarism
c) Congenital central nervous system defects
d) Constitutional delay
e) Congenital absence of the uterus and vagina
f) Cervical atresia
g) Intersex disorders include androgen insensitivity
h) 17-ketoreductase deficiency

2) 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 recommended

Minimal 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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Customer: replied 4 years ago.
Thank you very much!!! We just checked her hormonal status, it's absolutely perfect

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

Customer: replied 4 years ago.

Thank you !!!!

You are most welcome, Masha.

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