For teens and families
No periods yet (medical term: primary amenorrhoea)
If your period has not started yet, you are not alone. This page explains what timing is usually expected, when to get checked, and what the first assessment usually involves.
Medical term (for reference)
You may hear the term primary amenorrhoea. It means no first period by age 15, or assessment by age 13 if breast development has not started.
What is usually expected with first periods?
Most girls go through other puberty changes before the first period. If periods have not started by age 15, a review is recommended.
Normal timing has a range: development is not exact, and many healthy girls start a little earlier or later.
Usually around 8 to 13
Breast development begins
This is often the first visible sign that puberty has started.
Over the next 2 to 3 years
Puberty progresses gradually
Growth, body shape changes, and discharge may happen before the first period.
Commonly around 10 to 15
First period starts
Many girls start around 12, but there is a normal range.
Arrange a check if there is no breast development by 13, or no first period by 15. If periods started very early (before age 10), that should also be reviewed.
Reassurance: timing can vary. A check-up is about getting answers and support, not blame.
When to book a check
- No first period by age 15 with otherwise normal growth/puberty
- No breast development by age 13
- Cyclical lower abdominal or pelvic pain without periods (possible outflow obstruction)
Common reasons
Most causes are manageable once identified. We group them into clear categories so families can understand what is happening and what comes next.
Ovary development or chromosome causes
What this means: the ovaries may not make enough oestrogen for periods to start. Next step: blood tests and, in some cases, chromosome testing (for example, for Turner syndrome).
Uterus, vagina, or outflow pathway differences
What this means: puberty hormones may be present, but bleeding cannot flow normally due to a structural difference. Next step: examination and imaging to define the pathway, with procedure-based treatment if needed.
Hormone signal causes
What this means: hormone signals from the brain may be delayed or reduced. Next step: check contributing factors such as thyroid/prolactin, chronic illness, low energy intake, or high training load.
What the assessment usually includes
Step 1
Conversation and examination
We review puberty timing, growth, symptoms, and medical/family history.
Step 2
First blood tests
Typical first tests include hCG, FSH, thyroid (TSH), and prolactin.
Step 3
Pelvic ultrasound (if needed)
This helps check the uterus, cervix, ovaries, and possible outflow blockage.
Step 4
Next-step tests
Extra tests (such as karyotype or additional hormones) depend on first results.
What happens after diagnosis
Care depends on the cause, and most plans are step-by-step. We explain options clearly, then review progress over time.
Treatment may involve:
- Treatment: hormone support may be used to support puberty, protect bone health, and help establish periods (in selected causes).
- Procedure: if there is an outflow blockage or structural difference, treatment is aimed at correcting the pathway.
- Contributing factors: plans may include nutrition, training-load, thyroid, or prolactin management where relevant.
- Fertility planning: future fertility is discussed early, with options based on the specific diagnosis.
You should have time to ask questions, and plans can be adjusted at follow-up.
Goal of care: give clear answers, protect long-term health, and support both patient and family with a practical plan.
Common questions
Frequently asked questions
Is it normal to not have periods yet at 14?
Often yes. If puberty has started and growth is progressing, periods can still begin later. A check-up can provide reassurance and a clear plan.
When should we book a check for no first period?
Book a check if there is no first period by age 15, or if breast development has not started by age 13.
What tests are usually done first?
The first steps are a clinical review, basic blood tests (such as hCG, FSH, thyroid and prolactin), and pelvic ultrasound when needed.
Does no first period always mean a serious problem?
No. There are many possible causes, and some are manageable once identified. The goal of assessment is to find the cause and guide treatment if needed.
Will treatment affect future fertility?
That depends on the cause. I will explain what your diagnosis means for future fertility and what options are available.
Still unsure? We can talk through symptoms and the right next step for your age and stage.