A comparison of skeletal growth and maturation in undernourished and well-nourished girls before and after menarche

A 25 year study comparing undernourished and well-nourished girls found that malnutrition delayed menarche and delayed, but did not stunt, skeletal growth. The Birmingham, Alabama study followed 30 undernourished and well-nourished local white girls from approximately 4 - 19 years of age. The well-nourished girls' diets met the US Daily Recommended Allowances but the other girls' diets were deficient in nutrients especially Vitamin A, ascorbic acid, iron, calcium and animal protein. The girls' height was measured every 3 months, serial sequential roentgenograms were taken of their left hands and wrists every 6 months and the age of menarche of noted. The undernourished group's rate of skeletal maturation was significantly slower premenstrually than the others and the occurrence of menarche was closely related to skeletal maturation. Menarche was over 24 months later in the malnourished group at which time their skeletal maturation was similar to the group at the time of their menarche. The postmenstrual rate of skeletal maturation of both groups was similar. Asymmetry of maturation (the range from the most to the least advanced bones in an individual's hand) was higher in the undernourished group at the earliest age but declined in both groups with age. The well-nourished group reached zero asymmetry at age 18; the malnourished group about two years later. The mean height at maturity of both groups was not significantly different but the undernourished groups' greatest growth spurt was again 18-24 months behind the other group.     

Primary amenorrhea in adolescent girls. Incidence of isolated delayed menarche

In its strict meaning, primary amenorrhea is defined as the absence of any menstruation in a young girl without genital malformations who has reached her complete morphological development. Twenty-four cases corresponding to this definition, with bone ages of at least 15 years, breasts for at least 2 years, and adult type pubic hair were examined. In only 10 could a cause be found: anorexia nervosa, slight hyperandrogenism, acquired intracranial lesion. The other 14 girls, mean age of 16.2 +/- 1.4 years, were considered as presenting with simple delayed menarche. They were not given treatment, although 4 of them had been given steroids in artificial cyclical form previously. The 8 who were followed finally spontaneously developed normal cycles at a mean age of 17.6 +/- 2.8 years, one not until 24 years. Such data should lead to avoiding unnecessary treatments.     

Age at menarche in adolescent Khasi girls, Meghalaya

The mean and median age at menarche in 360 Khasi girls was found to be 13.22 ± 0.88 and 12.13 ± 0.79 years, respectively; socio-economic status was observed to be a strong predictor of age at menarche in this population.     

Ovarian function after bone marrow transplantation performed before menarche.

AIM: To examine the long term effect of bone marrow transplantation (BMT) on ovarian function in girls. METHODS: Eighteen girls who underwent BMT before menarche, had been disease free for more than six years, and were over 14 years of age at the time of study were investigated. The preparative regimen consisted of irradiation and chemotherapy. The occurrence of menarche and changes in basal serum follicle stimulating hormone (FSH) concentrations were studied. RESULTS: Twelve patients achieved menarche at a median age of 12.8 years. Age at transplant was significantly younger in patients who achieved menarche than in those who did not (mean (SD), 7.2 (0.5) v 11.1 (1.7) years). Basal FSH began to rise to menopausal concentrations after 10 years of age, and the girls who did not experience menarche had a sustained rise in FSH concentrations. Among those with raised FSH concentrations, five girls experienced menarche while serum FSH values were decreasing and four achieved menarche while FSH remained raised. CONCLUSIONS: The high incidence of menarche suggests a favourable outcome of ovarian function in girls who undergo BMT at a young age.     

Attitudes and feelings towards menstruation and womanhood in girls at menarche

Aim: To elucidate early adolescent girls' attitudes, thoughts and feelings towards menstruation and their bodies. Methods: 309 12-y-old girls answered questionnaires. One part of the questionnaire dealt with thoughts and feelings towards menstruation. The other part dealt with thoughts and feelings towards menstruation and sex and ability to communicate on aspects of womanhood. Results: Postmenarcheal girls were less positive towards menstruation than premenarcheal girls (p=1×10^-6). Many girls (43%) did not reaffirm the statement “I like my body” and almost one quarter stated being teased for their appearance. Many of the girls claimed that they had been called “cunt” (38%) or “whore” (46%). If called “cunt” or “whore”, 17% stated that they felt alone, 76% felt anger and 50% were offended. Mothers were those with whom girls could most easily “chat” about their period. Sixty-seven per cent received information about menstruation from school nurses.

Conclusion: Wanting to be an adult and liking that their body develops seem to be associated with a more positive feeling towards menstruation. Furthermore, mothers' timing and ability to communicate attitudes towards menstruation and the body are as important as those in a girl's immediate environment.     

基于初潮时骨龄预测女童初潮后身高剩余生长潜力的横断面调查

背景 初潮是女童进入青春发育后期的重要标志,也是身高干预的最后一个机会窗口期,且初潮受多种因素影响、个体差异很大。正确认识和掌握女童初潮后的生长规律和特点,可为临床实践中不同初潮年龄女童的终身高评估和干预决策的制定提供参考依据。目的 通过分析女童初潮时年龄、骨龄和体格发育特征,探讨初潮后预测终身高(PAH)的临床评估方法。设计 横断面调查。方法 回顾性收集2008至2018年于首都儿科研究所附属儿童医院(我院)生长发育门诊就诊、有女童月经初潮时间、体格测量数据、骨龄X片的病例。排除初潮时间与就诊时间间隔≥3个月的病例、病历诊断中有明确的影响儿童生长发育的疾病、病历诊断中有明确病因引起的继发性中枢性性早熟或外周性性早熟和既往使用过生长激素或促性腺激素释放激素抑制剂药物的病例。按事先定义的方法计算实际年龄、骨龄、身高的标准差分值(HtSDS)、PAH和预测生长潜力、骨龄HtSDS(HtSDS_BA)和女童遗传身高,3名儿童保健科医生从纸质或电子病历中按照纳入和排除标准筛选病历、提取数据和判断,单人录入至Epidata数据库。以初潮年龄每1岁为段分组,以初潮时骨龄每0.5岁为段分组。主要结局指标 初潮骨龄、PAH和预测生长潜力。结果 ① 694例女童的初潮年龄8.5~13.2(10.7±1.1)岁,初潮时骨龄12.4~12.8(12.4±0.6)岁。②初潮年龄越小的女童,骨龄提前越多,HtSDS也越高。例如,8~岁组骨龄提前(3.8±0.5)岁,HtSDS为2.6±1.3;13~岁组骨龄落后(0.7±0.7)岁,HtSDS为-1.05±0.59。骨龄校正后不同初潮年龄组的平均HtSDS_BA为-1.17~-0.68,组间差异较小。③初潮后的预测生长潜力为(7.3±2.6)cm,生长潜力仅与初潮时的骨龄高度负相关(r=-0.960,P<0.001),骨龄从11.0~岁组到13.0~岁组,平均生长潜力从12.7 cm降至4.0 cm(F=1 194.393,P<0.001)。④本研究获得PAH计算公式[0.868×身高(cm)-3.754×骨龄(岁)+73.677],拟合优度R²=0.992,据此计算预期达到不同终身高的女童初潮时身高应达到的临界值。例如,女童初潮时骨龄为12岁,PAH达到150 cm则初潮时身高应＞139.8 cm,PAH达到160 cm初潮时身高应＞151.3 cm。结论 女童初潮时骨龄相对稳定,骨龄是反映身体成熟度和预测月经来潮的可靠指标,也是预测初潮后生长潜力的关键指标。     

Body composition, dehydroepiandrosterone sulfate and leptin concentrations in girls approaching menarche

There is strong evidence that the initiation of adrenarche and gonadarche during puberty in girls depends on body mass in general and body fat in particular. The aim of this study was to analyze changes in body composition, i.e. body fat (BF), fat percentage (BF%), and lean tissue mass (LM) in girls during pre-menarcheal stages of development, including the earliest stage lacking clinical manifestations of changes in primary, secondary, and tertiary sexual characteristics. Puberty was assessed according to clinical and ultrasonographic staging of sex features developed by us. Concentrations of leptin and DHEA-S were compared and related to changes in body composition. SUBJECTS AND METHODS: The study was carried out on 65 healthy girls aged 8 years and older who were followed every 3 months over a 5-year period. Age, height, weight, and BMI were recorded. Body composition (BF, BF%, LM) was determined with an infrared method. Tertiary sexual features were staged according to Tanner. Vaginal secretion was assessed according to Peter et al. Transabdominal ultrasound of the uterus and ovaries was performed with the bladder unvoided. Groups were formed according to developmental stage: E0A = pre-estrogenization (no ultrasonographic or clinical evidence of estrogenization); E0B pre-estrogenization with 'luminosity' of mucus in cervical canal; E1 = onset of estrogenization; E = full estrogenization; M = menarche +/- 3 months. Concentrations of DHEA-S and leptin were determined by radioimmunoassay. RESULTS: BF in prepubertal girls averaged 16%. At menarche, BF was 23.9%. Body weight at menarche was 50.6 kg and the LM/BF ratio was 3.0. High leptin concentrations were found in E0B and M groups. Leptin concentrations were lowest during full estrogenization (E). Positive correlations of leptin with BF and LM were found in girls during developmental stages preceding menarche. Mean concentration of DHEA-S started at 1,091.6 microg/l during E0A stage, dropped significantly on passing to E0B (p <0.05), and increased by menarche. DHEA-S levels were found to correlate with BF, LM, and leptin in E0A, E0B, and E1 groups. Correlation coefficients were highest (DHEA-S/BF r = 0.61; DHEA-S/LM r = 0.54; DHEA-S/LEP r = 0.57) in the E0A group, i.e. about 5 months before the appearance of 'luminosity' of cervical mucus, considered to be the first ultrasonographic sign of puberty. Apparently, leptin stimulates somatic maturation during this stage of gonadarche which terminates with menarche. The action of DHEA-S is exerted during the early stages of female puberty.     

Age at menarche in contemporary Greek girls: evidence for levelling-off of the secular trend

AIM: To examine the secular trend of menarcheal age in Greek girls during the last decade. METHODS: Seven hundred and fifty senior high schoolgirls were asked through a questionnaire to report their date of menarche, participation in physical activities and their weight status at menarche. The data were compared with those of a study of 1996. RESULTS: Mean age at menarche (+/-SD) in 2006 was 12.29 (1.19) and in 1996 it was 12.27 (1.13) years, p = 0.73. Maternal menarcheal age was 13.02 (1.32). There was a significant correlation between age at menarche of the schoolgirls and their mothers, p < 0.0001. There was a significant difference in the age at menarche according to the schoolgirls' perceived weight status. Menarcheal age of obese girls (n = 56) was 11.73 (1.21) years, of normal weight girls (n = 474) was 12.29 (1.21) years and of lean girls (n = 220) was 12.42 (1.14) years, p < 0.001. There was no significant difference in the age at menarche between the girls that participated, 12.23 (1.19), and those that did not participate in sporting activities, 12.32 (1.19), p = 0.31. CONCLUSION: Levelling-off of the age at menarche over the last 10 years occurred in Greek girls living in Athens. Menarcheal age is influenced by the weight status and maternal menarcheal age.     

Effect of low versus normal birthweight on menarche in 14-year-old Polish girls

OBJECTIVE: The relationship between intrauterine growth retardation and sexual maturation has not been completely established. The aim of the present study was to compare menarche in 14-year-old Polish girls of low and normal birthweight, along with an evaluation of the impact of socio-economic status and body mass index (BMI). METHODS: We studied 1060 girls (177 pre- and 883 post-menarche) aged 13.5-14.5 years. These girls attended the 7th grade of randomly selected primary schools in Wroclaw, Poland. The BMI was used as a measurement of general adiposity. The cut-off value of the 10th percentile of birthweight for gestational age was used to differentiate between girls born small for gestational age (SGA) and girls with a birthweight appropriate to gestational age (AGA). Parental education level and other measures were used to assess socio-economic status (SES). RESULTS: Birthweight (OR = 2.54; 95% CI 1.22-5.28) and BMI at the age of 14 years (OR = 7.93; 95%CI 4.67-13.48) were factors affecting the onset of menarche among the 14-year-old girls. CONCLUSION: Polish girls born small for gestational age are more likely to have experienced menarche by the age of 14 years, compared with their peers of normal weight at birth. These findings seem to be consistent with the hypothesis that the age of menarche is, to some extent, set by patterns of gonadotropin release, established prior to birth. Additionally, the age of menarche varies depending on levels of fat accumulation during childhood and adolescence.     

Sickle cell disease and age at menarche in Jamaican girls: observations from a cohort study.

AIMS: (1) To investigate the distribution of age at menarche in a representative sample of 99 patients with homozygous sickle cell (SS) disease, 69 with sickle cell haemoglobin C (SC) disease, and 100 controls with a normal haemoglobin (AA) genotype followed in a cohort study from birth. (2) To explore the determinants of the age at menarche. METHODS: Children ascertained in a newborn screening programme were followed prospectively from birth to age 18-26.5 years with regular assessments of height, weight, pubertal stage, and haematological indices at the Sickle Cell Clinic of the University Hospital of the West Indies. RESULTS: All subjects have now reached menarche and the mean age in normal controls (13.0 years) was significantly earlier than in SC disease (13.5 years) or SS disease (15.4 years). Greater weight and earlier age at menarche was the only association significant across all genotypes although additional contributions occurred from fetal haemoglobin and red cell count in SS disease. Alpha thalassaemia, which ameliorates many of the effects of SS disease, had no discernible effect on menarche. CONCLUSIONS: Mean age at menarche is delayed by 0.5 years in SC disease and by 2.4 years in SS disease. Weight appears to be the principle determinant of age at menarche.     

Increment in height of the upper segment and bi-iliac diameter after menarche in young girls. Longitudinal study of 40 adolescents]

The growth in height, upper segment and biiliac diameter after the menarche has been studied in 40 girls followed longitudinally until the mean age of 18 years 3 months. The mean increase in height after the menarch was 7.3 +/- 2 cm., with significant individual variations. The upper segment was responsible for much of the total increase, which was greater with an early menarche. The percentage of the final height attained by the menarche was constant: 95.5 % +/- 1,2 %. After cessation in height growth, the biiliac diameter still increased for 75 % of the children. The median value for this increase after the menarche was 2 cm., with a significant scatter. The increase in these three parameters was in indirect correlation with the bone age: the less the bone age at the menarche, the greater the increase in height, upper segment and biiliac diameter.