Menarcheal Age and Growth Pattern of Indian Girls Adopted in Sweden: I. Menarcheal Age

ABSTRACT. The median menarcheal age of 107 girls adopted from India by families in Sweden was 11.6 years, which was significantly lower than in Swedish and most Indian studies. Five girls had menarche before the age of 9 years, the earliest at 7.3 years. Those who arrived at a later age had earlier menarche. No differences in menarcheal age were found with respect to geographic origin. The reasons for the earlier pubertal maturation are not clear. Factors associated with the rapid transition from an underprivileged to a privileged environment are probably involved, besides genetic determinants. The serious medical, social and emotional consequences of very early pubertal development necessitate further clarification of the underlying mechanisms.     

Menarcheal age among urban Kenyan primary school girls

Aim: To determine the mean menarcheal age among urban primary school girls in Kenya. Subjects and methods: A structured questionnaire was administered to 820 primary grade 6–8 girls aged between 12 and 17 years in five public primary schools, Langata division of Nairobi West district, Nairobi Kenya. The girls came from low and middle socioeconomic status residences. Declared menarcheal age by recall to the nearest month was recorded. Data were analysed using SPSS version 15.0 for windows. The results are presented using tables and bar charts. Results: The mean menarcheal age was 12.5 ± 2.8 years with peak at 12–14 years. A substantial number of girls (10.8%) attained menarche before the age of 11 years, with 2% of them attaining it before 10 years. None attained menarche before nine or after 16 years. Of those who attained early menarche, 64.3% were from middle while only 35.7% came from low socioeconomic status residence, respectively. Conclusion: Mean menarcheal age of 12.5 years is lower than previously reported with over 10% of the girls attaining menarche by 11 years. Early commencement of reproductive health education and follow‐up for complications of early menarche is recommended.     

Menarcheal age and growth pattern of Indian girls adopted in Sweden. II. Catch-up growth and final height

Adopted girls (n=107) previously studied regarding menarcheal age in relation to age at arrival, were analysed as to growth pattern and final height related to nutritional status at arrival and menarcheal age. It was found that most girls had catch-up growth regarding height and half of them regarding weight. Faster catch-up and later arrival age in Sweden were associated with earlier menarche. The catch-up growth was, however, incomplete, and lower the initial height for age, lower was the height for age at the succeeding measurements, and the final height. The mean final height was 154 cm, but 8% of the girls were 145 cm or shorter. The data suggest that linear growth and final height is influenced by the preadoptive nutritional condition, as well as by the degree and timing of subsequent catch-up growth, and the timing of puberty. Pubertal onset is related to the degree and timing of catch-up growth.     

Does handedness and altitude affect age at menarche?

Although there is knowledge about earlier mean age at menopause among left-handed postmenopausal women, it is unclear from the literature whether age of menarche is influenced by the prenatal hormonal pattern and cerebral lateralization. We therefore planned to investigate the relation between age of menarche and cerebral lateralization in girls at an altitude of nearly 2000 m. Sixty-two girls, aged between 9.4 and 15.5 years, were interviewed by questionnaire about manual dominance and menarcheal age. All girls were divided into two groups: left-handers (n = 31) and right-handers (n = 31). It was shown that there was a significantly lower average age of menarcheal appearance (12.96 +/- 1.34 years) in the left-handers' compared with the right-handers' (13.72 +/- 1.41 years; p = 0.025). The earliest menarcheal age was 9.4 years in left-handers and 10.1 years in right-handers.A menarcheal age of 13.34 +/- 1.35 years was found for the whole group at an altitude of nearly 2000 m. This data leads us to believe the existence of a link between functional brain asymmetry and menarche. It would appear that the activation of the hypothalamic-pituitary-gonadal axis is earlier in left-handed females than in right-handed females.     

北京市儿童青少年女性青春期性征发育流行病学研究

摘要 目的：了解北京市6~18岁学龄女生青春期第二性征发育现状,以及人群性早熟发生率。方法：利用2004年北京市儿童代谢综合征调查（BCAMS）总样本中9 778名6~18岁中小学女生的青春期发育数据，用概率单位回归法计算月经初潮、乳房、阴毛不同发育时期的中位年龄。8岁前乳房或阴毛发育达Tanner II 期（B2,P2），或10岁前月经初潮者被定义为性早熟。结果：9 778名6~18岁中小学女生中城市人口5 040人，占总样本51.5%。北京市学龄女生月经初潮年龄平均为 （12.1±1.1）岁，城市女生（11.9±1.1）岁，农村女生（12.5±1.1）岁；女性第二性征开始发育年龄（总体/城市/农村）分别为，乳房：（9.5±1.2）岁/（9.3±1.1）岁/(9.6±1.2）岁；阴毛:(11.1±1.1）岁/(10.8±1.1）岁/(11.4±1.1）岁。城市女生月经初潮、乳房和阴毛发育均显著早于农村女生。月经初潮早发生率为0.79%，城市高于农村（1.03%：0.55%；x2=6.93，P<0.01）；乳房、阴毛早发育率分别为2.91%和0.22%。1962~1982年期间，北京女生月经初潮年龄平均每10年提前0.7岁（8.4个月）；近10年平均提前0.43岁（5.2个月）。结论：北京市城区女生青春期第二性征发育明显早于郊区县女生。月经初潮年龄提前的长期变化趋势依然存在，但近10年这一趋势趋于减缓。     

Age at menarche in a Korean population: secular trends and influencing factors

This study was designed to identify the secular trend in the age at menarche and to investigate the possible factors that influence the age at menarche using representative Korean data from the 2005 Korean National Health and Nutrition Survey. Three thousand five hundred sixty-two women born between 1920 and 1985 were enrolled to identify secular trends in the age at menarche and 620 girls born between 1986 and 1995 were recruited to evaluate the factors influencing the age at onset of menarche. Mean age at menarche decreased from 16.90 ± 1.25 years for women born between 1920 and 1925 to 13.79 ± 1.37 years for those born between 1980 and 1985, indicating a downward trend of 0.68 years per decade (95% CI, 0.64–0.71) in age at menarche. Mean age at menarche of girls born between 1986 and 1995 was 13.10 ± 0.06 years as estimated by the Kaplan–Meier method. Among girls born between 1986 and 1995, menarcheal girls had a larger waist circumference, a higher body mass index (BMI), and lower maternal menarcheal age and maternal age at birth than premenarcheal girls. The energy and nutrient intake of protein, sugar, fiber, ash, phosphate, natrium, thiamine, riboflavin, and niacin were greater for menarcheal girls than for premenarcheal girls. These data indicate a decreasing secular trend of age at menarche in a Korean population born between 1920 and 1995. Furthermore, maternal menarcheal age, BMI, maternal age at birth, and nutrition are important variables that appear to influence age at menarche in Korean girls.     

Interpreting the continued decline in the average age at menarche: results from two nationally representative surveys of U.S. girls studied 10 years apart

OBJECTIVES: To determine whether average age at menarche declined in the United States during the past decade, and whether associations between menarcheal timing, weight status, and race/ethnicity changed. STUDY DESIGN: Relative weight, race/ethnicity, and menarcheal status of girls (n = 1577) in the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) were compared with those of girls (n = 1720) in NHANES 1999-2002. Probit analysis estimated average age at menarche overall and also by race/ethnicity. Logistic regression assessed associations of relative weight and race/ethnicity with menarcheal status. RESULTS: In the United States, average age at menarche declined from 12.53 years (95% confidence interval [CI] = 12.43 to 12.63 years) in 1988-1994 to 12.34 years (95% CI = 12.24 to 12.45 years) in 1999-2002. By race/ethnicity, average age at menarche estimates were as follows: non-Hispanic whites, 12.57 years (95% CI = 12.45 to 12.69 years) and 12.52 years (95% CI = 12.38 to 12.67 years); non-Hispanic blacks, 12.09 years (95% CI = 11.82 to 12.36 years) and 12.06 years (95% CI = 11.81 to 12.32 years); and Mexican Americans, 12.24 years (95% CI = 11.88 to 12.59 years) and 12.09 years (95% CI = 11.81 to 12.37 years). Higher relative weight was consistently associated with increased likelihood of having reached menarche. CONCLUSIONS: Average age at menarche in the United States declined by 2.3 months between 1988-1994 and 1999-2002; by race/ethnicity, declines were considerably smaller. Changes in the population distribution of race/ethnicity and relative weight should be considered when interpreting trends in age at menarche.     

Relationships between age of puberty onset and height at age 18 years in girls and boys

Background

Changes during puberty may influence final adult height. Height is related to multiple health conditions, including lung function. We investigated the association between the age of onset of five puberty events and height at age 18 years, analyzing boys and girls separately.

Methods

Of 1456 children recruited into the Isle of Wight birth cohort (1989–1990), 1313 were followed up at age 18 years. Height was measured, and age of pubertal onset was collected at age 18 years. Cluster analysis was performed on the five puberty events in boys and girls and linear regression was applied with the clusters predicting height at age 18 years. Individual linear regression analyses assessed the age of onset of each pubertal event as a potential predictor for height at age 18 years.

Results

Of the 1313 children followed up at age 18 years, 653 were males and 660 were females. All puberty variables had high internal consistency. In girls, earlier age of menarche, breast development, and growth spurt were related to shorter height. In boys, earlier age of growth spurt and slower progression through puberty were related to taller height at age 18 years.

Conclusions

Given that boys and girls may have opposing associations between pubertal timing and adult height and that height is an important predictor of lung function, the effect of pubertal timing on respiratory health should be explored.     

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.     

Timing and secular trend of pubertal development in Beijing girls

Background

Historical research is limited in changes in pubertal development in Chinese girls. We aimed to identify the timing of pubertal characteristics and the secular trend of menarche age among Beijing girls from the 1980s through the 2000s.

Methods

Six data sets were analyzed, including the Beijing Child and Adolescent Metabolic Syndrome study in 2004, where 9778 Bejing girls aged 6–18 years were studied. The Fetal Origins of Adult Disease study provided retrospective menarche age from 1940 through 1960. Other four studies were conducted in Beijing to obtain supplementary information to assess secular trend in menarche age. Linear regression method was used to analyze the data.

Results

Among Beijing girls in 2004, the median age at menarche was 12.1 years, which was 0.6 years earlier in urban than in rural areas. The median age at Breast Tanner Stage 2 was 9.5±1.2 years, representing 9.4±1.1 years and 9.6±1.2 years for urban and rural girls, respectively. In contrast, the median age at Pubic Hair Tanner Stage 2 was 11.1±1.1 years, representing 10.8±1.1 and 11.4±1.1 years for urban and rural girls, respectively. The menarche age of urban girls decreased by 4.2 months per decade, and that of rural girls by 9.6 months per decade from 1980 to 2004.

Conclusions

Urban girls mature earlier than rural girls in Beijing. A secular trend towards earlier menarche was observed between the 1980s and the 2000s.     

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.     

Height and weight at menarche and a hypothesis of menarche

Height and weight at menarche were estimated by interpolation of longitudinal growth data for 181 girls. Mean weight at menarche, about 48 kg, does not change as menarcheal age increases, whereas mean height increases significantly. Early and late menarcheal girls gain the same amount of height, about 22 cm, and the same amount of weight, about 17 kg, in the interval from the initiation of the adolescent spurt to menarche, though late maturers grow at slower rates during the spurt, including the year of menarche. A hypothesis of a direct relation between a critical weight and menarche is proposed. Such an interaction would explain the delaying effect of malnutrition on menarche and the secular trend to an earlier menarche.     

Height velocity, body fat and menarcheal age of Indian girls

OBJECTIVE: To understand the onset of menarche in relation to changes in physical measurements that take place during adolescence, especially the changes in height velocity and changes in body fat. DESIGN: Adolescent girls in the 9-16 year age group were observed longitudinally every six months for a period of two years. SETTING: Girls from schools catering to urban high socio-economic class (HSE, n = 135) and those catering to low socio-economic class (LSE, n = 398) were evaluated. METHODS: Six monthly measurements of weight, height and triceps skinfold thickness (TSFT) were done. Menarcheal age was recorded by recall method for the girls who were menstruating at the beginning of the study and prospectively for girls whose onset was after the initiation of the study. Body fat (%) was estimated using weight, height and TSFT. RESULTS: The girls from LSE not only had lower attained weight, height, skinfold thickness at triceps and body fat but also had a significant difference (p < 0.05) in menarcheal age (15.4 yr) as compared to girls from HSE (12.1 yr). Although social class differences delayed the occurrence of the event by chronological age, the time between peak height velocity (PHV) and onset of menarche remained similar (1.5 yr) irrespective of social class. The mean weight at menarche, at group level (but not at individual level), was around 38 kg in both socio-economic classes, irrespective of age at onset. Further menarche represented the point of maximum deceleration in height velocity and maximum acceleration in body fat in both social classes. CONCLUSION: Our data indicated a partial support for critical weight hypothesis and suggested that these limits vary from community to community. The analysis revealed that rather than absolute values of weight, height and body fat, changes in these measurements are of significance with regard to onset of menarche.     

Menarcheal age in Northumberland.

A second survey of age at menarche in north-east England, how it is affected by family environment and how it affects physique, was carried out in 1960-70 on a large sample of schoolgirls in the suburbs of Newcastle. Age at menarche shows no independent effect of social class or of position in sibship, but is strongly influenced by the size of family in which a girl grows up. Menarche is associated with pronounced increments in height and weight, in the presence of which no consistent effects of variables of the family environment on physique can be clearly identified. The results are very similar to those from the first study in South Shields, County Durham.     

Pubertal maturation in girls treated for childhood acute leukaemia

Eleven girlds treated during childhood for acute leukaemia were followed up during their pubertal development. At each examination weight, height, pubertal stage, FSH, LH, oestradiol, testosterone, androstenedione and dehydroepiandrosterone sulphate levels were evaluated. Clinical and endocrinological studies were performed according to age and pubertal stage and compared to those of healthy girls matched for age and pubertal stage. Results showed that pubertal maturation and gonadal function were not affected by oncotherapy; however menarche was attained earlier. Early menarche was explained by the overweight of treated girls during early puberty. No evidence of early hypothalamic activation was found, but endocrine patterns showed a faster hypothalamopituitary-ovarian axis maturation in patients than controls. Cranial irradiation showed no correlation with pubertal onset and age at which menarche was attained. Adolescent menstrual and endocrine patterns were normal.     

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.     

A mixed-longitudinal study on the pattern of pubertal growth: relationship to socioeconomic status and caloric-intake--IV

The pubertal growth pattern was observed on 791 girls belonging to upper and low SES. These girls ranged between 7-16 years. The effect of calorie intake on the pubertal growth was also ascertained. The development of breast was first to appear at the age of 8.25 years. It was followed by pubic and axillary hair development. The mean age of menarche was 12 years and 12.8 years for USES and LSES, respectively. The onset of menarche, breast and pubic hair was significantly delayed in LSES girls by 0.8 years. Menarche was found to correlate better with breast development than pubic or axillary hair. The girls on adequate calories showed early onset of breast, pubic hair and axillary hair development and of menarche. Similarly, these girls attained mature stage (adult) of these variables earlier compared to those who were on inadequate calories. However, intermittent developmental stages of pubic hair and axillary hair showed no consistency with intake of calories. The girls on inadequate calories showed approximately one year late onset of breast and pubic hair development. The present observations suggest that the onset of puberty is strongly influenced by environment but its attainment is under the genetical control.     

VI. Somatic pubertal development.

The pubertal development of 212 randomly selected Swedish urban children has been investigated as part of a prospective longitudinal study of growth and development. The timing and pattern of pubertal changes were in agreement with the findings in other contemporary studies. The good agreement with data on pubertal development reported in other investigations of Swedish children indicates that the present sample was representative of contemporary Swedish children. Two procedures of assessment of secondary sex characters - clinical examination and whole-body photography - have been compared and contrasted. A clinical examination is less laborious and resource-consuming and also has psychological advantages but should be supplemented in boys by the estimation of testicular volume (orchidometry). In girls the two methods have similar precision and reliability. The first pubertal changes may be observed before 9 years in girls (breast development) and before 10 years in boys (genital development). On average the first change takes place about one year earlier in girls than in boys. Peak height velocity (PHV) is an early event during puberty in girls and a relatively late event during puberty in girls and a relatively late one in boys, the sex difference in mean age being about two years. In girls, menarche is a late event, always occurring after PHV. At the age of 13-14 years some boys and girls have not yet begun theri pubertal development, while others have reached the adult stage.     

Weight and age at menarche.

In the National Child Development Study (1958 cohort) information on their age at menarche and their weights and heights measured at 7, 11, and 16 years was available for 4427 girls. The distribution of age at menarche was not influenced by social class. Weight adjusted for height did not play an important part in the timing of sexual maturation of the girls in the study. Relative weight (weight expressed as a percentage of standard weight) at the ages of 7 and 11 years explained only 3.2%, and 4.9%, respectively of the variation in age at menarche, and changes in relative weight between these two ages accounted for 2%. Girls with early menarche were more likely to be overweight at ages 7, 11, and 16 years than those with late menarche, although early menarche was also reported by girls who were underweight or of average weight. These findings support the hypothesis that in well nourished populations the relation between menarche and body size is largely regulated by genetic factors and that nutrition is less important.     

Onset of puberty at eight years of age in girls determines a specific tempo of puberty but does not affect adult height

AIMS: To analyse the effect of early puberty (onset between 7.5 and 8.5 y) on pubertal growth and adult height in girls, and the implications of this effect for the age limit for normal onset of puberty. METHODS: Longitudinal study in Reus (Spain) of 32 girls with early puberty until they reached adult height. Data from these girls were compared with longitudinal data from girls (116) from the same population with normal onset at 10 (n = 37), 11 (n = 47), 12 (n = 19) and 13 (n = 13)y. We analysed height, target height, adult height, pubertal height increase, duration of pubertal growth, age at menarche and time to menarche. RESULTS: The adult height of girls with early puberty (160.9 +/- 5.4cm) was similar to that of girls with onset at later ages (p = not significant). In these girls, puberty lasted 5.4 +/- 0.7 y and the mean growth during puberty was 31.1 +/- 3.5 cm. As the age of onset of puberty increases, the duration of puberty and mean growth during puberty progressively decreased (p < 0.001). Girls with early puberty reached menarche at a mean age of 10.9 +/- 1.0 y, 3.2 +/- 0.9 y after onset of puberty, and this time span was greater than in the other groups. CONCLUSION: Girls with onset of puberty at 8 y show all the compensatory phenomena related to height at onset, pubertal duration and height increase during puberty. These phenomena cause their adult height to be similar to that of girls who begin puberty at the age of 10 to 13 y.