Showing papers on "Menarche published in 2013"

'We keep it secret so no one should know'--a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya.

Abstract: Background: Keeping girls in school offers them protection against early marriage, teen pregnancy, and sexual harms, and enhances social and economic equity. Studies report menstruation exacerbates school-drop out and poor attendance, although evidence is sparse. This study qualitatively examines the menstrual experiences of young adolescent schoolgirls. Methods and Findings: The study was conducted in Siaya County in rural western Kenya. A sample of 120 girls aged 14–16 years took part in 11 focus group discussions, which were analysed thematically. The data gathered were supplemented by information from six FGDs with parents and community members. Emergent themes were: lack of preparation for menarche; maturation and sexual vulnerability; menstruation as an illness; secrecy, fear and shame of leaking; coping with inadequate alternatives; paying for pads with sex; and problems with menstrual hygiene. Girls were unprepared and demonstrated poor reproductive knowledge, but devised practical methods to cope with menstrual difficulties, often alone. Parental and school support of menstrual needs is limited, and information sparse or inaccurate. Girls’ physical changes prompt boys and adults to target and brand girls as ripe for sexual activity including coercion and marriage. Girls admitted ‘others’ rather than themselves were absent from school during menstruation, due to physical symptoms or inadequate sanitary protection. They described difficulties engaging in class, due to fear of smelling and leakage, and subsequent teasing. Sanitary pads were valued but resource and time constraints result in prolonged use causing chafing. Improvised alternatives, including rags and grass, were prone to leak, caused soreness, and were perceived as harmful. Girls reported ‘other girls’ but not themselves participated in transactional sex to buy pads, and received pads from boyfriends. Conclusions: In the absence of parental and school support, girls cope, sometimes alone, with menarche in practical and sometimes hazardous ways. Emotional and physical support mechanisms need to be included within a package of measures to enable adolescent girls to reach their potential.

Genome-wide Association and Longitudinal Analyses Reveal Genetic Loci Linking Pubertal Height Growth, Pubertal Timing, and Childhood Adiposity

Abstract: The pubertal height growth spurt is a distinctive feature of childhood growth reflecting both the central onset of puberty and local growth factors. Although little is known about the underlying genetics, growth variability during puberty correlates with adult risks for hormone-dependent cancer and adverse cardiometabolic health. The only gene so far associated with pubertal height growth, LIN28B, pleiotropically influences childhood growth, puberty and cancer progression, pointing to shared underlying mechanisms. To discover genetic loci influencing pubertal height and growth and to place them in context of overall growth and maturation, we performed genome-wide association meta-analyses in 18 737 European samples utilizing longitudinally collected height measurements. We found significant associations (P 1.67 10(8)) at 10 loci, including LIN28B. Five loci associated with pubertal timing, all impacting multiple aspects of growth. In particular, a novel variant correlated with expression of MAPK3, and associated both with increased prepubertal growth and earlier menarche. Another variant near ADCY3-POMC associated with increased body mass index, reduced pubertal growth and earlier puberty. Whereas epidemiological correlations suggest that early puberty marks a pathway from rapid prepubertal growth to reduced final height and adult obesity, our study shows that individual loci associating with pubertal growth have variable longitudinal growth patterns that may differ from epidemiological observations. Overall, this study uncovers part of the complex genetic architecture linking pubertal height growth, the timing of puberty and childhood obesity and provides new information to pinpoint processes linking these traits.

Associations between age at menarche and menopause with cardiovascular disease, diabetes, and osteoporosis in Chinese women.

Abstract: Context: Ages at menarche and menopause are associated with cardiovascular disease (CVD), diabetes, and osteoporosis in Caucasian women, but associations remain unexplored in Chinese women. Objective: The purpose of this study was to assess associations between age at menarche and menopause with CVD, diabetes, and osteoporosis in Chinese women. Design and Setting: A cross-sectional, population-based study was conducted in Fujian, China, from June 2011 to January 2012. Participants: Among 6242 women aged 21 to 92 years, 3304 postmenopausal women were enrolled, excluding premenopausal women (n = 2527), those with unreported ages at menarche and menopause (n = 138), those with unrecorded physical measurements (n = 203), and those with menarche age 20 years (n = 70). Main Outcome Measures: An oral glucose tolerance test, a 12-lead resting electrocardiogram, and calcaneus quantitative ultrasound were performed. Results: No significant associations were found between menarche age, diabetes, and ost...

Age at Menarche and Type 2 Diabetes Risk: The EPIC-InterAct study

Abstract: OBJECTIVE Younger age at menarche, a marker of pubertal timing in girls, is associated with higher risk of later type 2 diabetes. We aimed to confirm this association and to examine whether it is e ...

Trends in menarcheal age between 1955 and 2009 in the Netherlands.

Abstract: Aim: To assess and compare the secular trend in age at menarche in Dutch girls (1955-2009) and girls from Turkish and Moroccan descent living in the Netherlands (1997-2009). Methods: Data on growth and maturation were collected in 20,867 children of Dutch, Turkish and Moroccan descent in 2009 by trained health care professionals. Girls, 9 years and older, of Dutch (n = 2138), Turkish (n = 282), and Moroccan (n = 295) descent were asked whether they had experienced their first period. We compared median menarcheal age in 2009 with data from the previous Dutch Nationwide Growth Studies in 1955, 1965, 1980 and 1997. Age specific body mass index (BMI) z-scores were calculated to assess differences in BMI between pre- and postmenarcheal girls in different age groups. Results: Median age at menarche in Dutch girls, decreased significantly from 13.66 years in 1955 to 13.15 years in 1997 and 13.05 years in 2009. Compared to Dutch girls there is a larger decrease in median age of menarche in girls of Turkish and Moroccan descent between 1997 and 2009. In Turkish girls age at menarche decreased from 12.80 to 12.50 years and in Moroccan girls from 12.90 to 12.60 years. Thirty-three percent of Turkish girls younger than 12 years start menstruating in primary school. BMI-SDS is significantly higher in postmenarcheal girls than in premenarcheal girls irrespective of age. Conclusion: There is a continuing secular trend in earlier age at menarche in Dutch girls. An even faster decrease in age at menarche is observed in girls of Turkish and Moroccan descent in the Netherlands. © 2013 Talma et al.

Reproductive factors and risk of estrogen receptor positive, triple-negative, and HER2-neu overexpressing breast cancer among women 20-44 years of age.

Abstract: Aspects of reproductive history are among the most well-established breast cancer risk factors. However, relatively little is known about how they influence risk of different molecular subtypes of breast cancer, particularly among younger women. Using data from a population-based case–control study of women 20–44 years of age, we assessed the relationships between various reproductive factors and risk of estrogen receptor positive (ER+), triple-negative, and HER2-overexpressing breast cancers. Detailed reproductive histories were obtained through structured interviewer administered in-person questionnaires. Reproductive histories among control women (n = 941) were compared to those of ER+ cases (n = 781), triple-negative cases (n = 180), and HER2-overexpressing cases (n = 60) using polytomous logistic regression. Age at menarche, parity, and number of full-term pregnancies were similarly associated with risk of all three breast cancer subtypes. In contrast, age at first live birth, the interval between age at menarche and age at first birth, and breastfeeding were inversely associated with risk of triple-negative breast cancer (P values for trend 0.002, 0.006 and 0.018, respectively), but were not associated with risk of ER+ or HER2-overexpressing cancers. A strong inverse association between breastfeeding and risk of triple-negative breast cancer has now been consistently observed across numerous studies, and at present it is the most well-established protective factor for this aggressive and lethal form of breast cancer. Further studies clarifying the biological mechanisms underlying this relationship and confirming our results with respect to age at first birth and the interval between age at menarche and age at first birth are needed.

Clinical review: Adolescent anovulation: maturational mechanisms and implications.

Abstract: Context: Adolescents are at high risk for menstrual dysfunction. The diagnosis of anovulatory disorders that may have long-term health consequences is too often delayed. Evidence Acquisition: A review of the literature in English was conducted, and data were summarized and integrated from the author's perspective. Main Findings: Normal adolescent anovulation causes only minor menstrual cycle irregularity: most cycles range from 21–45 days, even in the first postmenarcheal year, 90% by the fourth year. Approximately half of symptomatic menstrual irregularity is due to neuroendocrine immaturity, and half is associated with increased androgen levels. The former is manifest as aluteal or short/deficient luteal phase cycles and usually resolves spontaneously. The latter seems related to polycystic ovary syndrome because adolescent androgen levels are associated with adult androgens and ovulatory dysfunction, but data are sparse. Obesity causes hyperandrogenemia and, via unclear mechanisms, seems to suppress LH...

Maternal Pre-pregnancy BMI, Gestational Weight Gain, and Age at Menarche in Daughters

Abstract: Life course theory suggests that early life experiences can shape health over a lifetime and across generations. Associations between maternal pregnancy experience and daughters’ age at menarche are not well understood. We examined whether maternal pre-pregnancy BMI and gestational weight gain (GWG) were independently related to daughters’ age at menarche. Consistent with a life course perspective, we also examined whether maternal GWG, birth weight, and prepubertal BMI mediated the relationship between pre-pregnancy BMI and daughter’s menarcheal age. We examined 2,497 mother-daughter pairs from the 1979 National Longitudinal Survey of Youth. Survival analysis with Cox proportional hazards was used to estimate whether maternal pre-pregnancy overweight/obesity (BMI ≥ 25.0 kg/m2) and GWG adequacy (inadequate, recommended, and excessive) were associated with risk for earlier menarche among girls, controlling for important covariates. Analyses were conducted to examine the mediating roles of GWG adequacy, child birth weight and prepubertal BMI. Adjusting for covariates, pre-pregnancy overweight/obesity (HR = 1.20, 95 % CI 1.06, 1.36) and excess GWG (HR = 1.13, 95 % CI 1.01, 1.27) were associated with daughters’ earlier menarche, while inadequate GWG was not. The association between maternal pre-pregnancy weight and daughters’ menarcheal timing was not mediated by daughter’s birth weight, prepubertal BMI or maternal GWG. Maternal factors, before and during pregnancy, are potentially important determinants of daughters’ menarcheal timing and are amenable to intervention. Further research is needed to better understand pathways through which these factors operate.

Long-term effects of prenatal exposure to perfluoroalkyl substances on female reproduction

Abstract: Study question Does prenatal exposure to perfluoroalkyl substances (PFASs) have long-term effects on female reproductive function?. Summary answer Our results suggest an association between in utero exposure to perfluorooctanoic acid (PFOA) and delay in age of menarche. What is known already Previous cross-sectional studies have reported possible effects of PFASs on female reproduction including reduced fecundity, delayed puberty and accelerated age at menopause. Only limited data exist from follow-up studies on long-term implications of prenatal exposure to PFASs. Study design, size, duration In this study we used data from a Danish population-based cohort established in 1988-1989. Of 1212 eligible pregnant women, 965 participated. Follow-up was initiated in 2008 on the female offspring at ∼20 years of age. Three hundred and sixty seven (84%) daughters answered a questionnaire and 267 (61%) daughters furthermore attended clinical examinations which were conducted in 2008-2009. Participants/materials, setting, methods The final study population consisted of 343 daughters of which 254 had attended the clinical examinations and 89 had answered the questionnaire only. Levels of PFASs in maternal serum from pregnancy week 30 were used as a measure of prenatal exposure and related to age of menarche, menstrual cycle length, levels of reproductive hormones and follicle number of the daughters. Data were divided into three groups according to tertiles of maternal concentrations of PFASs (low, medium, high). Main results and the role of chance In adjusted regression analyses, daughters exposed to higher levels of PFOA in utero had a 5.3 (95% confidence interval: 1.3; 9.3) months later age of menarche compared with the reference group of lower PFOA. Crude (P = 0.05) and adjusted (P = 0.01) trend tests also indicated a relationship between higher prenatal PFOA exposure and delay of menarche. Limitations, reasons for caution We did not measure the exact amount of PFASs to which the daughters had been exposed prenatally. Instead we used PFAS concentrations in maternal serum as surrogates. However, PFASs are efficiently transferred to the fetus via placenta. Information on age of menarche was collected retrospectively but the time interval for recall in our study was relatively short (2-10 years). The remaining outcome measures depended on participation in clinical examination which reduced the number of observations leading to limited statistical power and risk of selection bias. Wider implications of the findings Since PFASs can be detected in humans all over the world, effects of prenatal exposure on female reproductive function later in life may have wide health implications. Study funding/competing interest(s) The study was supported by the Danish Council for Independent Research (271-05-0296, 09-065631), the Danish Ministry of Interior and Health (0-302-02-18/5), the Danish Council for Strategic Research (09-067124 (Centre for Fetal Programming), 09-063072, 2101-06-0005), the Novo Nordisk Foundation, the Aarhus University Research Foundation, the Frimodt-Heineke Foundation, the Foundation of Maria Dorthea and Holger From, the Beckett-Foundation, the Research Grant of Organon and the Foundation of Lily Benthine Lund. There are no competing interests. Trial registration number Not applicable.

Prenatal and infant exposures and age at menarche

Abstract: Age at menarche is a frequently used marker of puberty that has been related to later health. Early menarche (≤11 years) has been associated with increased risk of breast cancer, adult obesity, type 2 diabetes, metabolic syndrome, and other markers of cardiovascular disease.1,2 Mean age at menarche in the United States decreased from the late 1800s to the 1950s, although it is unclear whether a decline has continued since the 1950s.3 A younger mean age at menarche in the United States compared with Japan may partially explain the historically higher US breast cancer rates.4 In US girls, blacks and Hispanics have been reported to experience earlier menarche than whites.5,6 Maternal age at menarche and childhood adiposity have been consistently associated with age at menarche.1,7 Prenatal exposure to maternal smoking8-14 and body size at birth, especially birth weight,11,12,15-25 have been widely studied in relation to age at menarche, with inconsistent results. Studies in mice suggest that pubertal timing can be affected by exogenous estrogens including diethylstilbestrol (DES) and genistein, one of the key isoflavones in soy formula.26-28 Maternal pre-pregnancy or gestational diabetes have been linked with later childhood obesity,29-31 but no study has examined whether maternal diabetes influences daughter’s age at menarche. We evaluated whether prenatal and other early-life exposures were associated with age at menarche, using a large sample of U.S. and Puerto Rican women.

Life-course origins of the ages at menarche and menopause.

Abstract: A woman’s age at menarche (first menstrual period) and her age at menopause are the alpha and omega of her reproductive years. The timing of these milestones is critical for a woman’s health trajectory over her lifespan, as they are indicators of ovarian function and aging. Both early and late timing of either event are associated with risk for adverse health and psychosocial outcomes. Thus, the search for a relationship between age at menarche and menopause has consequences for chronic disease prevention and implications for public health. This article is a review of evidence from the fields of developmental biology, epidemiology, nutrition, demography, sociology, and psychology that examine the menarche–menopause connection. Trends in ages at menarche and menopause worldwide and in subpopulations are presented; however, challenges exist in constructing trends. Among 36 studies that examine the association between the two sentinel events, ten reported a significant direct association, two an inverse association, and the remainder had null findings. Multiple factors, including hormonal and environmental exposures, socioeconomic status, and stress throughout the life course are hypothesized to influence the tempo of growth, including body size and height, development, menarche, menopause, and the aging process in women. The complexity of these factors and the pathways related to their effects on each sentinel event complicate evaluation of the relationship between menarche and menopause. Limitations of past investigations are discussed, including lack of comparability of socioeconomic status indicators and biomarker use across studies, while minority group differences have received scant attention. Suggestions for future directions are proposed. As research across endocrinology, epidemiology, and the social sciences becomes more integrated, the confluence of perspectives will yield a richer understanding of the influences on the tempo of a woman’s reproductive life cycle as well as accelerate progress toward more sophisticated preventive strategies for chronic disease.

Age at menarche and its relationship to body mass index among adolescent girls in Kuwait

Abstract: Despite the increasing rates of childhood obesity and rapid change in socio-economic status, the mean age at menarche remains mostly unknown among contemporary girls in Kuwait and other countries in the Gulf region. This study aimed to estimate the mean age at menarche among schoolgirls in Kuwait and investigate the association between age at menarche and obesity. A cross-sectional study was conducted on 1,273 randomly selected female high school students from all governorates in Kuwait. Overweight was defined as higher than or equal to the 85th percentile and obesity as higher than or equal to the 95th percentile using growth charts provided by the Centres for Disease Control and Prevention (CDC, 2000). Data on menarche, socio-demographic status, physical activity and diet were collected using confidential self-administered questionnaire. Out of 1,273 students, 23 (1.8%) were absent or refused to participate. The mean age at menarche was 12.41 years (95% CI: 12.35-12.48). The prevalence of early menarche, defined as less than 11 years of age, was 8.5% (95% CI: 7.0-10.2%). The prevalence of obesity and overweight was 18.3% (95% CI: 16.2-20.6%) and 25.8% (95% CI: 23.42-28.30%), respectively. Age at menarche was inversely and significantly associated with odds of overweight and obesity after adjusting for potential confounders, odds ratio 0.84 (0.77-0.93); (p = 0.001). Age at menarche among contemporary girls in Kuwait is similar to that in industrialized countries. There is an inverse association between age at menarche and obesity or overweight. Trends in menarcheal age should be monitored and time of sexual maturation and its related factors should be taken into account in strategies that aim to combat obesity.

Reproductive factors and risk of hormone receptor positive and negative breast cancer: a cohort study

Abstract: Background: The association of reproductive factors with hormone receptor (HR)-negative breast tumors remains uncertain. Methods: Within the EPIC cohort, Cox proportional hazards models were used to describe the relationships of reproductive factors (menarcheal age, time between menarche and first pregnancy, parity, number of children, age at first and last pregnancies, time since last full-term childbirth, breastfeeding, age at menopause, ever having an abortion and use of oral contraceptives [OC]) with risk of ER-PR- (n = 998) and ER+PR+ (n = 3,567) breast tumors. Results: A later first full-term childbirth was associated with increased risk of ER+PR+ tumors but not with risk of ER-PR- tumors (≥35 vs. ≤19 years HR: 1.47 [95% CI 1.15-1.88] ptrend < 0.001 for ER+PR+ tumors; ≥35 vs. ≤19 years HR: 0.93 [95% CI 0.53-1.65] ptrend = 0.96 for ER-PR- tumors; Phet = 0.03). The risk associations of menarcheal age, and time period between menarche and first full-term childbirth with ER-PR-tumors were in the similar direction with risk of ER+PR+ tumors (phet = 0.50), although weaker in magnitude and statistically only borderline significant. Other parity related factors such as ever a full-term birth, number of births, age- and time since last birth were associated only with ER+PR+ malignancies, however no statistical heterogeneity between breast cancer subtypes was observed. Breastfeeding and OC use were generally not associated with breast cancer subtype risk. Conclusion: Our study provides possible evidence that age at menarche, and time between menarche and first full-term childbirth may be associated with the etiology of both HR-negative and HR-positive malignancies, although the associations with HR-negative breast cancer were only borderline significant.

Height, age at menarche and risk of hormone receptor-positive and -negative breast cancer: A cohort study

Abstract: Associations of breast cancer overall with indicators of exposures during puberty are reasonably well characterized; however, uncertainty remains regarding the associations of height, leg length, sitting height and menarcheal age with hormone receptor-defined malignancies. Within the European Prospective Investigation into Cancer and Nutrition cohort, Cox proportional hazards models were used to describe the relationships of adult height, leg length and sitting height and age at menarche with risk of estrogen and progesterone receptor negative (ER-PR-) (n = 990) and ER+PR+ (n = 3,524) breast tumors. Height as a single risk factor was compared to a model combining leg length and sitting height. The possible interactions of height, leg length and sitting height with menarche were also analyzed. Risk of both ER-PR- and ER+PR+ malignancies was positively associated with standing height, leg length and sitting height and inversely associated with increasing age at menarche. For ER+PR+ disease, sitting height (hazard ratios: 1.14[95% confidence interval: 1.081.20]) had a stronger risk association than leg length (1.05[1.001.11]). In comparison, for ER-PR- disease, no distinct differences were observed between leg length and sitting height. Women who were tall and had an early menarche (13 years) showed an almost twofold increase in risk of ER+PR+ tumors but no such increase in risk was observed for ER-PR- disease. Indicators of exposures during rapid growth periods were associated with risks of both HR-defined breast cancers. Exposures during childhood promoting faster development may establish risk associations for both HR-positive and negative malignancies. The stronger associations of the components of height with ER+PR+ tumors among older women suggest possible hormonal links that could be specific for postmenopausal women.

Puberty in Children Born Small for Gestational Age

Abstract: Small for gestational age (SGA) children are more prone to have precocious pubarche and exaggerated precocious adrenarche, an earlier onset of pubertal development and menarche, and faster progression of puberty than children born of appropriate for gestational age (AGA) size. The majority of studies investigating the onset of puberty in children born SGA and AGA established that, although puberty begins at an appropriate time (based on chronological age and actual height) in SGA children, onset is earlier relative to AGA children. Evaluating pubertal growth in SGA children, a more modest bone age delay from chronological age at the onset of puberty and more rapid bone maturation during puberty compared to AGA children were reported. Peak height velocity in adolescence is reached at an earlier pubertal stage and lasts for a shorter period in children born SGA than in those born AGA. These differences lead to an earlier fusion of the growth plates and a shorter adult height. The pathophysiological mechanism underlying the unique pubertal growth pattern of children born SGA remains unclear. However, it seems that this is not only related to birth weight, gestational age, adiposity or obesity, but that there may also be an influence of rapid weight gain in early childhood on pubertal onset: excess weight gain in childhood may be related to central adiposity, decreased insulin sensitivity, and increased IGF-I levels and might thus predispose to precocious pubarche.

Women wearing white: Discourses of menstruation and the experience of menarche:

Abstract: This study examines how dominant societal discourses of menstruation are appropriated, rejected, or interpreted as adolescent girls make meaning of their menarche. Thirteen women ages 18–21 participated in flexible in-depth interviews to retrospectively recount their menarcheal experience. A variation of the Reading Guide was used for primary data analysis, which identified four themes highlighting girls’ ambivalence regarding menarche. Participants were conflicted at menarche about their putative status as ‘women’; used imprecise, distancing language when discussing menstruation; engaged in material and discursive practices of concealing menstruation; and referenced a community of menstrual suffering. Further, discourse analysis of participants’ talk suggests their continued discomfort. We argue that girls experience menarche ambivalently in relation to menstrual taboos, body shame and emergent womanhood. Negative discourses of menstruation and women’s bodies converge to set girls on a problematic gender...

Alcohol Intake Between Menarche and First Pregnancy: A Prospective Study of Breast Cancer Risk

Abstract: Results We identified 1609 breast cancer cases and 970 proliferative BBD cases confirmed by central histology review Alcohol consumption between menarche and first pregnancy, adjusted for drinking after first pregnancy, was associated with risks of breast cancer (RR = 111 per 10 g/day intake; 95% confidence interval [CI] = 100 to 123) and proliferative BBD (RR = 116 per 10g/day intake; 95% CI = 102 to 132) Drinking after first pregnancy had a similar risk for breast cancer (RR = 109 per 10 g/day intake; 95% CI = 096 to 123) but not for BBD The association between drinking before first pregnancy and breast neoplasia appeared to be stronger with longer menarche to first pregnancy intervals

Association of female reproductive factors with body composition: the Framingham Heart Study.

Abstract: Background: Identifying reproductive risk factors in women offers a life course approach to obesity and cardiovascular disease prevention. The association of female reproductive factors with measures of regional body fat distribution has not been comprehensively studied. Methods: We examined the association of female reproductive factors (age at menarche, parity, age at natural menopause, menopausal status) in association with body composition data from women who participated in the Offspring and the Third Generation Framingham Heart Study cohorts. Visceral adipose tissue (VAT) and sc adipose tissue (SAT) were measured volumetrically by multidetector computerized tomography. We modeled the relationship between each fat depot and female reproductive factors after adjusting for various factors such as age, smoking status, alcohol intake, physical activity index, hormone replacement therapy, and menopausal status. Results: Earlier age at menarche was associated with increased body mass index (BMI), waist cir...

Study protocol: the Childhood to Adolescence Transition Study (CATS)

Abstract: Puberty is a multifaceted developmental process that begins in late-childhood with a cascade of endocrine changes that ultimately lead to sexual maturation and reproductive capability. The transition through puberty is marked by an increased risk for the onset of a range of health problems, particularly those related to the control of behaviour and emotion. Early onset puberty is associated with a greater risk of cancers of the reproductive tract and cardiovascular disease. Previous studies have had methodological limitations and have tended to view puberty as a unitary process, with little distinction between adrenarche, gonadarche and linear growth. The Childhood to Adolescence Transition Study (CATS) aims to prospectively examine associations between the timing and stage of the different hormonally-mediated changes, as well as the onset and course of common health and behavioural problems that emerge in the transition from childhood to adolescence. The initial focus of CATS is on adrenarche, the first hormonal process in the pubertal cascade, which begins for most children at around 8 years of age.

Relationships between biomarkers of inflammation, ovarian steroids, and age at menarche in a rural Polish sample.

Abstract: Objectives To test the hypothesis that life history trade-offs between maintenance and reproductive effort would be evident through inverse associations between levels of a biomarker of inflammation [C-reactive protein (CRP)], and ovarian hormones. Associations between CRP and age at menarche were also explored. Methods Urinary CRP, salivary progesterone, and estradiol were measured over one menstrual cycle from rural Polish women (n = 25), representing a natural fertility sample. Age of menarche was assessed through interview recall methods. We used minimum second-order Akaike Information Criteria as a means of multiple regression model selection, and repeated measures ANOVA to test cycle-dependent hypotheses. Results Comparisons of individuals in high and low CRP tertiles revealed that those with high CRP had significantly lower progesterone (luteal P = 0.03, mid luteal P = 0.007) but not estradiol (follicular P = 0.21, luteal P = 0.15) concentrations through the menstrual cycle. However, when the age at menarche was included in the analysis, both age at menarche and urinary CRP were negatively associated with estradiol (R2 = 0.44, P = 0.0007). Age at menarche and estradiol were the strongest negative predictors of CRP (R2 = 0.52, P = 0.0001). Conclusions Inflammation itself may suppress ovarian function, or indicate immune challenges that lead to ovarian suppression. The timing of menarche may also influence adult inflammatory sensitivity and ovarian hormone concentrations. This lends support to existing models of trade-offs between maintenance and reproduction in women. Am. J. Hum. Biol. 25:389–398, 2013. © 2013 Wiley Periodicals, Inc.

Association of Adiposity Genetic Variants With Menarche Timing in 92,105 Women of European Descent

Abstract: Obesity is of global health concern. There are well-described inverse relationships between female pubertal timing and obesity. Recent genome-wide association studies of age at menarche identified several obesity-related variants. Using data from the ReproGen Consortium, we employed meta-analytical techniques to estimate the associations of 95 a priori and recently identified obesity-related (body mass index (weight (kg)/height (m)(2)), waist circumference, and waist:hip ratio) single-nucleotide polymorphisms (SNPs) with age at menarche in 92,116 women of European descent from 38 studies (1970-2010), in order to estimate associations between genetic variants associated with central or overall adiposity and pubertal timing in girls. Investigators in each study performed a separate analysis of associations between the selected SNPs and age at menarche (ages 9-17 years) using linear regression models and adjusting for birth year, site (as appropriate), and population stratification. Heterogeneity of effect-measure estimates was investigated using meta-regression. Six novel associations of body mass index loci with age at menarche were identified, and 11 adiposity loci previously reported to be associated with age at menarche were confirmed, but none of the central adiposity variants individually showed significant associations. These findings suggest complex genetic relationships between menarche and overall obesity, and to a lesser extent central obesity, in normal processes of growth and development.

Pubertal Timing and Substance Use in Middle Adolescence: A 2-Year Follow-up Study

Abstract: Earlier research has associated early puberty with emotional and behavioral symptoms particularly among girls, while among boys, findings have been contradictory as to whether risks are associated with early or late pubertal timing. We studied the association between pubertal timing and substance use behaviors in middle adolescence in a 2-year follow up study of 2,070 (mean age 15.5 years, SD 0.36; 56.4% females) Finnish adolescents. Pubertal timing was measured by age at menarche/oigarche. Eleven years or less was classified as early, 12–13 years as normative and 14 years or later as late pubertal timing. Substance use behaviors were elicited by a number of questions related to alcohol use patterns, smoking and cannabis use. As factors that could explain the association between pubertal timing and substance use, we studied depressive symptoms, delinquency and aggression, and parental monitoring. In boys, all these substance use behaviors were the more common the earlier the puberty and the associations persisted at age 17. Among girls, early pubertal timing was similarly associated with substance use behaviors at age 15, but no longer at age 17. The associations between pubertal timing and substance use behaviors persisted when symptom dimensions and parental monitoring were added into the models. Early puberty is a risk factor for substance use particularly among boys. Among girls, the impact of pubertal timing already tempers off during adolescence.

Predictors of the resumption of menses in adolescent anorexia nervosa

Abstract: The resumption of menses is an important indicator of recovery in anorexia nervosa (AN). Patients with early-onset AN are at particularly great risk of suffering from the long-term physical and psychological consequences of persistent gonadal dysfunction. However, the clinical variables that predict the recovery of menstrual function during weight gain in AN remain poorly understood. The aim of this study was to investigate the impact of several clinical parameters on the resumption of menses in first-onset adolescent AN in a large, well-characterized, homogenous sample that was followed-up for 12 months. A total of 172 female adolescent patients with first-onset AN according to DSM-IV criteria were recruited for inclusion in a randomized, multi-center, German clinical trial. Menstrual status and clinical variables (i.e., premorbid body mass index (BMI), age at onset, duration of illness, duration of hospital treatment, achievement of target weight at discharge, and BMI) were assessed at the time of admission to or discharge from hospital treatment and at a 12-month follow-up. Based on German reference data, we calculated the percentage of expected body weight (%EBW), BMI percentile, and BMI standard deviation score (BMI-SDS) for all time points to investigate the relationship between different weight measurements and resumption of menses. Forty-seven percent of the patients spontaneously began menstruating during the follow-up period. %EBW at the 12-month follow-up was strongly correlated with the resumption of menses. The absence of menarche before admission, a higher premorbid BMI, discharge below target weight, and a longer duration of hospital treatment were the most relevant prognostic factors for continued amenorrhea. The recovery of menstrual function in adolescent patients with AN should be a major treatment goal to prevent severe long-term physical and psychological sequelae. Patients with premenarchal onset of AN are at particular risk for protracted amenorrhea despite weight rehabilitation. Reaching and maintaining a target weight between the 15th and 20th BMI percentile is favorable for the resumption of menses within 12 months. Whether patients with a higher premorbid BMI may benefit from a higher target weight needs to be investigated in further studies.

Early and late menarche are associated with oligomenorrhea and predict metabolic syndrome 26 years later

Abstract: Objective We determined whether simple, clinical information on late and early menarche could help identify adult women with metabolic syndrome (MetS) and oligomenorrhea. Materials/Methods We carried out a 26-year prospective follow-up of 272 suburban schoolgirls from ages 5–22 to 30–46. Results Early menarche (≤10years, 5.2% of girls) and late menarche (≥16years, 6.7% of girls) were both associated with oligomenorrhea (≥42days) in adulthood, 29% and 11%, vs. 5% for normal menarche (11–15years), p=.004. Early menarche was characterized by high childhood BMI (LS mean±SE: 21.2 ±1.0kg/m 2 ) and by high childhood and adult MetS (15%, 36%). Girls with late menarche had the lowest childhood BMI (18.1±1.0), no childhood MetS, and the highest adult MetS (47%). Increasing age at menarche was associated with uniformly decreasing childhood BMI and MetS, but with a U-shaped pattern of BMI (p = .05), MetS (p=.008), and oligomenorrhea (p=.02) in adulthood. Change to MetS from median ages 13 to 38 was associated with early–late menarche (OR=3.11, 95% CI 1.37–7.07, p=.007). MetS in adulthood was associated with childhood MetS (OR=8.03, 95% CI 2.57–25.08, p=.0003) and with early–late menarche (OR =3.43, 95% CI 1.44–8.15, p=.005). Conclusions Menarche age had a curvilinear (‘U' shaped) relationship with MetS and oligomenorrhea in adulthood. Late menarche and early menarche are risk factors for adult oligomenorrhea, MetS, and cardiometabolic abnormalities. Girls with early (≤ age 10) and with late menarche (≥ 16) represent a group at high risk for adult cardiometabolic abnormalities and oligomenorrhea that is easily identifiable by physicians.

Longitudinal reliability of self-reported age at menarche in adolescent girls: variability across time and setting.

Abstract: Age at menarche is collected during routine adolescent or adult health care visits, but it is a key variable in social-behavioral as well as clinical research studies. For example, studies focusing on the secular trend of early maturation use age at menarche to describe pubertal differences across cohorts (Chumlea et al., 2003), whereas biobehavioral studies use age at menarche to categorize pubertal timing (e.g., “early”, “on-time”, “late”) (Deardorff, Gonzales, Christopher, Roosa, & Millsap, 2005; Marklein, Negriff, & Dorn, 2009; Mendle, Turkheimer, & Emery, 2007; Obeidallah, Brennan, Brooks-Gunn, & Earls, 2004). Alternatively, clinical studies use age at menarche to describe risk associated with certain diseases as illustrated by literature showing girls with earlier menarche may be at greater risk for cardiovascular disease (Remsberg et al., 2005) or adult breast cancer (Apter, Reinila, & Vihko, 1989; Hamilton & Mack, 2003). On an individual level, age at menarche can provide critical input into clinical decision making, whereas findings from research studies about risks associated with timing of menarche can be used to direct patient care or inform community-wide prevention. With the application of age of menarche for numerous purposes and settings, it is critical to note the dearth of research describing the reliability of age at menarche across time or whether reliability varies across methods of assessment. Age of menarche is a marker that must rely on self-report, or in some cases parent report, since identifying the actual onset objectively would require tracking efforts prior to the event that would be labor intensive and virtually prohibitive. Thus, in the strictest sense, no real “gold standard” exists for determining age at menarche. Using correlations, studies of age at menarche report reliability across as much as 40 years range from .60 to .83(Artaria & Henneberg, 2000; Bergsten-Brucefors, 1976; Damon & Bajema, 1974; Hediger & Stine, 1987; Koo & Rohan, 1997; Koprowski, Coates, & Bernstein, 2001; Livson & McNeill, 1962; Must et al., 2002). However, most of these studies rely on as few as two assessments, a decade or more apart. Correlational studies do not fully address consistency in reports; in turn, they may underestimate the degree of fluctuation in self-reported age at menarche across time. For example, kappa coefficients were reported as low to moderate (e.g., k = .35) when comparisons included an adolescent self-report and then self-report at age 48 (Cooper et al., 2006). Further, there may be some instances in which repeated self-report varies by several months. The resulting error from this methodological influence may be more crucial for certain research questions than others. For example, reports varying by a year may be less important for a study examining an outcome 30–40 years later compared with a longitudinal study categorizing pubertal-age girls into timing categories where the event is more proximal. Such variability was noted by a study of 9–13 year-olds where they were asked their age at menarche by clinician interview and then by questionnaire at baseline, 6- and 12-months later. Reports varied by as much as 18 months across one year (Dorn et al., 1999). As such, different conclusions about timing of age at menarche and its effect on an outcome (e.g., substance use, depression) will be drawn in the absence of a reliable method of assessing age at menarche. To address the gap in the adolescent literature, our aims were to use two methods of assessment (in-person, phone) to determine: 1) the average method reliability of reporting age at menarche across the three years, 2) test-retest reliability of reports between different time points and methods, 3) intraindividual variability of reports, and 4) whether intraindividual variability of reports differed by method or individual characteristics (i.e., race, pubertal timing and gynecological age). The analytic goal was descriptive rather than predictive. Thus, specific hypotheses were not made.

Genome-wide association study of age at menarche in African-American women

Abstract: African-American (AA) women have earlier menarche on average than women of European ancestry (EA), and earlier menarche is a risk factor for obesity and type 2 diabetes among other chronic diseases. Identification of common genetic variants associated with age at menarche has a potential value in pointing to the genetic pathways underlying chronic disease risk, yet comprehensive genome-wide studies of age at menarche are lacking for AA women. In this study, we tested the genome-wide association of self-reported age at menarche with common single-nucleotide polymorphisms (SNPs) in a total of 18 089 AA women in 15 studies using an additive genetic linear regression model, adjusting for year of birth and population stratification, followed by inverse-variance weighted meta-analysis (Stage 1). Top meta-analysis results were then tested in an independent sample of 2850 women (Stage 2). First, while no SNP passed the pre-specified P < 5 × 10(-8) threshold for significance in Stage 1, suggestive associations were found for variants near FLRT2 and PIK3R1, and conditional analysis identified two independent SNPs (rs339978 and rs980000) in or near RORA, strengthening the support for this suggestive locus identified in EA women. Secondly, an investigation of SNPs in 42 previously identified menarche loci in EA women demonstrated that 25 (60%) of them contained variants significantly associated with menarche in AA women. The findings provide the first evidence of cross-ethnic generalization of menarche loci identified to date, and suggest a number of novel biological links to menarche timing in AA women.

The Function of Ethnicity, Income Level, and Menstrual Taboos in Postmenarcheal Adolescents’ Understanding of Menarche and Menstruation

Abstract: The purpose of this study was to examine differences in knowledge about menstruation, feelings of preparation for menarche, and menstrual attitudes of early adolescent girls from different ethnic groups and income levels. An interaction between ethnicity and income level was also investigated. Participants were 165 postmenarcheal adolescent girls’ (ages 11–15) from Pittsburgh, Pennsylvania, USA, who were categorized into four groups: higher income European Americans, lower income European Americans, higher income African Americans, and lower income African Americans. It was predicted that African Americans, lower income participants, and lower income African Americans would score lower on a menstrual knowledge test, report feeling less prepared for menarche, and report more negative menstrual attitudes (i.e., fewer positive feelings about menstruation, more negative feelings about menstruation, and less openness toward menstruation) than European Americans, higher income participants, and any other income level and ethnicity grouping. Not all hypotheses were fully supported. Participants’ lacked accurate menstrual knowledge and felt unprepared for menarche, but menstrual attitudes were ambivalent. Ethnicity and income level alone did not play a substantial role in girls’ understanding of menarche and menstruation; however, they did interact. Overall, higher income European Americans fared better than the other participants. Theories and research regarding girls’ understanding of menarche and menstruation must take sociocultural factors into account.

Assessment of Beliefs and Practices Relating to Menstrual Hygiene of Adolescent Girls in Lebanon

Abstract: Introduction: Poor menstrual hygiene prevents achieving the several Millennium Development Goals. The aim of this study was to assess menstrual hygiene practices based on sociocultural beliefs of adolescent girls in Lebanon. Methods: A community-based cross-sectional survey was conducted, in 2010, among 389 postmenarcheal adolescent girls aged 13 to 19 years, at five high schools in Sidon city and suburbs, using a cluster randomized sampling and self-completed questionnaires. Collected data was analyzed by using descriptive and inferential statistics. Results: Of 389 participants, 89.5% did not follow all menstrual hygiene practices recommended, they adopted menstrual practices based on the dominant sociocultural beliefs found in the Lebanese society about these matters: 66.9% and 16.5%, respectively, did not shower in the first three days of menstruation or during all days of menstruation, and activity restrictions included physical (70.3%) and social (18.2%) activity and diet (35.5%). A significant association was found between describe menstrual hygiene practices based on sociocultural beliefs and type of school, religion, both parents’ education levels, as well as family monthly income. Logistic regression analyses indicated that significant variables predicting describe menstrual hygiene practices based on sociocultural beliefs were mother level education (OR = 2.8; P < 0.001), and religion (OR = 0.7; P = 0.002). Conclusion: Findings indicate the need for health school education programs during puberty; they also can help design appropriate intervention strategies.