Abstract
Objective
To explore the independent role of age at menarche on menstrual abnormalities among adolescents.
Methods
The present study was a multicenter cross-sectional study on a large sample (n = 3782) of Italian girls aged 13–21 y attending secondary school who already had menarche. Girls were asked to fill in a questionnaire on menarcheal age and menstrual features during the latest three menses. The gynecological age was computed as the difference between age at the survey and the age at menarche. Main outcome measures were: prevalence of oligomenorrhea, polymenorrhea, menstrual cycle irregularity, abnormal bleeding length and dysmenorrhea. Irregularity in the recent past and since menarche was also studied. Multiple logistic models were used to identify any independent association between each abnormal feature and age at menarche or gynecological age. Adjusted ORs and 95%CI were performed.
Results
After adjusting for covariates, menarcheal age was not independently associated with polymenorrhea (OR = 0.81; 95%CI 0.63–1.04), oligomenorrhea (OR = 1.16; 95%CI 0.94–1.43), menstrual cycle irregularity (OR = 0.99; 95%CI 0.86–1.14), abnormal bleeding length (OR = 0.96; 95%CI 0.87–1.06) and dysmenorrhea (OR = 1.03; 95%CI 0.85–1.24). The multivariate analysis suggests that the higher prevalence of oligomenorrhea and menstrual cycle irregularity among the girls who were older at menarche might be purely explained by their younger gynecological age.
Conclusions
No evidence of any independent influence of age at menarche on menstrual abnormalities among young girls was shown by the investigation. The findings suggest that, after menarche, adolescent girls’ menstrual health should be checked to monitor the endocrine system maturation and to early intercept latent disorders becoming symptomatic.
Similar content being viewed by others
References
American Academy of Pediatrics Committee on Adolescence, American College of Obstetricians and Gynecologists Committee on Adolescent Health Care, Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics. 2006;118:2245–50.
Treloar AE, Boynton RE, Behn BG, Brown BW. Variation of the human menstrual cycle through reproductive life. Int J Fertil. 1967;12:77–126.
Vollman RF. The menstrual cycle. Major Probl Obstet Gynecol. 1977;7:1–193.
Flug D, Largo RH, Prader A. Menstrual patterns in adolescent Swiss girls: a longitudinal study. Ann Hum Biol. 1984;11:495–508.
Metcalf MG, Skidmore DS, Lowry GF, Mackenzie JA. Incidence of ovulation in the years after the menarche. J Endocrinol. 1983;97:213–9.
Mansfield MJ, Emans SJ. Adolescent menstrual irregularity. J Reprod Med. 1984;29:399–410.
Vihko R, Apter D. Endocrine characteristics of adolescent menstrual cycles: impact of early menarche. J Steroid Biochem. 1984;20:231–6.
Adams Hillard PJ. Menstruation in adolescents: what’s normal, what’s not. Ann N Y Acad Sci. 2008;1135:29–35.
Southam AL, Richart RM. The prognosis for adolescents with menstrual abnormalities. Am J Obstet Gynecol. 1966;94:637–45.
Wiksten-Almströmer M, Hirschberg AL, Hagenfeldt K. Menstrual disorders and associated factors among adolescent girls visiting a youth clinic. Acta Obstet Gynecol Scand. 2007;86:65–72.
Venturoli S, Porcu E, Flamigni C. Polycystic ovary syndrome. Curr Opin Pediatr. 1994;6:388–96.
Cheung LP, Ma RCW, Lam PM, et al. Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome. Hum Reprod Oxf Engl. 2008;23:1431–8.
Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997;18:774–800.
World Health Organization Task Force on Adolescent Reproductive Health. World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. II. Longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles. J Adolesc Health Care. 1986;7:236–44.
Adams Hillard PJ, Nelson LM. Adolescent girls, the menstrual cycle, and bone health. J Pediatr Endocrinol Metab. 2003;16:673–81.
Anai T, Miyazaki F, Tomiyasu T, Matsuo T. Risk of irregular menstrual cycles and low peak bone mass during early adulthood associated with age at menarche. Pediatr Int. 2001;43:483–8.
Clavel-Chapelon F, E3N-EPIC Group. European Prospective Investigation into Cancer. Evolution of age at menarche and at onset of regular cycling in a large cohort of French women. Hum Reprod. 2002;17:228–32.
Hosokawa M, Imazeki S, Mizunuma H, Kubota T, Hayashi K. Secular trends in age at menarche and time to establish regular menstrual cycling in Japanese women born between 1930 and 1985. BMC Womens Health. 2012;12:19.
Dossus L, Kvaskoff M, Bijon A, et al. Determinants of age at menarche and time to menstrual cycle regularity in the French E3N cohort. Ann Epidemiol. 2012;22:723–30.
Widholm O, Kantero RL. A statistical analysis of the menstrual patterns of 8,000 Finnish girls and their mothers. Acta Obstet Gynecol Scand Suppl. 1971;14:1–36.
Rigon F, Bianchin L, Bernasconi S, et al. Update on age at menarche in Italy: toward the leveling off of the secular trend. J Adolesc Health. 2010;46:238–44.
Rigon F, De Sanctis V, Bernasconi S, et al. Menstrual pattern and menstrual disorders among adolescents: an update of the Italian data. Ital J Pediatr. 2012;38:38.
De Sanctis V, Bernasconi S, Bianchin L, et al. Onset of menstrual cycle and menses features among secondary school girls in Italy: a questionnaire study on 3,783 students. Indian J Endocrinol Metab. 2014;18:S84–92.
Kvåle G. Reproductive factors in breast cancer epidemiology. Acta Oncol Stockh Swed. 1992;31:187–94.
Dossus L, Allen N, Kaaks R, et al. Reproductive risk factors and endometrial cancer: the European prospective investigation into cancer and nutrition. Int J Cancer. 2010;127:442–51.
Rowland AS, Baird DD, Long S, et al. Influence of medical conditions and lifestyle factors on the menstrual cycle. Epidemiol Camb Mass. 2002;13:668–74.
Järvelaid M. The effect of gynecologic age, body mass index and psychosocial environment on menstrual regularity among teenaged females. Acta Obstet Gynecol Scand. 2005;84:645–9.
Kivimäki M, Lawlor DA, Smith GD, et al. Association of age at menarche with cardiovascular risk factors, vascular structure, and function in adulthood: the cardiovascular risk in young Finns study. Am J Clin Nutr. 2008;87:1876–82.
Author information
Authors and Affiliations
Contributions
CDS conception and design of the study, acquisition of data, revision of the paper. VDS conception of the scientific question and design of the study, acquisition of data, interpretation of data, revision of the paper. EP conception of the scientific question and design of the study, analysis and interpretation of data, draft and revision of the paper. GR conception and design of the study, acquisition of data, interpretation of data, revision of the paper. FR conception and design of the study, acquisition of data, interpretation of data, revision of the paper. EP will act as guarantor for this paper.
Corresponding author
Ethics declarations
Conflict of Interest
None.
Source of Funding
None.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
De Sanctis, V., Rigon, F., Bernasconi, S. et al. Age at Menarche and Menstrual Abnormalities in Adolescence: Does it Matter? The Evidence from a Large Survey among Italian Secondary Schoolgirls. Indian J Pediatr 86 (Suppl 1), 34–41 (2019). https://doi.org/10.1007/s12098-018-2822-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-018-2822-x