Onset of menstrual cycle and menses features among secondary school girls in Italy: A questionnaire study on 3,783 students

Understanding Adolescent Gynecological Issues: A Cross-Sectional Study at a Tertiary Care Center

BACKGROUND AND OBJECTIVES

Adolescence is a crucial phase in a woman's life, as it signifies the beginning of her reproductive journey. During this time, there are notable variations in sexual development and a sense of caution that can present challenges for healthcare providers. The rationale for studying adolescent gynecological problems lies in the need to understand and address the unique reproductive health challenges faced by young girls. By investigating these issues, researchers and healthcare professionals can develop effective strategies for prevention, early detection, and treatment of gynecological conditions in adolescents. This knowledge is crucial for promoting the overall well-being and reproductive health of young girls, ensuring they receive appropriate care and support during this critical stage of development. This study focuses on identifying the most common gynecological issues in teenagers, exploring the root causes, examining the available treatment options, and understanding how they are managed at a tertiary care facility.  Methods: This cross-sectional observational study took place at a tertiary care center and focused on gynecological issues in adolescent females who sought care at the gynecology department from January 2016 to December 2022. The study participants were categorized into three groups: early adolescence (10-13 years), middle adolescence (14-16 years), and late adolescence (17-19 years) for analysis. Ethical approval was obtained for this hospital-based research, which involved examining, investigating, and treating the study participants.

RESULTS

Out of the 49,700 new female patients, 2000 (4.02%) fell within the specified age range. The average age of the participants was 16.87±2.16, and the majority of them sought help for menstrual issues (63.45%), followed by abdominal discomfort (15.6%) and vaginal discharge (7.2%). Menstrual disorders were the most common concern, with dysmenorrhea and puberty menorrhagia being prevalent issues. Abdominal pain was caused by various factors, such as urinary tract infections, ovarian tumors, pelvic inflammatory disease, endometriosis, and endometrial tuberculosis. The majority of cases were treated conservatively, with only a small percentage requiring surgical intervention.

CONCLUSION

The significance of early detection and intervention in addressing gynecological issues among adolescents is highlighted in the findings of this research, underscoring the necessity for specialized healthcare services that cater to the specific needs of this demographic. Adolescent gynecology plays a crucial role in safeguarding the reproductive health and overall well-being of young women, emphasizing the importance of seeking assistance proactively.

PCOS in Adolescents-Ongoing Riddles in Diagnosis and Treatment

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. A diagnosis of PCOS is established when a patient exhibits two of three Rotterdam criteria: oligoovulation or anovulation, excess androgen activity, and polycystic ovarian morphology. The pathogenesis of PCOS, as it affects adolescents, is often discussed in terms of a "two-hit" theory. This refers to a stepwise process in which the first "hit" is an inborn congenitally programmed predisposition, while the second "hit" arises from a provocative factor such as insulin resistance. The dynamic physiological and anatomical changes which occur in puberty make for a challenging diagnosis in this group of patients. It is important to be mindful of the physiological particularities in adolescence which often mimic the symptoms of PCOS. In their first-year post-menarche, approximately 75% of menstruating adolescents report their cycle to last between 21-45 days. Recent studies have shown that regular menstrual cyclicity is only achieved within 2-3 years post-menarche. Anovulation, as a crucial diagnostic element for PCOS, features in about half of early-post-menarchal adolescents. Hirsutism and acne are the most common clinical manifestations of hyperandrogenism, and mild features are developed by most adolescents as a result of elevated androgen levels. Distinguishing between a pathological sign and normal features of maturation is often difficult. A polycystic ovarian morphology (PCOM) through ultrasound has been found in up to 40%, 35%, and 33.3% of patients when assessed at 2, 3, and 4 years, respectively, after menarche. PCOM in adolescence is not associated with future abnormalities in ovulatory rate or menstrual cycle duration. For this reason, international guidelines recommend against the use of pelvic ultrasound until 8 years post-menarche. The primary aim of management is focused mainly on improving hormonal and metabolic status, the prevention of future comorbid complications, and generally improving the overall quality of life in young women with PCOS. Considerable controversy surrounds the choice of optimal pharmacological treatment to address PCOS in adolescents. Reliable studies, which include this sub-section of the population, are very limited. There is a lack of robust and reliable trials in the literature addressing the use of combined oral contraceptives. Further work needs to be undertaken in order to provide safe and effective care to the adolescent population in this regard.

Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review

Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions in women. PCOS may be more challenging to diagnose during adolescence due to an overlap with the physiological events of puberty, which are part of the diagnostic criteria in adult women. This review focuses on the evidence available in relation to PCOS diagnostic criteria for adolescents. Adolescent PCOS should be diagnosed using two main criteria irregular -menstrual cycles (relative to number of years post-menarche) and hyperandrogenism (clinical and/or biochemical); after excluding other conditions that mimic PCOS. Accurate definitions of the two main criteria will decrease challenges/controversies with the diagnosis and provide timely diagnosis during adolescence to establish early management. Despite the attempts to create accurate diagnostic criteria and definitions, this review highlights the limited research in this area, especially in the follow up of adolescents presenting with one diagnostic feature that are called “at risk of PCOS”. Studies in adolescents continue to use the Rotterdam diagnostic criteria that uses pelvic ultrasound. This is inappropriate, because previous and emerging data that show many healthy adolescents have polycystic ovarian morphology in the early years post-menarche. In the future, anti-Müllerian hormone levels might help support PCOS diagnosis if adolescents meet two main criteria.

Factors Affecting Menstrual Cycle Developmental Trajectory in Adolescents: A Narrative Review

CONTEXT

The time interval between the age at menarche and regulation of menstrual cycles (menstrual cycle developmental trajectory) is considered an indicator of the function of the reproductive system later in life. This study aimed to summarize the factors affecting this trajectory.

EVIDENCE ACQUISITION

A comprehensive literature search in PubMed, Scopus, Google Scholar, and Web of Science was performed to identify studies investigating factors influencing the regularity of the menstrual cycle in adolescents.

RESULTS

The interval between menarche and the onset of the regular menstrual cycle in adolescent girls may vary from several months to several years. Several factors, including genetic, race/ethnicity, intrauterine situation, social factors, geographical factors, lifestyle, and chronic diseases, are considered the predisposing factors for the trajectory.

CONCLUSIONS

Age at menarche and the onset of regular menstrual cycles are directly and indirectly influenced by several genetic, environmental, and lifestyle factors. Understanding these factors may improve our practice in managing irregular menstrual cycles that commonly happen in the first years after menarche.

A Retrospective Long-Term Study on Age at Menarche and Menstrual Characteristics in 85 Young Women with Transfusion-Dependent β-Thalassemia (TDT)

Background

Menarche is an important milestone in a feminine reproductive life, and regular menstrual cycles reflect normal functioning of the hypothalamic-pituitary-ovarian axis, a vital sign of women’s general health.

Aim of the study

We explored the age at menarche and the following menstrual cycles characteristics among 85 unmarried Transfusion-Dependent β-Thalassemia (TDT) women, born between 1965 and 1995, concerning iron chelation therapy (ICT) with desferrioxamine (DFO) and nutritional status, assessed by body mass index (BMI).

Results

53 adolescents who had begun ICT before the age of 10 years experienced menarche at 13,7 ± 1,6 years (mean ± DS), whereas 32 who began treatment after ten years experienced menarche significantly later (15.5 ± 1.9 yrs; p: 0.001). At the age of menarche: BMI-Z score (n= 67, −0,09 ±1) was inversely correlated with both age at starting ICT (r = −0,39; p = 0001) and age at menarche (−0,45, p = 0,0001). Serum ferritin levels (SF) were significantly correlated with the age at starting chelation therapy (n = 79; r = 0,34; p = 0,022). In 56 TDT adolescents who developed secondary amenorrhea (SA), the SF levels were significantly higher (4,098 ± 1,907 ng/mL) compared to 23 TDT adolescents with regular menstrual cycles (2,913±782 ng/mL; p = 0,005). Nutritional status of “thinness” at menarche was associated with a lower prevalence of subsequent regular menstrual cycles and a higher prevalence of early SA.

Conclusion

An early ICT in TDT patients was associated with a normal “tempo” of pubertal onset and a higher frequency of subsequent regular menstrual cycles. In TDT patients, who developed SA, a diagnosis of acquired central hypogonadism was made, mainly due to the chronic exposure to iron overload, however other potential causes linked to nutritional status, deficient levels of circulating nutrients, and the chronic disease itself cannot be fully excluded.

An Open Trial of a Mind-Body Intervention for Young Women with Moderate to Severe Primary Dysmenorrhea

OBJECTIVE

To evaluate the feasibility, acceptability, and preliminary efficacy of a mind-body intervention for moderate to severe primary dysmenorrhea (PD).

DESIGN

Open trial (single arm).

SETTING

Academic medical school.

SUBJECTS

A total of 20 young adult women with moderate to severe primary dysmenorrhea were included across four separate intervention groups.

METHODS

All participants received five 90-minute sessions of a mind-body intervention and completed self-report measures of menstrual pain, depression, anxiety, somatization, and pain catastrophizing at baseline, post-treatment, and at one-, two-, three-, and 12-month follow-up. Self-report of medication use and use of skills learned during the intervention were also collected at all follow-up points.

RESULTS

Participants reported significantly lower menstrual pain over time compared with baseline. No changes in anxiety, depression, or somatization were observed, although pain catastrophizing improved over time. Changes in menstrual pain were not associated with changes in medication use or reported use of skills.

CONCLUSIONS

A mind-body intervention is a promising nondrug intervention for primary dysmenorrhea, and future research should focus on testing the intervention further as part of a randomized clinical trial.

Menstrual Cycle Patterns and the Prevalence of Premenstrual Syndrome and Polycystic Ovary Syndrome in Korean Young Adult Women

Menstruation is one of the important indicators of reproductive health. Therefore, in order to improve the reproductive health of women in puberty and early adulthood, it is necessary to investigate menstrual health and symptoms. This cross-sectional descriptive correlational study was conducted to identify young women’s menstrual cycle patterns, prevalence of Premenstrual Syndrome (PMS), Polycystic Ovary Syndrome (PCOS) and the relationships of health-related factors according to menstrual regularity and PCOS. 462 women participated in the first phase of the study and completed the menstrual health and health-related behaviors questionnaire. In the second phase, 88 women with irregular menstruation in phase one had blood tests taken and body composition measured. As a result, Menarche was slightly later in irregular menstruation group. Women with regular menstruation had a mean number of 11.7 menstrual cycles over the past year, 93.0% of them reported a normal menstruation cycle frequency (21–35 days), 95.2% reported a normal duration (2–7 days) and 55.9% of participants had heavy menstrual bleeding. In the irregular menstrual group, there were higher percentages of underweight and obese women as well as more women experiences weight and diet changes. The estimated prevalence rates of PMS and PCOS were 25.5%, 5.2% respectively. This study provides updated basic data about menstrual health among Korean young women but more extensive and sophisticated studies are needed in the future.

The levelling-off of the secular trend of age at menarche among Italian girls

OBJECTIVE

The main aim of this study was to verify whether the secular trend stopped in Italy by comparing the results of a 1990-2000 birth cohort versus a 1980-1990 birth cohort of Italian young women. The results were used to speculate about age at menarche as adaptive response to non-genetic factors.

METHODS

In 2016, a study was set on 413, 18-to-26 year-old women (1990-2000 birth cohort) attending two Italian Universities by web-based, self-reported questionnaires. Previously in 2000, a research including 3,783 high school female students (1980-1990 birth cohort) was led. The age at menarche distribution was performed by Kaplan-Meier analysis. The comparison between the findings of the two birth cohorts was performed by Wilcoxon sum-rank test. Mixed models analysis was applied to evaluate the effect of cohort and socio-economic status on age at menarche.

RESULTS

1990-2000 cohort's age at menarche median was 12.44y (95%CI 12.37; 12.59y). There was no significant difference with age at menarche of the previous cohort (p = 0.56). Consistently, the advance of age at menarche in comparison to the mothers' one was not significantly different between the two cohorts (-0.27y±0.10y vs -0.25y±0.03y, p = 0.33). The socio-economic level was not significantly associated with menarcheal age.

CONCLUSIONS

The findings of this study confirm that, like in other developed countries, the advance of age at menarche has stopped in Italy, consistently with the stop of the improvement of socio-economic conditions. Further studies are needed to explore the differential effect of each non-genetic factor to outline future scenarios of human sexual maturation.

TRIAL REGISTRATION

the Comitato Etico per la Sperimentazione Clinica (CESC) della Provincia di Padova of the Veneto Region (Italy), n°3993/U16/16.

Age at Menarche in Women With Bipolar Disorder: Correlation With Clinical Features and Peripartum Episodes

BACKGROUND

Bipolar disorder (BD) is related to reproductive cycles. However, findings on putative correlation between age at menarche and course of BD are particularly scarce and conflicting. The aim of the present study is to analyze the relationship between age at menarche and characteristics of BD, including comorbid medical conditions and peripartum mood episodes.

METHODS

The study sample consists of 288 women with BD type I, II, or not otherwise specified (NOS). Age at menarche was both considered as a continuous variable and categorized into three groups: early menarche (≤11 years), normal menarche (12-14 years), and late menarche (≥15 years). The study focused on two sets of comparisons, by age at menarche and women with vs. without children. Spearman correlation matrix was produced to calculate correlations between the variables of interest. Socio-demographic and clinical characteristics between early, normal and late menarche, and women with vs. without children were examined through descriptive statistics. Finally, adjusted logistic regression analysis was run to examine the association between variables.

RESULTS

Out of 288 women included in the study, 21.5% had early menarche, 55.6% had normal, and 22.9% had late menarche. Women with early menarche had higher rates of metabolic syndrome compared to women with normal menarche even after adjustment for age. The subgroup of women with children does not present clinical differences compared to women without children except a lower rate of psychiatric comorbidities. At least one mood episode with peripartum onset occurred in 29.6% of the women with children. After controlling for confounding variables, women with late menarche were associated with lower probability of BD peripartum episodes compared to women with normal menarche.

CONCLUSION

Age at menarche may be related to specific characteristics of women with BD. The results deserve to be deepened in further studies.

Socioeconomic factors and lifestyle affecting the variability of menstrual cycle characteristics in women from Central Poland

Regularity, length of the cycle and duration of menstrual flow are a reflection of women health. The purpose of the research was to assess the relationships between socioeconomic status, cycle length, duration of menses, regularity and dysmenorrhea. A survey was conducted among 896 healthy women from Łódź and Warsaw (Poland), aged 15.71–26.98. Women who were menarche at least 3 years ago were asked to complete the survey. Women were asked about cycle length (number of days), duration of menstrual flow, regularity of the cycle, dysmenorrhea, birth place, parental education level, attendance at physical education classes, participation in additional sports activities, self-assessment of stress levels at home and at school/university, and smoking. For data analysis, t-test, analysis of variance, and chi-square were used, and p<0.05 was considered to be statistically significant. There were no significant relationships between the mean cycle length, regularity and the environmental factors, except for differences in the average length of the menstrual cycle in women from Łódź who attend additional sports activities. Women who are more physically active are characterized by a shorter menstrual cycle. In terms of the length of the menstrual flow, daughters of better educated fathers were characterized by longer menses. In contrast, dysmenorrhea was associated with longer menstrual periods and longer menstrual bleeding, as well as with higher levels of stress, both at home and at school. Environmental factors affected the features of menstruation cycles in women from Central Poland.

The relationship between the duration of menstrual bleeding and obesity-related anthropometric indices in students

BACKGROUND

Many women of childbearing age suffer from problems such as dysmenorrhea and irregular menstruation.

OBJECTIVES

The objective of the study is to determine the relationship between the duration of menstrual bleeding and obesity-related anthropometric indices in students.

METHODS

This cross-sectional study was carried out on 250 students in 2016. Data were collected by a questionnaire composed of: 1) demographic information, 2) information concerning menstrual cycle and 3) obesity-related anthropometric parameters. Anthropometric parameters include height, weight, waist circumference, hip circumference, and arm circumference. Independent t-test, Pearson correlation coefficient, and multiple linear regressions with backward strategy were used.

RESULTS

The average age of students was 21/295 (±1/585) years. For most participants, the duration of menstrual bleeding was 3-7 days (87/2%, 218 people). None of the participants had menstrual bleeding <3 days, and the duration of bleeding was >7 days for 32 participants (12/800%). A significant relationship was observed between the intervals of menstruation and the waist-to-hip ratio (r = 0/136, P < 0/041). Based on multiple linear regression, hip circumference and waist-to-weight, hip-to-waist, arm-to-weight, hip-to-thigh, and arm-to-height ratios are predictors for menstrual duration.

CONCLUSIONS

In this study, a significant association was found between the anthropometric indices and menstrual characteristics. These findings suggest the need for modifying anthropometric indicators to control menstrual cycle problems.

Dysmenorrhoea among students aged 18-45 years attending University in Uganda: A cross-sectional multicenter study of three Universities in Uganda

AIM

Dysmenorrhoea presents as pain associated with menstruation. It is often an issue discussed privately, yet it continues to affect girls and women with grave impact on their education, social activities and work. This study sought to assess the factors associated with dysmenorrhoea among female students aged 18-45 years in three selected universities in Kampala Capital city, Uganda.

DESIGN AND METHODS

The study was a cross-sectional study conducted among 351 female students of three Universities in Kampala, Uganda. Purposive sampling methods were used. A self-administered questionnaire was used for data collection, a 95% confidence interval was considered and analysis was done using SPSS version 20.

RESULTS

Respondents (N = 351) fully completed the study out of 383 invited participants. The prevalence of dysmenorrhoea was 75.8%. Associated factors included having children (p < 0.05), daily consumption of sugary foods (p < 0.05) and family history of dysmenorrhoea (p < 0.01).

CONCLUSION

As nursing professionals, we believe comfort is a fundamental determinant of health. Therefore, evidence suggesting a high prevalence of dysmenorrhoea as revealed in this study is concerning. We recommend schools to have school clinics and school nurses who could help students during such days of discomfort. Further studies assessing the casual relationships of various correlates to dysmenorrhoea and the impact of dysmenorrhoea specifically on academic life of the students should be conducted.

Age at Menarche and Menstrual Abnormalities in Adolescence: Does it Matter? The Evidence from a Large Survey among Italian Secondary Schoolgirls

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.

Parametric survival analysis of menarche onset timing among Nigerian girls

BACKGROUND

This study was a response to the dearth of information on the timing of menarche in low-income countries, and the need to update knowledge on the condition. It thereby enables the provision of adequate support to young girls during menarche. The study determined the timing and range of onset of menarche and identified the factors influencing the timing.

METHODS

We used data on girls' sexual and reproductive processes from a nationally representative population survey of girls aged 15-24 years in Nigeria. Descriptive statistics, and survival analysis techniques were used for data analysis at p = 0·05.

FINDING

A quarter of the respondents (26%) had commenced menstruation by age 12. Almost all, (90%) had experienced menstruation by age 17. Girls aged 20-24 years reported later menarche (time ratio 1·066, 95% CI: 1·045-1·087) compared to those aged 15-19 years. An increase of respondents age by one year resulted in 0·8% delay in onset timing. Significant differences were also found in the zone of residence among the sampled population. Compared with girls from the South East, the timing of menstruation was generally delayed among the girls from South-South by 5%, North Central by 9%, South West by 10%, North East by 16% and 17% among girls from the North West.

INTERPRETATION

There was a wide range in menarcheal age in Nigerian girls with a peak at 13-14 years and the possibility of a secular trend in the timing of onset. Early family life education is recommended.

Menarche, menstrual problems and suicidal behavior in Chinese adolescents

BACKGROUND

Menarche is the first menstrual cycle. Menstrual problems, such as dysmenorrheal menorrhagia, oligomenorrhea, and irregular cycle are common in female adolescents. This research aims to examine the associations between age at menarche and menstrual problems and suicidal behavior among Chinese female adolescents.

METHODS

An epidemiological survey of 5831 female adolescents from eight high schools of three counties of Shandong province, China, was conducted. A self-administered paper-and-pencil questionnaire was used to collect information. Logistic regression analyses were used to examine the association between menstruation and suicidality.

RESULTS

The mean age of the sample was 15.02 (SD=1.44) years. Of the sample, 5,231 (90.0%) had experienced their first menstrual cycle, and 23.2%, 10.4%, and 4.5% of the sample reported having had suicidal ideation, plan and attempt, respectively. In multivariate models, menarche at ≤11 years was associated with increased risk of suicidal ideation (OR=1.41, 95%CI: 1.10-1.81) and menarche at 12 years was associated with suicide plan (OR=1.23, 95%CI: 1.00-1.51). Irregular menstrual cycle was significantly associated with increased risk of suicidal ideation (OR=1.40, 95%CI: 1.05-1.86) and menstrual period less than or equal to 4 days was significantly associated with increased risk of suicide plan (OR=1.32, 95%CI: 1.06-1.66).

LIMITATIONS

This cross-sectional study cannot establish the causal directions between menstrual problems and suicidality in adolescents.

CONCLUSIONS

Our study suggests that earlier menarche, irregular menstrual cycle and short menstrual period are associated with suicidal behavior in female adolescents. Further research is warranted to examine the causal relationship between menstrual problems and suicidal behavior in adolescents.

Age at menarche predicts age at onset of major affective and anxiety disorders

BACKGROUND

Menarche age has been associated inconsistently with the occurrence, timing or severity of major depressive disorder (MDD), but rarely studied in women with bipolar (BDs) or anxiety disorders.

METHODS

We investigated women patients at a Sardinian mood disorder center for associations of age at menarche with age at illness onset for major affective or anxiety disorders, year of birth, and other selected factors, using bivariate comparisons and multivariate regression modeling.

RESULTS

Among women (n=1139) with DSM-IV MDD (n=557), BD-I (n=223), BD-II (n=178), or anxiety disorders (n=181), born in 1904-1998, of mean age 42.9 years, menarche age averaged 12.8 [CI: 12.7-12.9] years. Illness onset age averaged 30.9 [30.1-31.8] years, ranking: BD-I, 25.8; anxiety disorders, 28.0; BD-II, 30.3; MDD, 34.1 years. Menarche age declined secularly over birth years, and was associated with younger illness-onset, having no or fewer siblings, more psychiatrically ill first-degree relatives, living in rural environments, being suicidal, substance abuse, and being unemployed. Earlier menarche and earlier illness-onset were significantly associated for onset age groups of ≤ 20, 20-39, and > 40 years. Menarche age versus diagnosis ranked: BD-II<BD-I<anxiety disorders<MDD.

CONCLUSIONS

Age at menarche in Sardinia, as elsewhere, has declined over the past decades. It was strongly associated with age at onset of bipolar and anxiety, as well as major depressive disorders across the age range, suggesting sustained effects of biological maturational factors.