The effect of early menarche on the sexual behaviors of Korean female adolescents

The sexual and reproductive health covariates of early menarche among adolescent girls

INTRODUCTION

Research suggests that girls who reach menarche at an early age are at greater risk for negative sexual and reproductive health (SRH) outcomes than their later-maturing counterparts, but very little research has examined this issue in sub-Saharan Africa, especially in West Africa. The goal of the current study was to determine whether early menarche was associated with any SRH outcomes in a sample of Ghanaian girls.

METHODS

The study data were drawn from the baseline assessment of a longitudinal study involving two age cohorts (13-14 and 18-19 years) of 700 adolescent girls from Ghana. Logistic regressions were used to assess the association between early menarche (before age 13) and seven SRH outcomes (adolescent sexual activity, early sexual initiation, inconsistent condom use, transactional sex, sexual violence, multiple sexual partners, and adolescent pregnancy).

RESULTS

Early menarche was significantly associated with adolescent sexual activity (odds ratio [OR] = 6.4; 95% confidence interval [CI] 2.1-19.7), and sexual violence (OR = 3.2; 95% CI 1.6-6.2) in the younger cohort and early sexual initiation (OR = 3.2; 95% CI 1.19-8.61) and multiple sexual partners (OR = 3.7; 95% CI 1.39-9.87) in the older cohort. Early menarche was also associated with transactional sex and teen pregnancy in the full sample.

CONCLUSIONS

These findings suggest the need for special attention to the needs of early-maturing girls in SRH programming. Interventions are needed to delay adolescent sexual activity in girls with early menarche. Efforts to prevent sexual violence among adolescent girls in Ghana may benefit from targeting and addressing the specific needs of early-maturing girls.

Prevalence and factors associated with medication adherence in children with central precocious puberty: a cross-sectional study

Objectives: This study aimed to investigate the prevalence and influencing factors of medication adherence in children with central precocious puberty (CPP), and provide references for clinical practice. Methods: Children under 12 years of age with CPP and their caregivers at a women's and children's hospital were selected for a cross-sectional study from February to May 2023, and a questionnaire was used to collect basic characteristics of pediatric patients and their caregivers, information of medication, cognition of medication, and medication adherence. The 8-item Morisky Medication Adherence Scale (MMAS-8) was adopted to assess medication adherence, and the potential influencing factors were explored by univariate and multivariate analyses. Results: A total of 125 valid questionnaires were collected. The medication adherence rate of children with CPP reported by caregivers was 76.0%. The univariate analysis showed that the percentage of parental caregivers (p = 0.027), the age of caregivers (p = 0.029), the education level of caregivers (p = 0.001), the financial burden (p < 0.000), the incidence of adverse effects (p = 0.008), and the cognition of medication including the importance of medication (p = 0.002), the dosage of medication (p = 0.002), the adverse effects of medication (p = 0.007), the harm of non-compliance with medication (p < 0.000), and the evaluation of the price of medication (p = 0.003) in the poor adherence group were significantly inferior to those in the better adherence group. The multivariate analysis showed that the higher incidence of adverse effects (p = 0.20), not understanding the harm of non-compliance with medication (p = 0.004), and evaluation of the price of medication as expensive (p = 0.043) were independent risk factors for poor medication adherence. Conclusion: Medication adherence in children with CPP is relatively better, and the factors leading to poor medication adherence are mainly on the caregivers of pediatric patients. It is recommended to increase the health education among caregivers of children with CPP to enhance the cognition of the condition and medication, and further improve the therapeutic efficacy for CPP.

Exploring the effect of early menarche on sexual violence among adolescent girls and young women in southeastern Ghana: a longitudinal mediation analysis

Research from several high-income countries links early menarche with an increased risk for sexual violence. However, the role of early menarche in adolescent girls' and young women's sexual violence risk in sub-Saharan Africa, where sexual violence rates are high, is not well understood. The current study explores the association between early menarche and sexual violence in Ghana with secondary analysis of data collected from 700 adolescent girls and young women followed over three years. Logistic regressions were used to assess the cross-sectional association between early menarche and sexual violence. Generalised estimating equations were used to assess whether the association between early menarche and sexual violence persisted over time. Inverse odds weighting was used to test potential mediators of the association between early menarche and sexual violence. Sexual violence was fairly common in the study sample, with 27% reporting having experienced sexual violence at baseline, and approximately 50% at year three. Early menarche was associated with 72% greater odds of having experienced sexual violence at baseline (95% confidence interval: 1.01-2.93). However, the odds ratio attenuated and lost significance over the three-year study period, with a lower risk of sexual violence among girls with early menarche at year three. Neither child marriage nor early sexual initiation significantly mediated the association between early menarche and sexual violence. The findings suggest that early-maturing girls may be particularly vulnerable to sexual violence in early adolescence, thus necessitating prevention interventions around the time of menarche to reduce the risk for sexual violence.

Dose inhibin B or anti-Müllerian hormone relate to precocious puberty in girls? result of a systematic review and meta-analysis

BACKGROUNDS

Existing studies have investigated the relationship between the levels of serum inhibin B (INHB), anti-müllerian hormone (AMH) and precocious puberty in girls, but the results are inconsistent.

OBJECTIVE

The aim of this meta-analysis was to assess whether the INHB and AMH levels changed in girls with precocious puberty relative to healthy controls.

METHODS

PubMed, Embase, Cochrane Library and Web of Science were searched through June 2022. We included observational clinical studies reporting the serum levels INHB and AMH in girls with precocious puberty. Conference articles and observational study abstracts were included if they contained enough information regarding study design and outcome data. Case series and reports were excluded. An overall standard mean difference (SMD) between precocious puberty and healthy controls was estimated using a DerSimonian-Laird random-effects model.

RESULTS

A total of 11 studies featuring 552 girls with precocious puberty and 405 healthy girls were selected for analysis. The meta-analysis showed that the INHB level of precocious puberty [including central precocious puberty (CPP) and premature the larche (PT)] were significantly increased. While there was no significant association between precocious puberty [including CPP, PT, premature pubarche (PP) and premature adrenarche (PA)] and the level of serum AMH.

CONCLUSION

Scientific evidence suggested that the INHB level, but not the AMH level, altered in girls with precocious puberty compared with healthy controls. Through our results we think that INHB level might be a marker for the auxiliary diagnosis of precocious puberty (especially CPP and PT). Therefore, it is important to evaluate and thoroughly investigate the clinical indicators (e.g., INHB) in order to ensure early diagnosis and medical intervention, and the risk of physical, psychological and social disorders in immature girls with precocious puberty is minimized.

A study on the reliability and validity of the Korean version of the parenting outcome expectancy scale for parents of elementary school students

Introduction

Many parents do not engage in active discussions with their children about sexuality. This can contribute to negative sexual and reproductive health outcomes among youth. To foster a healthy environment for sexual activity, it is crucial for parents to provide comprehensive sex education to their children at home. This study aims to cross-culturally adapt and evaluate the psychometric properties of a Korean version of the Parenting Outcome Expectancy Scale to measure the sexual communication abilities of parents of elementary school students in South Korea.

Method

The study participants were parents of elementary school students between 6 to 13 years old. We used exploratory and confirmatory factor analyses to examine the reliability and validity of the 23-item Korean version of the Parenting Outcome Expectancy Scale.

Results

The study confirms the reliability and validity of the scale, comprising five factors and 22 items, for the evaluation of the outcome expectancy of communication about sex between parents and their children. Results also demonstrate that talking about sex is still a challenge for many parents.

Discussion

This instrument can help parents prepare for sex communication with their children and for sexual education, potentially yielding a positive effect on children's sexual health and parental satisfaction.

Leuprolide and triptorelin treatment in children with idiopathic central precocious puberty: an efficacy/tolerability comparison study

Introduction

Central precocious puberty (CPP) results from premature activation of hypothalamic-pituitary-gonadal axis, with the consequent increase of gonadotropin-releasing hormone (GnRH); GnRH agonists (GnRHa) represent the gold-standard therapy in children with CPP although their use might be responsible for pituitary GnRH receptors down-regulation, that in turn suppresses luteinizing hormone (LH) and follicle stimulating hormone (FSH) and blocks of gonadal sex hormones release. The most prescribed GnRHa in the clinical practice are leuprolide and triptorelin, whose use is generally safe and well tolerated; however, mild menopausal-like side effects could appear. The aim of the present study was to investigate and compare the efficacy and tolerability profile of leuprolide and triptorelin in CPP patients.

Methods

110 girls affected by CPP were enrolled in this retrospective study, carried out from 2018 to 2020. The enrolled patients received leuprolide (n = 48) or triptorelin (n = 62). Efficacy was investigated by the means of clinical parameters and radiological changes and side effects were also recorded to evaluate the possible relationship between the two GnRHa treatments and side effects appearance.

Results

At baseline triptorelin patients had significantly higher LH and LH peak levels than leuprolide patients, whereas no significant difference in other patient characteristics was observed between the two groups. The leuprolide treatment lasted 971 days [790-1,171 days] while the duration of triptorelin administration was 792 days [760-1,003 days] (p < 0.001). Overall 46 (41.8%) of the studied patients reported mild menopausal-like symptoms: among these 27 were treated with triptorelin and 19 with leuprolide (p = 0.558). Patients treated with triptorelin, or leuprolide showed headache (27.4% vs. 16.7%), mood swings (12.9% vs. 16.7%), increased appetite (12.9% vs. 18.8%) and nausea (1.6% vs. 10.4%) respectively. Moreover, the onset of side effects appearance related to GnRHa therapy significantly reduces with the increase of the initial bone age (p = 0.038).

Conclusion

Leuprolide and triptorelin treatment appear to be effective and safe without significant difference between the two drugs in term of efficacy and tolerability, making both good options for treating CPP.

Obesity-Related Factors in Adult Women with Early Menarche

The average menarche age among South Korean women has decreased over time. Early menarche in women causes a higher incidence of obesity owing to the continuous fat accumulation induced by prolonged exposure to estrogen and adrenal steroids. Identifying the factors affecting obesity in women who experience early menarche is essential for managing obesity in adult women. This study aimed to analyze the factors associated with obesity in adult women who experienced early menarche and to provide basic data for obesity management. This study was a cross-sectional and descriptive survey from the seventh Korea National Health and Nutrition Examination. A total of 371 women aged ≥ 19 years experienced early menarche, and the propensity matching method was used to analyze the obesity-related factors identified in previous studies. The results showed that obesity in adult women with early menarche was negatively associated with the level of aerobic exercise (OR = 0.53, 95% CI = 0.30-0.93, p = 0.028) and muscle-strengthening exercise (OR = 0.33, 95% CI = 0.17-0.64, p = 0.001). Future longitudinal studies on girls who experience early menarche are needed to address female obesity prevention at every stage of life, and, based on these findings, obesity management programs can be developed and applied and their effectiveness determined.

Sexual Orientation and Age at Menarche in Three U.S. Longitudinal Cohorts

PURPOSE

The aim of this study is to examine age at menarche across sexual orientation groups.

METHODS

Data were obtained from 131,090 female participants, born 1947-2001, in 3 longitudinal studies-the Growing Up Today Study and Nurses' Health Study 2 and 3. We estimated the association between sexual orientation and age at menarche using regression models adjusted for age, race/ethnicity, birthweight, height, and body mass index.

RESULTS

Compared to heterosexual participants, sexual minorities were younger at menarche. Sexual minorities were more likely to have early menarche (≤11 years) and less likely to have late menarche (≥14 years) compared to heterosexual girls. As an example of this pattern, Nurses' Health Study 3 bisexual participants were >30% more likely than heterosexuals to have early versus average menarche (odds ratio 1.37, 95% confidence interval 1.09-1.72).

CONCLUSION

Sexual minority girls have a younger age at menarche than heterosexual girls and may benefit from screening for adverse outcomes associated with early menarche.

Determinants Factors of High-risk Sexual Behavior Pregnancy among Adolescent in Indonesia

BACKGROUND: The vulnerability of adolescent lifestyles, especially sexual behavior among adolescents, which causes an increase in pregnancy and early marriage. AIM: This study aimed to analyze the determinants of high-risk sexual behavior among adolescents in Indonesia. METHODS: A correlational analytic research design was used with a cross-sectional approach using secondary data for the 2017 Indonesian demographic and health survey data (IDHS). The data collection was carried out through filling in the instruments developed by the 2017 IDHS. The data were analyzed using percentages, Chi-square test, and logistic regression. The study population was all adolescents, totaling 9,971 women and 12,612 single men aged 15–24 and living in Indonesia in the 2017 IDHS. The sampling technique used total sampling. Time of research: August-November 2020. Place: research locations in 34 provinces in Indonesia. RESULTS: In male respondents, it was shown that the factors most influencing high-risk sexual behavior in adolescents were age (p = 0.000), knowledge (p = 0.003), place of residence (p = 0.000), discussion before wet dreams (p = 0.000), age at first wet dream (p = 0.000), age at first dating (p = 0.019), and internet usage (p = 0.000). Meanwhile, female respondents indicated that the most influential factors were age (p = 0.000) and place of residence (p = 0.032). CONCLUSION: Boys have many factors that influence high-risk sexual behavior than girls. Information on determinant factors of high-risk adolescent sexual behavior can be used as a basis for developing policies for developing interventions in solving problems of premarital pregnancy due to high-risk sexual behavior among adolescents.

Early menarche and its consequence in Korean female: reducing fructose intake could be one solution

The mean age at menarche (AAM) of Korean females has been rapidly decreasing over the last 50 years; currently, the prevalence of early menarche (<12 years) is 22.3%. Female adolescents who experience early menarche are known to be at greater risk of psychosocial and behavioral problems along with several physical health problems such as menstrual problems. They also tend to achieve a shorter final height and develop obesity. Population-based Korean studies have shown a strong association between early menarche and the risk of obesity, insulin resistance, metabolic syndrome, nonalcoholic fatty liver disease, diabetes, breast cancer, and cardiovascular disease in adulthood. Although the exact mechanism of how early menarche causes cardiometabolic derangement in later adulthood is unknown, childhood obesity and insulin resistance might be major contributors. Recent studies demonstrated that an excessive consumption of fructose might underlie the development of obesity and insulin resistance along with an earlier AAM. A positive association was observed between sugar-sweetened beverages (a major source of fructose) intake and obesity, metabolic syndrome, insulin resistance, and cardiometabolic risk in Korean females. In pediatrics, establishing risk factors is important in preventing disease in later life. In this regard, early menarche is a simple and good marker for the management of cardiometabolic diseases in adulthood. Decreasing one's fructose intake might prevent early menarche as well as the development of obesity, insulin resistance, and cardiometabolic diseases.

Gynaecology problems in puberty

With the onset of puberty a range of problems may be encountered by the young girl. Some of these include a range of gynaecological issues relating to delayed onset of puberty, delayed menarche, atypical pubertal changes and the identification of anomalies of the genital tract. The distinction between physiological events and pathological problems is important to avoid unnecessary distress and anxiety. The onset of cyclic hormonal changes also provokes a number of "non-gynaecological" problems - where the link to cyclic hormonal events is often overlooked and an important opportunity to potentially intervene and assist is missed. From a global perspective there are a range of problems that are particularly encountered with the onset of puberty including the risks of sexual violence, which in the setting of having achieved the age of reproductive potential result in unplanned pregnancies, unsafe abortions and adolescent pregnancy all of which pose life threatening risks. Sex education in its broadest sense is important for all young people. Access to contraception for adolescents is vital, such that clinicians across all streams of health care who are involved in the care of young people should take the opportunity to educate and provide this care.

Does exposure to PM10 decrease age at menarche?

BACKGROUND

There has been a consistent decrease in age at menarche in South Korea. A potential risk factor for early menarche is exposure to particulate matter (PM), because endocrine-disrupting compounds emitted into air from anthropogenic sources may be incorporated into PM. The objective of this study was to examine the association between pre-menarcheal exposure to PM ≤ 10 μm in diameter (PM₁₀) and age at menarche in adolescents of South Korea using Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012 data.

METHODS

We used self-reported age at menarche of 639 girls aged 13-17 years in this study. The cut-off age for early menarche was set to 12 years. Based on each subject's address, 1-year, 2-year, and 3-year averages of annual mean PM₁₀ concentrations (models 1-3) were linked to KNHANES. Models were adjusted for body mass index (BMI), city size, household income level, maternal age at menarche, and second-hand smoke exposure at home. SURVEYREG and SURVEYLOGISTIC procedures were used to address the complex survey design of KNHANES.

RESULTS

Overall analysis showed that exposure to PM₁₀ has a significant effect on decreasing age at menarche. Multiple linear regression results suggested that each 1 μg/m³ increase in 1-year, 2-year, 3-year averages of annual mean PM₁₀ concentrations accelerated age at menarche by 0.046 years (95% CI: -0.064, -0.027; p < .0001), 0.038 years (95% CI: -0.059, -0.018; p = 0.0003),and 0.031 years (95% CI: -0.047, -0.015; p = 0.0002), respectively. Adjusted ORs for a 1 μg/m³ increase in PM₁₀ concentration were 1.08 (95% CI: 1.04 -1.12) for model 1, 1.06 (95% CI: 1.02 -1.10) for model 2, and 1.05 (95% CI: 1.01 -1.09) for model 3.

CONCLUSION

Our findings suggest that elevated PM₁₀ concentration can decrease age at menarche. This is the first study that investigates the association between exposure to PM₁₀ and age at menarche using a nationally representative sample of Koreans.

Serum Anti-Müllerian Hormone Levels in Precocious Puberty Girls according to Stage of GnRH Agonist Treatment

Few studies have investigated the long-term effects of gonadotropin-releasing hormone (GnRH) agonist treatment on the reproductive function of central precocious puberty (CPP) girls. In this cross-sectional study, we assessed the ovarian function by analyzing the serum anti-Müllerian hormone (AMH) levels of CPP girls. Our study included 505 CPP girls subdivided into 5 groups according to the GnRH agonist treatment stage: group A (before treatment, n = 98), group B (3 months after initiation, n = 103), group C (12 months after initiation, n = 101), group D (24 months after initiation, n = 101), and group E (6 months after discontinuation, n = 102). We compared the serum AMH levels of the CPP girls with those of 100 bone age-matched controls (before treatment: n = 55; after discontinuation: n = 45). At baseline, the mean AMH level of the CPP girls was 5.9 ± 3.6 ng/mL. The mean AMH level after 3 months of the GnRH agonist treatment was lower (4.7 ± 3.2 ng/mL, P = 0.047) than that at baseline and recovered after 12 months of treatment. Six months after discontinuation, the AMH levels were similar to those at pre-treatment. Before and after the GnRH agonist treatment, the AMH levels were similar to those of the bone age-matched controls. In the precocious puberty girls, the AMH levels based on the GnRH agonist treatment stage were all within the normal reference range. The results of this study suggest that GnRH agonist treatment has no adverse effects on the reproductive function.

Effects of early menarche on physical and psychosocial health problems in adolescent girls and adult women

The menarcheal age of Korean women has been rapidly decreasing for the last 50 years, and the average menarcheal age of women born in the 1990s is approaching 12.6 years. In addition, interest in early puberty has been increasing recently owing to the rapid increase in precocious puberty. Generally, out of concern for short stature and early menarche, idiopathic central precocious puberty in female adolescents is treated with gonadotropin-releasing hormone analogs. Studies to date have described the association between early menarche and psychosocial problems such as delinquency and risky sexual behavior, as well as physical health problems such as obesity, diabetes, cardiovascular diseases, and breast cancer throughout the lifespan of women. However, the pathophysiological mechanism underlying this association has not been clarified thus far. In this article, we review and discuss the existing literature to describe the current understanding of the effects of early menarche on the physical and psychosocial health of adolescent girls and adult women.