Age at menarche and racial comparisons in US girls

BACKGROUND

Concern regarding change in the onset of sexual maturation of US girls has increased the need for current information on age at menarche from a national sample. Previous reports have been sparse and interpretation has been limited because of the racial composition and ages of the samples.

OBJECTIVE

The objectives of this study were to estimate the distribution of age at menarche for all US girls and for non-Hispanic white, black, and Mexican American girls in the Third National Health and Nutrition Examination Survey and to test for racial differences.

DESIGN

Menstrual status data were collected from 2510 girls aged 8.0 to 20.0 years. The Third National Health and Nutrition Examination Survey followed a complex, stratified, multistage probability cluster design. SUDAAN was used to calculate proportions of girls reaching menarche at an age. Ages at menarche were estimated by probit analysis at the ages at which 10%, 25%, 50%, 75%, and 90% of the girls attained menarche.

RESULTS

Less than 10% of US girls start to menstruate before 11 years, and 90% of all US girls are menstruating by 13.75 years of age, with a median age of 12.43 years. This age at menarche is not significantly different (0.34 years earlier) than that reported for US girls in 1973. Age at menarche for non-Hispanic black girls was significantly earlier than that of white girls at 10%, 25%, and 50% of those who had attained menarche, whereas Mexican American girls were only significantly earlier than the white girls at 25%.

CONCLUSION

Overall, US girls are not gaining reproductive potential earlier than in the past. The age at menarche of non-Hispanic black girls is significantly earlier than that of non-Hispanic white and Mexican American girls.

Risk factors for body dissatisfaction in adolescent girls: a longitudinal investigation

Because few prospective studies have examined predictors of body dissatisfaction--an established risk factor for eating disorders--the authors tested whether a set of sociocultural, biological, interpersonal, and affective factors predicted increases in body dissatisfaction using longitudinal data from adolescent girls (N = 496). Elevated adiposity, perceived pressure to be thin, thin-ideal internalization, and social support deficits predicted increases in body dissatisfaction, but early menarche, weight-related teasing, and depression did not. There was evidence of 2 distinct pathways to body dissatisfaction--1 involving pressure to be thin and 1 involving adiposity. Results support the contention that certain sociocultural, biological, and interpersonal factors increase the risk for body dissatisfaction, but suggest that other accepted risk factors are not related to this outcome.

Early age at menarche associated with cardiovascular disease and mortality

CONTEXT

The relationship between age at menarche and cardiovascular disease remains unclear. Two recent studies found an inverse association between age at menarche and all-cause mortality.

OBJECTIVE

The aim of this study was to examine the relationship between age at menarche and cardiovascular disease risk factors, events, and mortality.

DESIGN, SETTING, AND PARTICIPANTS

A population-based prospective study involving 15,807 women, aged 40-79 yr in 1993-1997 and followed up to March 2007 for cardiovascular disease events (median follow-up 10.6 yr) and February 2008 for mortality (median follow-up 12.0 yr) was used.

MAIN OUTCOME MEASURES

Odds ratios for cardiovascular disease risk factors and hazard ratios for incident cardiovascular disease and mortality were calculated.

RESULTS

There were 3888 incident cardiovascular disease events (1323 coronary heart disease, 602 stroke, and 1963 other) and 1903 deaths (640 cardiovascular disease, 782 cancer, and 481 other) during follow-up. Compared with other women, those who had early menarche (<12 yr) had higher risks of hypertension [1.13 (1.02-1.24)], incident cardiovascular disease [1.17 (1.07-1.27)], incident coronary heart disease [1.23 (1.06-1.43)], all-cause mortality [1.22 (1.07-1.39)], cardiovascular disease mortality [1.28 (1.02-1.62)], and cancer mortality [1.25 (1.03-1.51)], adjusted for age, physical activity, smoking, alcohol, educational level, occupational social class, oral contraceptive use, hormone replacement therapy, parity, body mass index, and waist circumference.

CONCLUSIONS

Early age at menarche (before age 12 yr) was associated with increased risk of cardiovascular disease events, cardiovascular disease mortality, and overall mortality in women, and this association appeared to be only partly mediated by increased adiposity.

Hormones and mood: from menarche to menopause and beyond

The lifetime prevalence of mood disorders in women is approximately twice that of men. The underlying causality of this gender difference is not yet understood. There is increasing scientific attention to the modulation of the neuroendocrine system by fluctuating gonadal hormones. This review attempts to summarize our current state of knowledge on the role and potential relevance of estrogen and other sex steroids to psychiatric disorders specific to women from menarche to menopause. The sudden appearance of higher levels of estrogen in puberty alters the sensitivity of the neurotransmitter systems. Moreover, the constant flux of estrogen and progesterone levels throughout the reproductive years portends constant modification of the neurotransmitter systems. Premenstrual syndromes may be the result of an altered activity or sensitivity of certain neurotransmitter systems. Pregnancy and delivery produce dramatic changes in estrogen and progesterone levels as well as significant suppression along the HPA axis, possibly increasing vulnerability to depression. At menopause, estrogen levels decline while pituitary LH and FSH levels increase. The loss of modulating effects of estrogen and progesterone may underlie the development of perimenopausal mood disorders in vulnerable women. The pattern of neuroendocrine events related to female reproduction is vulnerable to change and is sensitive to psychosocial, environmental, and physiological factors. Further research is needed to be able to identify specific genetic markers which might help us better understand how the balance between estrogen, progesterone, testosterone, and other steroid hormones affect neurotransmitter function.

Relative weight and race influence average age at menarche: results from two nationally representative surveys of US girls studied 25 years apart

OBJECTIVES

1) To establish with nationally representative US data whether menarche occurred earlier in the 1990s than it had 25 years before. 2) To assess whether the occurrence of menarche in relation to weight status and race had changed over this time period.

METHODS

Relative weight, race, and menarcheal status of girls in the National Health Examination Survey cycles II and III (1963-1970) were compared with results from the Third National Health and Nutrition Examination Survey (1988-1994). Probit analysis was used to determine the average age at menarche during the 2 survey periods. Logistic regression was used to assess the association of relative weight to likelihood of having reached menarche.

RESULTS

The average age at menarche dropped from 12.75 to 12.54 years, and the percentage of girls between 10 and 15 years old who were above the 85th percentile for body mass index increased from 16% to 27% over the 25 years between the 2 surveys. Higher relative weight was strongly associated with increased likelihood of having reached menarche after controlling for age and race. Black girls had a lower average age at menarche than did white girls, which was independent of the effect of relative weight.

CONCLUSIONS

These analyses from 2 nationally representative samples of US girls suggest a drop of about 2(1/2) months in the average age of menarche during the time period between 1963-1970 and 1988-1994. This was paralleled by a concurrent shift in the population distribution of body mass index z-score toward higher relative weights.

Age at natural menopause in a population-based screening cohort: the role of menarche, fecundity, and lifestyle factors

OBJECTIVE

To verify whether a population-based hypothesis (age at menarche and age at natural menopause have an inverse relationship) also applies at the level of the individual and to investigate what other factors predict age at natural menopause.

DESIGN

Prospective cohort study (the Doorlopend Onderzoek Morbiditeit/Mortaliteit [DOM] project).

SETTING

Prevention Breast Cancer Screening Centre, Utrecht, The Netherlands.

PATIENT(S)

A cohort of 3,756 Dutch women, born between 1911 and 1925, participating in a population-based breast cancer screening program, who experienced a natural menopause. Three samples of women were studied: a sample who did not use oral contraceptives (OCs) (n = 3,347), a sample of OC users (n = 409), and a combined sample of OC users and nonusers (n = 3,756).

MAIN OUTCOME MEASURE(S)

Age at menopause and menarche, fertility patterns, OC use, height, weight, smoking, and demographic variables.

RESULT(S)

No relation was found between age at menarche and age at natural menopause. The total percentage of variance in age at natural menopause explained by multiple regression including all factors was minimal, ranging from 1.3% to 9.7% in OC users. Linear regression analysis indicated a slight secular trend in age at menopause.

CONCLUSION(S)

Frisch's hypothesis could not be corroborated at the individual level. These results suggest that age at menarche and menopause should be treated as independent risk factors for breast cancer. Modification of age at menopause by lifestyle factors (except possibly for OC use) appears minimal.

International variability of ages at menarche and menopause: patterns and main determinants

The purpose of this study was to review published studies on the variability of age at menarche and age at menopause throughout the world, and to identify the main causes for age variation in the timing of these events. We first present a summary table including mean (or median) values of the age at menarche in 67 countries, and of the age at menopause in 26 countries. General linear models showed that mean age at menarche was strongly linked to the mean female life expectancy, suggesting that one or several variables responsible for inequalities in longevity similarly influenced the onset of menarche. A closer examination of the data revealed that among several variables reflecting living conditions, the factors best explaining the variation in age at menarche were adult illiteracy rate and vegetable calorie consumption. Because adult illiteracy rate has some correlation with the age at which children are involved in physical activities that can be detrimental in terms of energy expenditure, our results suggest that age at menarche reflects more a trend in energy balance than merely nutritional status. In addition, we found the main determinant of age at menopause to be the mean fertility. This study thus suggests that, on a large scale, age at menarche is mainly determined by extrinsic factors such as living conditions, while age at menopause seems to be mainly influenced by intrinsic factors such as the reproductive history of individuals. Finally, these findings suggest that human patterns cannot be addressed solely by traditional, small-scale investigations on single populations. Rather, complementary research on a larger scale, such as this study, may be more appropriate in defining some interesting applications to the practical problems of human ecology.

Age at menarche, age at menopause, height and obesity as risk factors for breast cancer: associations and interactions in an international case-control study

The importance of age at menarche, age at menopause, height, and obesity as risk factors for breast cancer, and the possible interactions among these factors in breast cancer causation were investigated in a data set collected in the late 1960's, in an international multicenter case-control study. Multiple logistic regression procedures were used to model data from 3,993 breast cancer cases and 11,783 controls from 7 study centers representing the range of international variation of breast cancer incidence. Height and obesity (measured through the weight/height2 index) were independent risk factors for breast cancer among post-menopausal but not pre-menopausal women; post-menopausal women taller by 10 cm had a 12% higher risk of breast cancer (95% confidence interval, CI, 3-21%) and post-menopausal women of average height (say 158 cm) had an 11% higher risk of breast cancer (CI 7-16%) when they were heavier by 10 kg (and, therefore, more obese by 4 kg/m2). Age at menarche was a risk factor among both pre-menopausal and post-menopausal women, a delay of 2 years corresponding to a 10% reduction in breast cancer risk (CI 6-15%). Age at menopause was also a breast cancer risk factor, women with menopause at each 5 year age difference having a 17% higher risk of breast cancer (CI 11-22%). There is evidence of an interaction (deviation from the logistic regression-postulated multiplicativity) between obesity and age at menarche, implying that the protective effect of late menarche may not apply to overweight women or that late menarche may become detrimental in obese women. The estimated relative risk coefficients, when applied to average risk factor levels observed among control women, can explain only a small fraction of the difference in breast cancer incidence between Boston and Tokyo.

Relation of age at menarche to race, time period, and anthropometric dimensions: the Bogalusa Heart Study

OBJECTIVE

To assess secular trends in menarcheal age between 1973 and 1994 and to determine whether childhood levels of height, weight, and skinfold thicknesses can account for racial (white/black) differences in menarcheal age.

METHODS

Data from 7 cross-sectional examinations of school-aged children, with menarcheal age obtained through interviews, were used for both cross-sectional (11 218 observations) and longitudinal (n = 2058) analyses. In the latter analyses, the baseline examination was performed between ages 5.0 and 9.9 years, and the mean follow-up was 6 years.

RESULTS

Black girls experienced menarche, on average, 3 months earlier than did white girls (12.3 vs 12.6 years), and during the 20-year study period, the median menarcheal age decreased by approximately 9.5 months among black girls versus approximately 2 months among white girls. As compared with 5- to 9-year-old white girls, black girls were taller and weighed more, characteristics that were predictive of a relatively early (before age 11.0 years) menarche. However, even after adjustment for weight, height, and other characteristics, the rate of early menarche remained 1.4-fold higher among black girls than among white girls.

CONCLUSIONS

Additional study of the determinants of menarcheal age is needed, as the timing of pubertal maturation may influence the risk of various diseases in adulthood.

Size at birth predicts age at menarche

OBJECTIVE

This study examines the relationship of intrauterine growth, measured by size and maturity at birth, to age at menarche, while also considering a wide range of other factors that may affect maturation. The research is motivated by the current debate about the importance of the prenatal environment as a determinant of later disease risk.

METHODS

Data were collected during the Cebu Longitudinal Health and Nutrition Survey. This community-based study has followed a cohort of several thousand Filipino infants since their birth in 1983 to 1984. Participants live in urban and rural communities of Metro Cebu, the second largest metropolitan area of the Philippines. The analysis sample includes 997 girls 14 to 15 years of age. The main outcome measure is age at menarche, determined from girls' self-report of the month and year of first menses. Factors that influenced age at menarche were identified using Weibull parametric survival time models. The main exposure variables of interest included weight and length (measured by trained field staff) and gestational age (assessed from mother's reported date of last menstrual period, augmented by clinical assessments at birth). The analysis also takes into account a wide range of other factors that are likely to affect age at menarche. These include the girls' early postnatal growth rates, premenarcheal body composition (body mass index and skinfold thicknesses measured at 8 years), current diet (measured by two 24-hour dietary recalls), and socioeconomic conditions of the household in which they live. We also assessed the contribution of maternal characteristics, including age at menarche, height, and nutritional status while pregnant with the study child.

RESULTS

The median age at menarche calculated from the hazard model is 13.1 years, with 50% of girls attaining menarche between 12.4 and 13.9 years. Earlier menarche is characteristic of girls who live in urban, higher socioeconomic status households, as indicated by higher maternal education, better housing quality, and possession of assets, such as a TV or refrigerator. Age at menarche is significantly associated with birth characteristics. Although birth weight alone was not significantly related to age at menarche, girls who were relatively long and thin at birth (>49 cm, <3 kg) attained menarche ~6 months earlier than did girls who were short and light (<49 cm, <3 kg). This effect of thinness at birth is most pronounced among girls with greater than average growth increments in 6 months of life. The effects of birth size are not modified when body mass index and skinfold thicknesses at 8 years are taken into account. Effects of birth size on age at menarche also remain significant when maternal nutritional status during pregnancy and the girl's current diet and socioeconomic indicators are taken into account.

CONCLUSIONS

The study provides additional evidence of fetal programming of later health outcomes by showing that future growth and maturation trajectories are established in utero. Furthermore, rapid postnatal growth potentiates the effects of size at birth and is related independently to earlier pubertal maturation.

Determinants of menarche

Menarche is a milestone in a woman's life as it denotes the start of reproductive capacity. Aim of this report is to review the recent developments and the current knowledge in the neuroendocrinology of pubertal onset and the factors, genetic and environmental, that influence menarcheal age. We also review the implications of early or late menarcheal age on a young woman's life.

The effects of intense exercise on the female reproductive system

Women have become increasingly physically active in recent decades. While exercise provides substantial health benefits, intensive exercise is also associated with a unique set of risks for the female athlete. Hypothalamic dysfunction associated with strenuous exercise, and the resulting disturbance of GnRH pulsatility, can result in delayed menarche and disruption of menstrual cyclicity. Specific mechanisms triggering reproductive dysfunction may vary across athletic disciplines. An energy drain incurred by women whose energy expenditure exceeds dietary energy intake appears to be the primary factor effecting GnRH suppression in athletes engaged in sports emphasizing leanness; nutritional restriction may be an important causal factor in the hypoestrogenism observed in these athletes. A distinct hormonal profile characterized by hyperandrogenism rather than hypoestrogenism is associated with athletes engaged in sports emphasizing strength over leanness. Complications associated with suppression of GnRH include infertility and compromised bone density. Failure to attain peak bone mass and bone loss predispose hypoestrogenic athletes to osteopenia and osteoporosis. Metabolic aberrations associated with nutritional insult may be the primary factors effecting low bone density in hypoestrogenic athletes, thus diagnosis should include careful screening for abnormal eating behavior. Increasing caloric intake to offset high energy demand may be sufficient to reverse menstrual dysfunction and stimulate bone accretion. Treatment with exogenous estrogen may help to curb further bone loss in the hypoestrogenic amenorrheic athlete, but may not be sufficient to stimulate bone growth. Treatment aimed at correcting metabolic abnormalities may in fact prove more effective than that aimed at correcting estrogen deficiencies.

Vitamin D status and muscle function in post-menarchal adolescent girls

CONTEXT

There has been a resurgence of vitamin D deficiency among infants, toddlers, and adolescents in the United Kingdom. Myopathy is an important clinical symptom of vitamin D deficiency, yet it has not been widely studied.

OBJECTIVE

Our objective was to investigate the relationship of baseline serum 25 hydroxyvitamin D [25(OH)D] concentration and PTH with muscle power and force.

DESIGN

This was a cross-sectional study.

SETTING

The study was community based in a secondary school.

PARTICIPANTS

A total of 99 post-menarchal 12- to 14-yr-old females was included in the study.

MAIN OUTCOME MEASURES

Jumping mechanography to measure muscle power, velocity, jump height, and Esslinger Fitness Index from a two-legged counter movement jump and force from multiple one-legged hops was performed. Body height, weight, and serum concentrations of 25(OH)D, PTH, and calcium were measured.

RESULTS

Median serum 25(OH)D concentration was 21.3 nmol/liter (range 2.5-88.5) and PTH 3.7 pmol/liter (range 0.47-26.2). After correction for weight using a quadratic function, there was a positive relationship between 25(OH)D and jump velocity (P = 0.002), jump height (P = 0.005), power (P = 0.003), Esslinger Fitness Index (P = 0.003), and force (P = 0.05). There was a negative effect of PTH upon jump velocity (P = 0.04).

CONCLUSION

From these data we conclude that vitamin D was significantly associated with muscle power and force in adolescent girls.

Evolution, development and timing of puberty

The age of menarche has fallen as child health has improved. Although there is ample evidence of delayed puberty being associated with poorer childhood nutrition, menarche is also influenced by prenatal factors. In particular, early onset of puberty is reported in children who have migrated from developing to developed countries. Evolutionary perspectives suggest that these effects can be explained by adaptive mechanisms. They also provide an explanation for the human pubertal growth spurt. In the past few decades, as puberty has advanced, biological maturation has come to precede psychosocial maturation significantly for the first time in our evolutionary history Although this developmental mismatch has considerable societal implications, care has to be taken not to medicalize contemporary early puberty inappropriately.

Age at menarche and risks of coronary heart and other vascular diseases in a large UK cohort

BACKGROUND

Early menarche has been associated with increased risk of coronary heart disease (CHD), but most studies were relatively small and could not assess risk across a wide range of menarcheal ages; few have examined associations with other vascular diseases. We examined CHD, cerebrovascular disease, and hypertensive disease risks by age at menarche in a large prospective study of UK women.

METHODS AND RESULTS

In 1.2 million women (mean±SD age, 56±5 years) without previous heart disease, stroke, or cancer, menarcheal age was reported to be 13 years by 25%, ≤10 years by 4%, and ≥17 years by 1%. After 11.6 years of follow-up, 73 378 women had first hospitalization for or death from CHD, 25 426 from cerebrovascular disease, and 249 426 from hypertensive disease. Using Cox regression, we calculated relative risks for each vascular outcome by single year of menarcheal age. The relationship was U-shaped for CHD. Compared with women with menarche at 13 years, the adjusted relative risk for CHD for menarche at ≤10 years of age was 1.27 (95% confidence interval, 1.22-1.31; P<0.0001) and for menarche at ≥17 years of age was 1.23 (95% confidence interval, 1.16-1.30; P<0.0001). U-shaped relationships were also seen for cerebrovascular and hypertensive disease, although the magnitudes of these risks for early and late menarche were smaller than those for CHD.

CONCLUSIONS

In this cohort, the relation of age at menarche to vascular disease risk was U shaped, with both early and late menarche being associated with increased risk. Associations were weaker for cerebrovascular and hypertensive disease than for CHD.

The measurement of puberty: a review

This paper has two main objectives. Firstly, to review the feasibility and validity of the various methods that have been used to measure puberty. With an appreciation of these measurement issues, the second objective is to summarize the evidence-base as to whether the age at menarche and the age at onset of puberty has decreased in recent years. In consideration of these methodologies, all of which report different levels of reliability and validity, it is only possible at present to draw inferences about possible changes in pubertal age and onset. Moreover, the wide variations in sample size, selection of participants (usually non-random), and study design reported in the reviewed studies have compounded this situation further. The paper closes by providing a summary of the findings which will be of relevance to those intending to critically review the current evidence surrounding age of puberty, as well as those set on carrying out future research into this area.

Infancy weight gain predicts childhood body fat and age at menarche in girls

CONTEXT

Rapid postnatal weight gain has been associated with subsequent increased childhood adiposity. However, the contribution of rapid weight gain during specific infancy periods is not clear.

OBJECTIVE

We aimed to determine which periods of infancy weight gain are related to childhood adiposity and also to age at menarche in UK girls.

DESIGN, SETTING, AND PARTICIPANTS

A total of 2715 girls from a prospective UK birth cohort study participated in the study.

MAIN OUTCOME MEASURES

Routinely measured weights and lengths at ages 2, 9, and 19 months were extracted from the local child health computer database. Body composition was assessed by dual-energy x-ray absorptiometry at age 10 yr, and age at menarche was assessed by questionnaire (categorized into three groups: <12.0, 12.0-13.0, and >13.0 yr).

RESULTS

Faster early infancy weight gain between 0 and 2 months and also 2 to 9 months were associated with increased body fat mass relative to lean mass at age 10 yr and also with earlier age at menarche. Each +1 unit gain in weight sd score between 0 and 9 months was associated with an odds ratio (95% confidence interval) = 1.48 (1.27-1.60) for overweight (body mass index > 85th centile) at 10 yr, and 1.34 (1.21-1.49) for menarche at less than 12 yr. In contrast, subsequent weight gain between 9 and 19 months was not associated with later adiposity or age at menarche.

CONCLUSIONS

In developed settings, rapid weight gain during the first 9 months of life is a risk factor for both increased childhood adiposity and early menarche in girls.

From menarche to menopause: exploring the underlying biology of depression in women experiencing hormonal changes

Epidemiologic data consistently report an elevated prevalence of major depressive disorder (MDD) in women. This increase begins during adolescence and continues through the menopausal transition. Population-based clinical studies report an increase in the incidence of MDD during perimenopause compared to either the premenopausal or postmenopausal period. Evidence suggests that fluctuations and decline of hormonal levels are correlated with this observed increase in risk for MDD. A strong predictor of depression in the perimenopausal period is a previous history of MDD. However, recent studies revealed an increased risk of new onset depression in perimenopausal women without a history of MDD. Additionally, recent reports have indicated that the presence of vasomotor symptoms may be associated with an increased the risk for MDD. The objective of this paper is to review evidence that would support our hypothesis that neurotransmitter systems are affected by changes in hormonal status over the course of a woman's life, leading to increase vulnerability to perimenopausal depression. Relevant data from nonclinical experiments will be discussed in the context of observed clinical evidence of the risk for MDD before, during, and after the menopausal transition. A testable hypothesis will be proposed to advance our understanding of hormonal effects on mood.

Childhood growth and age at menarche

OBJECTIVE

To study the influence of birthweight, and weight and height at age seven years, on menarcheal age in a national sample of 1471 girls in England, Scotland and Wales.

METHODS

We studied 1471 girls included in the MRC National Survey of Health and Development. During medical examinations carried out by school doctors in this cohort, born in the first week of March 1946, the mothers of girls were asked whether their daughters had started to menstruate, and if so, the month and year when this happened. Anthropometric measurements at birth and at age seven years were also obtained.

RESULTS

Girls who were heavier at age seven years had menarche at an earlier age. The average age at menarche of those in the highest fifth of the distribution of weight at seven years was 7.3 months less than that of those in the lowest fifth of the distribution. In contrast, girls who were heavier at birth had menarche at a later age. The average age at menarche of those in the highest fifth of the birthweight distribution was 2.2 months more than those in the lowest fifth. These opposing trends of birthweight and weight at seven years on age at menarche were observed across the distribution of each variable, and exerted statistically significant (P < 0.001) independent effects in a multivariate model.

CONCLUSIONS

These observations are consistent with the hypothesis that menarcheal age is linked to programmed patterns of gonadotrophin release established in utero, when the fetal hypothalamus is imprinted, and is subsequently modified by weight gain in childhood.

The impact of reproductive events on the course of bipolar disorder in women

BACKGROUND

Little is known about the impact of female reproductive hormones on the course of bipolar disorder. This study was designed to assess the influence of reproductive events and hormonal therapies on the course of bipolar disorder in women.

METHOD

Fifty women with DSM-IV bipolar disorder completed a structured clinical interview to assess the impact of reproductive events on the course of their illness.

RESULTS

The onset of bipolar disorder occurred before menarche in 32% (N = 16) of women; 18% (N = 9) experienced the onset within 1 year of menarche. Most women did not receive an accurate diagnosis of nor treatment for bipolar disorder until after they had children, and therefore the majority were not treated with mood stabilizers during or immediately after pregnancies. Of women with children, 20 (67%) of 30 experienced a postpartum mood episode. Of the women who had postpartum episodes after delivery of a first child, all had episodes after subsequent pregnancies. Having a postpartum mood episode after a first pregnancy significantly increased the risk of a postpartum episode after subsequent deliveries (p = .02). Postpartum episodes were almost exclusively depressive. Increased depressive symptoms during pregnancy were significantly associated with postpartum mood episodes (p = .01). Women who were not using hormone replacement therapy (HRT) were significantly more likely than those who were using HRT to report worsening of symptoms during perimenopause/menopause (p = .02).

CONCLUSION

These data suggest that hormonal fluctuations are associated with increased risk of affective dysregulation and mood episodes in women with bipolar disorder.

Development's tortoise and hare: pubertal timing, pubertal tempo, and depressive symptoms in boys and girls

Although the sequence of pubertal maturation remains consistent across most individuals, the timing and tempo of development fluctuate widely. While past research has largely focused on the sequelae of pubertal timing, a faster tempo of maturation might also present special challenges to children for acclimating to new biological and social milestones. Using latent growth curve modeling, the present study investigated how pubertal tempo and pubertal timing predicted depressive symptoms over a 4-year period in a sample of children recruited from New York City area public schools. Rate of intraindividual change in parent-reported Tanner stages was used as an index of pubertal tempo, and more advanced Tanner development at an earlier chronological age was used as an index of pubertal timing. For girls (N = 138, M = 8.86 years old at Time 1), pubertal timing emerged as the most salient factor, and the tempo at which girls progressed through puberty was not significant. In boys (N = 128, M = 9.61 years old at Time 1), both timing and tempo of development were significant; notably, however, the effects of pubertal tempo were stronger than those of timing. These findings highlight the need to consider multiple sources of individual variability in pubertal development and suggest different pubertal challenges for boys and girls.

Lessons from large population studies on timing and tempo of puberty (secular trends and relation to body size): the European trend

Ever since the publication of the first textbook on human growth by Johann Augustin Stoeller in 1729, temporal changes (or secular trends) in growth and pubertal maturation have been observed throughout the world. Data covering the longest time span are often reported from European populations. For example, in Norway and Denmark the age at menarche has fallen rapidly since the 19th century, by up to 12 months per decade. These changes have broadly paralleled increases in adult height in most European countries over the last century, with rates of around 10-30mm per decade. These secular trends are influenced by background ethnic, geographical and socio-economic factors, and clearly nutritional changes have an important role as reflected by positive correlations between age at puberty onset or age at menarche and childhood body size. Changes in height, pubertal maturation, and childhood body size have all also been related to rate of weight gain in infancy, and there is growing evidence to suggest that this early postnatal period may represent an early window of susceptibility to long-term 'programming' of various outcomes in humans. There is debate as to whether the secular trends in pubertal maturation are continuing or have reached their limit. Even where temporal changes are overall clearly significant, they are most marked in the more nutritionally deprived sub-groups. Whether over-nutrition and increasing childhood obesity will continue to lead earlier puberty is uncertain. The confirmation of an estimated advance in the age at menarche of 6-12 months per 100 years will require a long-term perspective on behalf of current investigators, and new consideration of methodological approaches in an age of increasing recognition of children's rights for privacy.

Age at menarche in relation to adult height: the EPIC study

In the last two centuries, age at menarche has decreased in several European populations, whereas adult height has increased. It is unclear whether these trends have ceased in recent years or how age at menarche and height are related in individuals. In this study, the authors first investigated trends in age at menarche and adult height among 286,205 women from nine European countries by computing the mean age at menarche and height in 5-year birth cohorts, adjusted for differences in socioeconomic status. Second, the relation between age at menarche and height was estimated by linear regression models, adjusted for age at enrollment between 1992 and 1998 and socioeconomic status. Mean age at menarche decreased by 44 days per 5-year birth cohort (beta = -0.12, standard error = 0.002), varying from 18 days in the United Kingdom to 58 days in Spain and Germany. Women grew 0.29 cm taller per 5-year birth cohort (standard error = 0.007), varying from 0.42 cm in Italy to 0.98 cm in Denmark. Furthermore, women grew approximately 0.31 cm taller when menarche occurred 1 year later (range by country: 0.13-0.50 cm). Based on time trends, more recent birth cohorts have their menarche earlier and grow taller. However, women with earlier menarche reach a shorter adult height compared with women who have menarche at a later age.

Maturational timing and overweight prevalence in US adolescent girls

OBJECTIVES

This study examined the relation of age at menarche to overweight in US adolescent girls.

METHODS

Effects of age at menarche and race/ethnicity on overweight were estimated via logistic regression, after adjustment for sociodemographic characteristics, in a sample of 6507 Hispanic, Black, White, and Asian American girls who participated in wave 2 of the National Longitudinal Study of Adolescent Health.

RESULTS

Overweight prevalence rates were significantly higher in early maturing adolescents of all racial/ethnic groups but highest (57.5%) among early maturing Black girls. Early maturation nearly doubled the odds of being overweight (body mass index at or above the 85th percentile).

CONCLUSIONS

Greater public health attention should be focused on the high prevalence of overweight, particularly among minority female adolescents.