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An 11-year-old girl was brought to us with complaints of restriction of movements of the left shoulder and a deformity of the back for the past 1 year, which had gradually progressed over 1 year. The child was yet to attain menarche. On examination, her physical development was found to be Tanner

Objectives To study total growth, rate of bone maturation, and menarche after discontinuation of Gonadotropin releasing hormone agonist (GnRHa) treatment for central precocious puberty (CPP). Methods Twenty girls with CPP on treatment with GnRHa were followed from discontinuation of treatment to final height (FH). Height, height velocity (HV), and bone age were measured every 6 months. Age at menarche was collected. Results Once treatment is discontinued, rate of bone maturation (bone age [BA]/chronological [CA]) accelerated from 0.7 ± 0.3 at end of treatment to 1.2 ± 0.8 post treatment, similar to BA/CA prior to treatment. BA at treatment discontinuation ranged from 11–14 years. On average, treatment was stopped when CA was within 9 months of BA. All girls continued to grow from end of treatment to menarche averaging an increase of 4.7 ± 3.7 cm, with HV 3.2 ± 2.0 cm/year. Post-menarche they grew an additional 4.6 ± 2.1 cm, with HV 2.4 ± 1.9 cm/year. Acceleration of HV was not seen post treatment. The younger the BA at initiation or completion of treatment, the longer time to menarche. No one had menarche prior to a BA of 12.5 year. Conclusions A pubertal growth spurt does not usually occur after treatment with GnRHa in girls with CPP. Rate of bone maturation accelerates post treatment. These factors are important in assessing optimal height outcome and decisions regarding cessation of treatment. This study will help clinicians give patients and families better estimates of growth and onset of menarche post treatment.

Changes in the levels of female sex hormones are associated with mood disorders in middle-aged women. This study investigated the association between female reproductive factors and the development of newly diagnosed bipolar disorder (BD). We used a South Korean nationwide medical records database. Postmenopausal women aged 40 or older who underwent health examinations were identified and followed for the occurrence of BD. We identified female reproductive factors including the age at menarche and menopause, parity, history of breastfeeding, oral contraceptive (OC) use, and hormone therapy (HT), and investigated their association with the occurrence of newly diagnosed BD. During an average of 8.32 years (SD 0.83) of follow-up, the incidence of BD was 0.50 per 1000 person-years in postmenopausal women. Compared to women with menopause at an age of 40 years or younger, those with menopause at an age of 45 years or older showed decreased risks of BD. Compared to women who had never breastfed, those who had breastfed for more than 12 months showed a decreased risk of BD. Compared to women who never received HT, those who received HT showed an increased risk of BD in a time-dependent manner. Among postmenopausal women, later menopause and breastfeeding for more than one year were associated with a decreased risk of BD occurrence, and receiving HT was associated with an increased risk.

Women with Turner syndrome (TS) are subfertile due to premature ovarian insufficiency. Most women require hormone replacement therapy for attaining menarche and assisted reproductive technology (ART) using donor oocytes, autologous oocytes or in-vitro fertilisation for conception. Irrespective of the karyotype, monosomy X (45, X) or mosaic pattern, women with TS hold a very high risk for pregnancy due to high mortality rate secondary to aortic dissection and severe pre-eclampsia. Such high-risk pregnancies mandate extensive prepregnancy counselling, the need for multidisciplinary teams, close surveillance and follow-up to attain a successful outcome. In this article, we report one such case of pregnancy in a woman with TS carrying a twin gestation following ART with donor oocyte.

Limited data exist on the reproductive hormone dynamics that govern the transition from menarche to the establishment of the mature ovulatory cycles of a fertile young woman. It is also unclear how environmental and lifestyle factors could modulate this transition in contemporary girls. Here, we introduce A Girl's First Period Study, an ambitious longitudinal study aimed at charting the early post-menarchal course of a cohort of healthy girls in the Triangle region of North Carolina.

Existing studies on the association of age at menarche and age at natural menopause with diabetes are conflicting.To explore the associations of age at menarche and age at natural menopause with diabetes, and to estimate whether body mass index, abdominal obesity, hypertension, and dyslipidemia would influence the relationships.In this cross-sectional study, 5090 postmenopausal women were included from the China Multi-Ethnic Cohort Study (CMEC) baseline in Chongqing province. Questionnaires, physical examinations, and biological samples testing were conducted. Logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals (CIs). And restricted cubic splines were performed to evaluate the pattern of association between ages at menarche and menopause with diabetes.The adjusted ORs for diabetes grouped by age at menarche (12, 12-17,17 years) were 0.76 (95%CI: 0.42-1.40), 1.00 (reference), and 0.73 (95%CI: 0.57-0.94). Similarly, the adjusted ORs for diabetes grouped by age at menopause (44, 44-52,52 years) were 1.38 (95%CI: 1.04-1.82), 1.00 (reference), and 1.11 (95%CI: 0.89-1.39). No significant interaction of age at menarche and menopause with body mass index, abdominal obesity, hypertension, and dyslipidemia in odds of diabetes was observed.Late menarche is associated with a lower prevalence of diabetes, while early natural menopause is associated with a higher prevalence of diabetes. No significant effect modification was observed by body mass index, abdominal obesity, hypertension, or dyslipidemia.

Supplementary tables for "Age at menarche, age at natural menopause and risk of lung and colorectal cancers: a Mendelian randomization study"

This study aims to describe the time trend of age at menarche in Brazilian schoolgirls evaluated in 2007, 2012/2013 and 2018/2019, and to assess its association with having overweight, including obesity and socio-economic conditions. Three cross-sectional studies were carried out in 2007, 2012/2013 and 2018/2019 in schoolchildren enrolled between the second and ninth years of elementary school and comprising 838, 688 and 326 schoolgirls, respectively. Body mass index Z scores were calculated and categorised as either without overweight or with overweight (including obesity). The type of school (a proxy of socio-economic condition) was categorised as either public or private. Menarche data were collected using the status quo and recall methods. The mean age at menarche was estimated by survival analysis. Differences in age at menarche according to the year of survey, weight status and type of school were verified by the Log-Rank test and Cox's univariate and multiple regression. There was an increase in the prevalence of overweight in girls throughout the surveys, with 21.4% in 2007, 27.2% in 2012 and 28.5% in 2018 (p = 0.007) having overweight. There was a decrease in the mean age at menarche between 2007 and 2018/2019 (12.3 vs. 11.9 years, respectively). The mean age at menarche in girls with overweight was lower in the three time periods when compared to girls without overweight (11.9, 11.8 and 11.5 vs. 12.4, 12.4 and 12.1, respectively). Girls with overweight were more likely to have had earlier age at menarche than girls without overweight (Hazard Ratio 1.57; 95% CI 1.36; 1.80). There were no differences in the age at menarche according to the type of school. The increase in the prevalence of girls with overweight (including obesity) may be associated with the age at menarche. Girls with overweight had a higher risk of earlier age at menarche than girls without overweight.

Background Heavier body mass index (BMI) is the most established predictor of earlier age at puberty. However, it is unknown whether the timing of the childhood switch to heavier BMI (age at BMI rebound) also matters for puberty. Methods In the LEGACY Girls Study (n = 1040), a longitudinal cohort enriched with girls with a family history of breast cancer, we collected paediatric growth chart data from 852 girls and assessed pubertal development every 6 months. Using constrained splines, we interpolated individual growth curves and then predicted BMI at ages 2, 4, 6, 8 and 9 years for 591 girls. We defined age at BMI rebound as the age at the lowest BMI between ages 2 and 8 years and assessed its association with onset of thelarche, pubarche and menarche using Weibull survival models. Results The median age at BMI rebound was 5.3 years (interquartile range: 3.6–6.7 years). A 1-year increase in age at BMI rebound was associated with delayed thelarche (HR = 0.90; 95% CI = 0.83–0.97) and menarche (HR = 0.86; 95% CI = 0.79–0.94). The magnitude of these associations remained after adjusting for weight between birth and 2 years, was stronger after adjusting for BMI at age 9, and was stronger in a subset of girls with clinically assessed breast development. Conclusions Earlier BMI rebound is associated with earlier pubertal timing. Our observation that BMI rebound may be a driver of pubertal timing in girls with and without a family history of breast cancer provides insight into how growth and pubertal timing are associated with breast cancer risk.

Throughout the 20 century, in developed countries there has been a secular trend toward earlier menarche. Over the past 2 decades, however, there has been an apparent stabilization in the average age of menarche age in most Western countries.The objective of this study was to analyze the mean age of menarche in a cohort of Italian girls, to analyze the mean age of breast button appearance (B2), and to correlate the B2 developmental stage and age at menarche with the most important clinical and auxological parameters.We retrospectively evaluated the data of 1458 Italian girls born between 1995 and 2003. We collected the main auxological and clinical parameters, including age at B2, age at menarche, height, weight, and body mass index (BMI) at B2 and menarche and, when possible, adult/near adult height.The mean age of B2 was 10.16 ± 1.00 years, significantly earlier than previously reported for Italian girls (P.05); the mean age of menarche was 12.07 ± 0.99 years, also significantly earlier than previously reported (P.0001). Age at B2 and menarche inversely correlated with BMI standard deviation score (SDS) (P.0001). The mean adult/near adult height of the girls in the study cohort was not statistically different from previously reported data for Italian women.Our results suggest a new trend for an earlier appearance of thelarche and menarche in Italian girls. Our data confirm a significant relationship between BMI and age of B2 and menarche. The girls' final height seems to be in line with average height for the Italian female population.

ObjectiveAlthough exposure to abuse in early life predicts earlier pubertal timing, especially for girls, it is unclear if this association generalizes to nonabuse stressors. In addition, the impact of race on the stress-maturation association remains unknown. To address these issues, we examined whether race moderates the effects of early adversity on pubertal timing and tempo using a longitudinal study design.MethodsIn a cohort of 9- and 10-year-old Black and White girls, pubertal (areolar and pubic hair) maturation was assessed annually for 7 years. In adulthood, 368 participants (186 Black, 182 White) reported on abuse and nonabuse stressors they experienced from ages 0 to 12 years.ResultsEarly life abuse was associated with earlier pubertal timing, as indexed by younger age at menarche (b = -0.22, p = .005, 95% confidence interval [CI] = -0.39 to -0.06) and greater pubic hair development (b = 0.11, p = .003, 95% CI = 0.04 to 0.18), in addition to slower pubertal tempo, as indexed by slower rate of pubic hair (b = -0.03, p < .001, 95% CI = -0.05 to -0.01) and areolar (b = -0.02, p = .02, 95% CI = -0.03 to -0.003) development. These associations were not found for nonabuse adversity. Black girls with early life abuse had greater pubic hair development (b = 0.23, p < .001, 95% CI = 0.12 to 0.35) and were slower in pubic hair tempo (b = -0.07, p < .001, 95% CI = -0.09 to -0.04) than their White counterparts.ConclusionsScreening for early life abuse may help address health disparities related to earlier pubertal timing.

Background Use of oral contraceptives (OCs) may modulate the clinical course of women with congenital long QT syndrome (LQTS). The safety of OC use by sex hormone content has not been assessed in women with LQTS. Objective We aimed to evaluate the association of OCs with the risk of cardiac events (CEs) in women with LQTS. Methods Beginning in 2010, information on menarche onset, OC use, pregnancy, and menopause were obtained from women enrolled in the Rochester LQTS Registry. Type of OC was categorized as progestin-only, estrogen-only, or combined (estrogen/progestin). Andersen-Gill multivariate modeling was used to evaluate the association of time-dependent OC use with the burden of CE (total number of syncope, aborted cardiac arrest, and LQTS-related sudden cardiac death) from menarche onset through 40 years. Findings were adjusted for genotype, corrected QT duration, and time-dependent β-blocker therapy. Results A total of 1659 women with LQTS followed through March 2021, of whom 370 (22%) were treated with an OC. During a cumulative follow-up of 35,797 years, there were a total of 2027 CE. Multivariate analysis showed that progestin-only OC was associated with a pronounced 2.8-fold (P = .01) increased risk of CEs in women who did not receive β-blocker therapy, while β-blockers were highly protective during progestin-only OC treatment (hazard ratio 0.22; P = .01; P = .006 for β-blocker-by-OC interaction). The risk associated with OC use without concomitant β-blocker treatment was pronounced in women with LQTS type 2. Conclusion Our findings suggest that progestin-only OC should not be administered in women with LQTS without concomitant β-blocker therapy. OCs should be used with caution in women with LQTS type 2.

Summary Objectives Previous studies of the relationships between female reproductive factors and osteoarthritis (OA) have shown conflicting results. In this study, we aimed to explore the relationships between reproductive factors and joint replacement arthroplasty of the knee (TKRA) and hip (THRA) in a large nationwide population-based cohort of postmenopausal Korean women. Methods We included 1,134,680 subjects who participated in national health examinations in 2009 in the study. The study outcomes were incident THRA or TKRA due to severe hip or knee OA. The relationships between reproductive factors and THRA or TKRA were evaluated using a multivariable-adjusted proportional hazards model. Results During a mean follow-up duration of 8.2 years, 1,610 incident THRA cases and 60,670 incident TKRA cases were observed. Later age at menarche, longer breastfeeding, HRT and OC use were associated with increased risk of TKRA for severe knee OA, while later age at menopause and longer reproductive span were associated with decreased risk. With regard to THRA for severe hip OA, later menarche, longer breastfeeding, HRT more than 5 years, and OC use more than 1 year were associated with higher risk. The associations between reproductive factors and severe OA were more pronounced in underweight and younger subjects. Conclusion We found that shorter estrogen exposure was associated with higher risk of TKRA due to severe knee OA, and such associations were more pronounced in underweight and younger subjects. The association between shorter estrogen exposure and THRA was not robust.

Some reproductive factors are found to be associated with metabolic outcomes in women; however, little is known about reproductive lifespan characteristics and the mutual effect of age at menarche and age at menopause on cardiovascular risk. This systematic review evaluated reproductive lifespan characteristics and describes the mutual effect of age at menarche and age at menopause on the risk of type 2 diabetes (T2DM) and hypertension at midlife. PubMed, EMBASE, and Web of Science were screened for studies published up to September 1, 2020. The individual effect estimates were reviewed and synthesized without meta-analysis due to methodological and clinical or conceptual diversity in reported studies. Of the 3033 identified studies, 20 were included in the final synthesis: 6 reported reproductive life span; 12 reported age at menarche, and 7 reported age at menopause. Synthesis of two cohorts, with a median follow-up of 9-11 years, showed that a shorter reproductive lifespan was positively associated with T2DM, yielding 6-15% higher risk of T2DM for a one-year decrease in reproductive lifespan. A few studies also demonstrated that women who experienced early menarche (four of six studies) and early menopause (two of five studies) were positively associated with risk of T2DM. The association between reproductive lifespan and hypertension was unclear due to the limited availability of studies. Our findings suggest that a shorter reproductive lifespan is associated with T2DM risk in postmenopausal women, especially those with early menarche and early menopause. Large cohort studies are needed to assess the association between reproductive lifespan and incident hypertension in midlife.

Menarche is a significant marker of maturity and puberty in girls, and it is a transition influenced by different biophysical factors. This study was carried out to determine the age, seasons and the influence of body mass index (BMI) on menarche. A total of 450 girls’ between the ages of 10 and 19 years participated in the study. Age at menarche was obtained via the recall quo cross sectional method. Parameters measured were; standing height (SH), weight (Wt) and BMI. A total of 373 (82.9%) girls had their menarche in their early adolescence while 77 girls (17.1%) had their menarche in mid adolescence. Mean age at menarche was 13.17± 1.48 years. The average value for BMI was 20.35 ± 3.77 kg/m2, SH was 161.09 ± 6.16 cm, Wt was 52.53 ± 9.21kg. Overweight girls were observed to attain menarche earlier, followed by those whose mean weight was in the normal range .Subjects in the underweight category had higher age at menarche. Menarche was high in the months of August, July and January. Menarche occurs early among secondary school girls in Port Harcourt and among other factors, those associated with BMI and stress are important in the onset of the biological event.

Age of menarche is a determinant factor of cardiometabolic risk, adiposity and stature at adulthood. However, little is known about the transgenerational effects of age of menarche, especially beyond childhood of any offspring, and the studies remain limited to anthropometric outcomes in children at birth or before adolescence. In the present study, we aim to investigate the relationship of maternal age at menarche (MAM) with anthropometric and metabolic parameters in the young adult offspring (aged 15-35 years) in a Persian population.In this cohort-based cross-sectional study, we recruited 1139 mother-young adult dyads enroled in Rafsanjan Cohort Study (RCS) at adult RCS (aged 35-70 years) and youth RCS (aged 15-35 years) as part of the comprehensive PERSIAN (Prospective Epidemiological Research Studies in IrAN). In this study, MAM was categorized to early (MAM 12 years), normal (12 ≤ MAM ≤ 14) and late menarche (MAM 14 years). For these analyses, bivariate and multiple logistic regression models were used to investigate the relationships between late or early MAM and offspring anthropometric and metabolic parameters.Early MAM displayed a significant association with an increased odds ratio (OR) of tall stature adjusting for sex, age, socioeconomic status index, maternal age at birth and maternal height (as genetically determined factor). Sensitivity analysis by sex indicated this relationship to be specific to male offspring only (adjusted OR: 1.84 95% CI: 1.13-3.00, p value: .014). In addition, late MAM displayed a significant association with reduced OR of overweight/obesity and abdominal obesity in daughters only (obesity adjusted OR: 0.49, 95% CI: 0.27-0.88, p value: .018, abdominal obesity adjusted OR: 0.44, 95% CI: 0.23-0.82, p value: .010). dose-response analysis by categorization of MAM, further supported our results. On the contrary, our analyses do not support a significant relationship between MAM and youth metabolic indices, that is, metabolic syndrome, fasting blood sugar (FBS), high-density lipoprotein (HDL) and triglyceride (TG).The results of the present study indicate an association of maternal age of menarche with anthropometric measures of offspring in young adulthood in a sex differential manner. The data does not support a significant relationship between the metabolic indices FBS, TG and HDL in offspring with MAM. Overall, this study provides evidence for the intergenerational effects of age at menarche in the development of anthropometric measures in offspring in young adulthood (15-35), which is the first study of this kind in this age range.

Background A “mismatch” sequence of less prenatal weight gain and more postnatal weight gain may lead to ectopic lipid accumulation, and trigger the development of early adrenarche/pubarche and the activation of the gonadotropic axis resulting in early puberty and ending up in full-blown adolescent polycystic ovary syndrome (PCOS). In the present study, we assess whether a low-dose combination of generics that collectively reduce ectopic fat through different pathways can slow down the accelerated maturation in “mismatch” girls with early puberty. Methods Randomized, placebo-controlled, multicenter, phase 2a, study in 64 girls [age, 8.0–9.3 years; birthweight (BW) for gestational age in lower tertile (−1.96< Z-score Z-score < +1.96) and early progressive puberty (Tanner B2 at 7.7–9.0 years)]. Pharmacological intervention will be with a half-dose version of SPIOMET (mini-spiomet), a combination that reverts the PCOS phenotype in “mismatch” adolescents; mini-spiomet will contain spironolactone (25 mg/day, to raise brown adipose tissue activity), pioglitazone (3.75 mg/day, to raise adiponectin and insulin sensitivity), and metformin (425 mg/day, to raise AMPK activity and GDF15). Recruitment: 1 year; double-blind treatment: 1 year; open follow-up: 1 year; analyses and reporting: 1 year. Interventions: randomization (1:1) for placebo vs mini-spiomet. Primary outcome: annualized bone age advancement (0–1 year) by BoneXpert; secondary outcomes: insulin, IGF-I, high-molecular-weight adiponectin (HMW-adip), sex hormone binding globulin (SHBG), ultra-sensitive C-reactive protein (usCRP), androgens, luteinizing hormone (LH), follicle-stimulating hormone (FSH), oestradiol, growth-and-differentiation factor 15 (GDF15), C-X-C motif chemokine ligand-14 (CXCL14), safety parameters, and quantification of hepato-visceral fat. Discussion The present study, if successful, may provide a first proof of the concept that the rapid maturation of girls with an upward mismatch between pre- and post-natal weight gain can be slowed down with a fixed low-dose combination of old and safe generics jointly targeting a reduction of ectopic fat without necessarily lowering body weight. Trial registration EudraCT 2021-006766-21. Registered on May 30, 2022.

Büyümenin ve olgunlaşmanın takip edilebilmesi, çocuk ve ergenlerin sağlıklı gelişimi için büyük önem taşımaktadır. Menarş yaşı da genç kızlarda olgunlaşmanın takibi açısından çok önemli bir belirteçtir. Bu takibin yapılmasında genellikle uluslararası standartlar kullanmaktır. Bölgesel ve etnik farkları göz önünde bulundurduğumuzda, her toplumun kendi referans değerlerinin belirlenmesi ve güncel tutulması gerekmektedir. Ülkemizde bölgesel olarak değerli veriler bulunmasına karşın henüz tek ve tüm bölgeleri kapsayıcı bir ulusal referans oluşmamıştır. Bu çalışmanın amacı ülkemizde menarş yaşındaki bölgesel değişimleri ve kuşaklar arası ilişkiyi değerlendirmektir. Bu bağlamda, 1960’lardan günümüze İç Anadolu Bölgesi temel alınarak menarş yaşındaki değişim trendi incelenmiştir. Araştırmamız sonucunda, 1960’lı yıllarda menarş başlangıç yaşının yaklaşık 13,31 yıl iken, günümüzde bu yaşın 12,8 yıla düştüğü ve pozitif yönde bir seküler değişim olduğu tespit edilmiştir. Son 150 yıl içerisinde birçok ülkede menarş yaşının önemli oranda düştüğü bilinmektedir. Ülkemizde de görülen bu düşüş, yaşam koşulları, eğitim, sağlık durumu gibi birçok sosyo-ekonomik faktörün olumlu yönde gelişmesi ile açıklanmaktadır., Monitoring growth and maturation is of great importance for the healthy development of children and adolescents. The age at menarche is also a very significant marker for the follow-up of maturation in young girls. Generally, international standards are used in this follow-up. Considering the regional and ethnic differences, each society's own reference values should be determined and kept up to date. Although there are regionally valuable data in our country, a single national reference covering all regions has not been formed yet. The aim of this study is to evaluate the regional changes in the age of menarche in our country and the relationship between generations. In this context, the trend of change in the age of menarche has been examined based on the Central Anatolia Region from the 1960s to the present. As a result of our research, it has been determined that while the age of onset of menarche was approximately 13.31 years in the 1960s, this age has decreased to 12.8 years today and there is a positive secular change. It is known that the age of menarche has decreased significantly in many countries in the last 150 years. This decline, which is also seen in our country is explained by the positive development of many socio-economic factors such as living conditions, education, and health status.

Young women who experience menarche often feel confused and sad. Adolescents who are not ready to face menarche will have a desire to refuse, they will feel menstruation as something cruel and threatening, this situation can continue in a more negative direction. SMP did not dare talk to his parents when experienced menarche. This research is a quantitative research with cross sectional design which aims to determine the relationship between knowledge, closeness of mother and child to the readiness of adolescents to face first menstruation ( menarche ) in SMP Negeri 04, 06 and 17 Jambi City. Population of 172 people with a sample size of 119 people, the sampling technique is proportional random sampling technique. The data was obtained by using a questionnaire for SMPN 04 and 0 6 students and google form on the SPN 17 student. Data were analyzed univariate and bivariate using the Chi-Square test. The results show that s ebanyak 45 (37,8 %) respondents have less knowledge, 71 (59,7 %) closeness to the mother well, 52 (43,7 %) mothers parenting is democratic, as many as 62 (52,1 %) said they were ready to face the first menstruation (menarche). The results of the test statisti k showed no significant relationship between knowledge ( p-value 0,001) , the proximity of the mother ( p-value 0,003 ) and the pattern of parenting (p-value 0,007) with the readiness of teenagers face first menstruation (menarche) in SMP Negeri 04, 06, and 17 Jambi City. It is expected that the schools work together with teachers BK to do counseling as scheduled and periodical about menstruation first (menarche) to increase the knowledge of adolescent and do consul about health reproduction in adolescents at school. Abstrak Remaja putri yang mengalami menarche sering merasakan kebingungan dan kesedihan.Remaja yang belum siap menghadapi menarche akan timbul keinginan untuk menolak, mereka akan merasa haid sebagai sesuatu yang kejam dan mengancam, keadaan ini dapat berlanjut ke arah yang lebih negatif. Penelitian ini merupakan penelitian kuantitatif dengan desain cross sectional yang bertujuan untuk mengetahui hubungan pengetahuan, kedekatan ibu dan anak terhadap kesiapan remaja menghadapi menstruasi pertama (menarche) di SMP Negeri 04, 06 dan 17 Kota Jambi. Populasi sebanyak 172 orang dengan jumlah sampel sebanyak 119 orang, teknik pengambilan sampel dengan teknik proporsional random sampling.. Data diperoleh dengan cara menggunakan kuesioner pada siswi SMPN 04 dan 0 6 dan google form pada siswi SPN 17. Data dianalisa univariat dan bivariat dengan menggunakan uji Chi-Square. Hasil menunjukkan bahwa sebanyak 45 (37,8%) responden mempunyai pengetahuan yang kurang, sebanyak 71 (59,7%) kedekatan dengan ibu baik, sebanyak 52 (43,7%) pola asuh ibu adalah demokratis, sebanyak 62 (52,1%) mengatakaan siap menghadapi menstruasi pertama (menarche). Hasil uji statistic menunjukkan ada hubungan yang bermakna antara pengetahuan (p-value 0,001), kedekatan ibu (p-value 0,003) dan pola asuh (p-value 0,007) dengan dengan kesiapan remaja menghadapi menstruasi pertama (menarche) di SMP Negeri 04, 06, dan 17 Kota Jambi. Diharapkan agar pihak sekolah bekerja sama dengan guru BK untuk melakukan penyuluhan secara terjadwal dan berkala tentang menstruasi pertama (menarche) untuk meningkatakan pengetahuan remaja serta melakukan konsul tentang kesehatan reproduksi pada remaja di sekolah. Kata kunci: pengetahuan, kedekatan ibu, pola asuh, dan menarche.

Fluoride exposure is associated with later pubertal development and decreased testosterone production in adolescent and adult males. However, its effects on female reproductive health and pubertal development are unclear. Therefore, we examined associations of fluoride exposure with reproductive health outcomes among adolescent girls and women in the United States. Participants were from The National Health and Nutrition Examination Surveys (2013 to 2016), aged 16–19 and identified as female. There were 524 and 460 participants with measures of plasma fluoride and household tap water fluoride respectively, who had at least one reproductive health outcome examined, and complete covariate data. We applied covariate adjusted survey-weighted linear or logistic regression to examine associations of fluoride exposure with age of menarche, menstrual cycle regularity, or serum sex steroid hormone levels. Median interquartile range (IQR) water and plasma fluoride concentrations were 0.48 (0.53) mg/L and 0.34 (0.30) µmol/L respectively. An IQR increase in water fluoride was associated with a 3.3 month earlier first menstrual period (B = − 0.28, 95%CI − 0.54, − 0.02, p = 0.05). Additionally, we observed a significant interaction between plasma fluoride and race/ethnicity in association with age of menarche (p = 0.01). Among Non-Hispanic Black adolescents, each IQR increase in plasma fluoride was associated with a 5-month earlier age of menarche (B = − 0.42, 95%CI − 0.61, − 0.23, p

Puberty onset is tightly regulated by a broad spectrum of neuroendocrine signals and peripheral stimuli which coordinate the hypothalamic-pituitary-gonadal (HPG) axis activation. Numerous studies suggest that light stimulation influences HPG axis function; however, the effect of blindness on puberty timing remains controversial. Given that menarche is a suitable marker for sexual development initiation, the evaluation of the age at which blind girls attain it allows to indirectly assess the effect of light-dark cycle disruption on pubertal development. The present investigation aimed to review the evidence regarding menarcheal age drift in visually impaired girls, as well as to discuss the findings based on the existing hypotheses of the physiological mechanisms linking the light-dark cycle and photic sensitivity loss to the onset of puberty. Eleven studies were retrieved from a literature search conducted in PubMed, Scopus, ScienceDirect, SpringerLink, and Google Scholar databases. Eight studies concluded that light perception impairment is related to a moderately earlier age at menarche. Moreover, the evidence gathered in this review suggests a positive association between the degree of light perception loss and precocious menarcheal onset; yet, no conclusive outcomes were found regarding menarche advancement in acquired versus congenital blindness. We encourage further research aiming to elucidate the physiological mechanism underlying photosensitive regulation and blindness effect on the neuroendocrine pathways involved in human sexual maturation.

Background: Menarche is an important milestone in women’s life usually occurring between 12-14 years of age. It reflects the health status of the population as it marks as the beginning of sexual maturation. The adolescent girls usually undergo menarche unprepared and they lack the knowledge of menstruation and also practice poor hygiene. Poor hygiene and inadequate self-care practices have major determinants of morbidities and other complications. Therefore, it is important to spread awareness of menstruation and its proper hygiene practices. Materials and Methods: A community-based survey was conducted among 84 school girls of Karad. Data was collected using a questionnaire including the demographic information of each participant. The duration of study was 6 months. Results: The study revealed that the mean age of menarche was 11.05 years. Out of total participants, 44.05% girls had poor knowledge of menstruation and 35.71% girls had poor hygienic practices during menstruation. Conclusion: The study concluded that there is a prevalence of early menarche and it is associated with various factors. The adolescent girls should be made aware about menstruation and its hygiene at an early age. The girls who attained menarche early had a poor knowledge than that of the girls who attained menarche at a normal age.

Osteoporosis, which means “porous bone”, is a disease in which the bones gradually become weak and brittle. Osteoporosis is often known as the silent thief because bone losses occur without symptoms and progressive loss and thinning of bone tissue happens over many years. The aim of the study was to assess the effectiveness of Structured Teaching Programme on knowledge regarding prevention of Osteoporosis among premenopausal women (35-50 years) attending OPDs in a selected hospital, Raipur. Objectives To assess the pretest level of knowledge regarding prevention of osteoporosis among premenopausal women in experimental group and control group. To determine the effectiveness of structured teaching programme on prevention of osteoporosis in experimental group. To find out the association between knowledge regarding prevention of osteoporosis and selected demographics variables of the premenopausal women. Review of literature was prepared relevant to the study. The conceptual framework of the study was based on “Kenny’s open system model. Pilot study was done among patients in general medicine OPD in a selected hospital, Raipur. The main study was conducted in Orthopedics and Obstetrics & Gynecology OPDs in a selected hospital, Raipur. A total of 90 patients included in the study and they were selected using convenient sampling. The instrument used for data collection was structured knowledge questionnaire. Validity and reliability of the tool was done. Data was collected for the period of 4 weeks. Descriptive and inferential statistics were used to analyse the data. It was observed in present study that majority (70%) of the total sample in experimental and control group had inadequate level of knowledge regarding prevention of Osteoporosis. And it was observed that the mean post test score of experimental group with standard deviation was 19.98±3.02 which was apparently higher than that of post test score of control group 14.11±4.74. Statistical differences were computed and the independent t value is 7.003 which was found significant at 0.05. Hence, Structured Teaching Programme was effective on knowledge regarding prevention of Osteoporosis. The study findings also shows that the association between knowledge score and educational status (ᵡ2=9.511, P=0.05), religion (ᵡ2=7.053, P=0.05) and previous knowledge (ᵡ2=46.44, P=0.05) were highly significant. Hence there was a significant association between pre-test knowledge and selected demographic variables of premenopausal women such as age, gender, education, income, religion, marital status, dietary pattern, age of menarche, age of marriage and previous knowledge. Key words: Structured Teaching Programme, Knowledge, Prevention of Osteoporosis, Premenopausal Women, Effectiveness.

Background: The suspicion of a disorder of sex development (DSD) often arises at birth, when the newborn presents with ambiguous genitalia, or even during prenatal ultrasound assessments. Less frequently, the aspect of the external genitalia is typically female or male, and the diagnosis of DSD may be delayed until a karyotype is performed for another health issue, or until pubertal age when a girl presents with absence of thelarche and/or menarche or a boy consults for gynaecomastia and/or small testes. Summary: In this review, we provide a practical, updated approach to clinical and hormonal laboratory workup of the newborn, the child, and the adolescent with a suspected DSD. We focus on how to specifically address the diagnostic approach according to the age and presentation. Key Message: We particularly highlight the importance of a detailed anatomic description of the external and internal genitalia, adequate imaging studies or surgical exploration, the assessment of reproductive hormone levels – especially testosterone, anti-Müllerian hormone, 17-hydroxyprogesterone, and gonadotropins – and karyotyping.

Menarche, the beginning of menstrual function occurs as a result of complex interaction between the hypothalamus, pituitary and ovarian hormones and is an important event in any girl’s life as it signifies the beginning of fertility. Rarely some diseases like migraine, epilepsy, inherited bleeding disorders can manifest at menarche and cause significant anxiety to the parents and the adolescent girl. A 13-year-old girl presented with convulsions following 8 days of excessive bleeding at the time of menarche. She had altered sensorium, severe anaemia with Respiratory alkalosis and needed ICU Care. She needed multiple transfusions of blood and blood products. She showed features of sepsis on haemogram at admission later manifested respiratory findings. Her bleeding per vaginum did not respond to antifibrinolytics and progesterones and stopped only after evacuation of contents on day 5 under GA. No organism could be isolated and she recovered on Day 6 of higher broad spectrum antibiotics. Her parents were counselled to watch for occurrence of seizures in later life as this catastrophe may signify onset of epilepsy in later life. Keywords: Menarche, Seizures, Puberty menorrhagia.

Menstruation is a physiological process which starts around 11-16 yrs of age in most girls andcontinues throughout the reproductive life until menopause. During these years females spend one-sixth of their time menstruating and in discomfort. It is of utmost importance that hygienic practices are followed for a healthy and safe life. Various social and cultural taboos and habits have clouded the situation along with restricted facilities creating a disease burden such as genital infections and menstrual problems, including missed days at schools and work. It is the responsibility of the policy makers and also the health care workers to help in bridging the gap of lack of knowledge and availability of resources in creating a female hygiene friendly infrastructure in all the places. The study was conducted to assess the knowledge and awareness about menarche and menstrual cycle in school going girls. Also it was carried to study the prevailing practices of menstrual hygiene among the adolescent girls. The various sociocultural restrictions and taboos under practice in relation to menstruation and were analysed the reasons alongwith their solutions to improve the present situation of female hygiene practices were tabulated. A semi structured, question answer style written survey was conducted among adolescentgirls aged 11-18 yrs from nearby schools of Index Medical College, with help of PG resident doctors and medical interns. The survey was followed by educational and awareness talk on female hygiene practices that need to be followed.The result of the study were as follows-56.4%% were aware about menstruation before attaining menarche, and 88.20% had attained menarche at the time of study. 68.5% had mother as first informant, 40.3% knew about menstruation only after getting their 1 period. 28.5% felt insecure, 18.4% had anxiety, 30.5% were worried about menstruation. 95.5% perceived menstruation as a natural process, 98.6% used sanitary pads for bleeding, 1.4% used old cloth. 98.6% cleaned private parts during menses of which 75.3% used only water. Only 78.1% had the facility to change pads in school, of which only 58.9% changed pads in school. 90.4% had a daily bath during menses. 38.6% were not allowed to pray. 5% were not allowed to attend school, 8.3% were not allowed to sleep on their regular bed, and 11% were asked not to touch family members. 5% were restricted from playing outside and were not even allowed to go out of their home. 81.3% shared their menstrual health problems with mother. This study provided an understanding of perception of menstruation amongschool going girls. It also deals with the understanding of the society that still menstruation is not taken as a natural process, but rather as a curse and menstruating girls and women are being put under a lot of restrictions due to such practices. Lack of proper infrastructural facilities are a reason why so many girls drop out and restrict their attendance at school after menarche and much still needs to be done in this field to ensure smooth and healthy transition of adolescent girls into adulthood.

The state of somatic energy stores in metazoans is communicated to the brain, which regulates key aspects of behaviour, growth, nutrient partitioning and development1. The central melanocortin system acts through melanocortin 4 receptor (MC4R) to control appetite, food intake and energy expenditure2. Here we present evidence that MC3R regulates the timing of sexual maturation, the rate of linear growth and the accrual of lean mass, which are all energy-sensitive processes. We found that humans who carry loss-of-function mutations in MC3R, including a rare homozygote individual, have a later onset of puberty. Consistent with previous findings in mice, they also had reduced linear growth, lean mass and circulating levels of IGF1. Mice lacking Mc3r had delayed sexual maturation and an insensitivity of reproductive cycle length to nutritional perturbation. The expression of Mc3r is enriched in hypothalamic neurons that control reproduction and growth, and expression increases during postnatal development in a manner that is consistent with a role in the regulation of sexual maturation. These findings suggest a bifurcating model of nutrient sensing by the central melanocortin pathway with signalling through MC4R controlling the acquisition and retention of calories, whereas signalling through MC3R primarily regulates the disposition of calories into growth, lean mass and the timing of sexual maturation. MC3R deficiency is associated with a delay in the onset of puberty, and a reduction in growth and lean mass.

Background and ObjectivesTo examine associations between indicators of estrogen exposure from women's reproductive history and brain MRI biomarkers of Alzheimer disease (AD) in midlife.MethodsWe evaluated 99 cognitively normal women 52 ± 6 years of age and 29 men 52 ± 7 years of age with reproductive history data, neuropsychological testing, and volumetric MRI scans. We used multiple regressions to examine associations among reproductive history indicators, voxel-wise gray matter volume (GMV), and memory and global cognition scores, adjusting for demographics and midlife health indicators. Exposure variables were menopause status, age at menarche, age at menopause, reproductive span, hysterectomy status, number of children and pregnancies, and use of menopause hormonal therapy (HT) and hormonal contraceptives (HC).ResultsAll menopausal groups exhibited lower GMV in AD-vulnerable regions compared to men, with perimenopausal and postmenopausal groups also exhibiting lower GMV in temporal cortex compared to the premenopausal group. Reproductive span, number of children and pregnancies, and use of HT and HC were positively associated with GMV, chiefly in temporal cortex, frontal cortex, and precuneus, independent of age, APOE ε4 status, and midlife health indicators. Although reproductive history indicators were not directly associated with cognitive measures, GMV in temporal regions was positively associated with memory and global cognition scores.DiscussionReproductive history events signaling more estrogen exposure such as premenopausal status, longer reproductive span, higher number of children, and use of HT and HC were associated with larger GMV in women in midlife. Further studies are needed to elucidate sex-specific biological pathways through which reproductive history influences cognitive aging and AD risk.

OBJECTIVE The purpose of this study was to examine age at natural menopause among women of Maya and non-Maya ancestry living in urban and rural communities in the state of Campeche, Mexico. METHODS Women ages 40 to 60 (n = 543) participated in semi-structured interviews and anthropometric measures. The last names, languages spoken, and the birthplace of the woman, her parents, and her grandparents were used to determine Maya or non-Maya ethnicity. Recalled age at natural menopause was compared across four communities; analysis of variance was used to compare means and Kaplan-Meier analyses were used to compare medians. Probit analysis was also used to estimate median ages at menopause. Cox regression analyses were applied to identify variables associated with age at menopause. RESULTS Mean recalled age at natural menopause across all sites was 46.7 years, ranging from 47.8 years in the city of Campeche to 43.9 years in the rural Maya communities in the municipality of Hopelchen. Median ages at menopause across all sites were 50.55 years by probit analysis and 50.5 years by Kaplan-Meier. Variables associated with a later age at menopause included higher socioeconomic status, higher parity, and a later age at menarche. CONCLUSIONS The early mean recalled age at menopause in southern Hopelchen was consistent with previous studies in the Yucatan peninsula. As expected, probit and Kaplan-Meier analyses demonstrated later ages at menopause. Contrary to our expectations, Maya/non-Maya ethnicity was not associated with age at menopause. Demographic and reproductive factors were more important than ethnicity in explaining variation in age at menopause within the state of Campeche, Mexico.

Herlin — Werner — Wunderlich syndrome or OHVIRA (Obstructed hemivagina and ipsilateral renal anomaly) is a rare type of uterine and vaginal doubling defect (0,1 – 10,0 % of all uterine abnormalities) which is characterized by a triad of symptoms: uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal dysgenesis. The manifestation of the disease usually present after menarche, is accompanied by severe pain syndrome, leads to redoubted complications and organ-carrying operations with decreasing the fertility. At an earlier age, it can manifest itself as an infection of the genitourinary system. The diagnosis is based on clinical and anamnestic data using instrumental methods, the most accessible and safe of which is ultrasound. This article presents three clinical cases of patients 5 – 6 years old with a description of the ultrasound picture of the OHVIRA syndrome.

According to the World Health Organization (WHO) about one-fifth of the world's population of adolescents aged 10-19 years. In Indonesia, 5.2% of women experience menarche under the age of 12 from 17 provinces. The purpose of this study was to find out in-depth the experience of menarche in adolescent girls, especially in the Muhammadiyah University of Jakarta. The type of research used is qualitative research. The statements of the four informants regarding their knowledge of menarche were good, with various attitudes, behaviors, and responses. Reproductive health education is needed at this menarche phase. FKM UMJ students have various experiences regarding menarche or their first menstrual period.

AIM Age at menarche is used as a risk indicator of gestational diabetes mellitus, preterm birth, and fetal growth. However, little is known regarding the age impact on obstetric outcomes among nulliparous women. This study investigated whether menarche age was correlated with obstetric outcomes among nulliparous women. METHODS We analyzed the data obtained for 37 645 singleton pregnancies between 2011 and 2014 in the Japan Environment and Children's Study. Age at menarche was categorized into the ≤9-, 10-, 11-, 12-, 13-, 14-, and ≥15-year-old groups (n = 363, 3155, 8390, 11 164, 6713, 5446, and 2414, respectively). We calculated the relative risk for cases of preterm birth

Bacterial vaginosis is condition in which abnormal vaginal discharge can cause. Due to this sexually transmitted diseases are causing in the women. In the bacterial vaginosis there is an imbalance in the vaginal acidity the pH becomes more than 5 the bacteria becomes overgrowth and due to this bacterial infection or bacterial vaginosis leads [1]. Objective: 1: To assess the prevalence of bacterial vaginosis among women. 2: To find out the association between prevalence of bacterial vaginosis among women with socio-demographic variable. Materials and Methods: Research Approach- Quantitative research approach. Research Design: Cross sectional survey design. Setting of the Study: The study was conducted at rural hospital and primary health centre. Population: women Sampling technique: non-probability convenient sampling technique. Sample size: 115. Results: The data obtained to describe the sample characteristics including demographic variables (age of women, education, marital status, occupation, age of menarche ,menstrual history, use of contraception, types of contraception), prevalence of bacterial vaginosis women the total participant was 115 women age of 30-50 years. Hence the all findings were describes there was no association between socio demographic variables and prevalence of bacterial vaginosis is 6.1%. Conclusion In this study the finding of the study shows that overall there was n association between bacterial vaginosis and demographic variables. The prevalence of bacterial vaginosis was 6.1% in the present study which was relatively low. However it vaginosis was common among sexually active women. The test was done by pap smear test which gave exact result and interpretation of test.

Background: Menarche is the first menstruation which occurs in middle age of adolescence before entering the reproductive period. Menarche can cause negative reactions in young women due to a lack of readiness and knowledge about personal hygine during menstruation, this is can cause of UTI (Urinary Tract Infection). Asserted that the factors that influence menarche were nutritional status, exposure to mass media and fast food consumption. Media exposure to adolescents will enhance many aspects related to the sexual maturation of the adolescences. Aim of study is to determine the pornographic exposure and economic status in students. Methods: A mix methods was match qualitative and quantitative research, the samples of the research used were 47 people, they were taken using purposive sampling technique. Results: The results of this research showed that the age of menarche which occurred were8 to 12 years old. Factors associated with the menarche were socioeconomic status (p-value 0.020) and exposure to pornography (p-value 0.037). Conclusion: Pornographic and socio economic status affect the age of menarchthe results can be used as material for consideration to provide early reproductive health education and supervise children in using cellphones and internet access.

Menopause and menarche are very natural events and definitely happen to a woman. The theory states that the age of menarche is related to the age at menopause. But the existing phenomenon is that currently many women experience menopause at a slower pace, even though several decades ago they experienced a lot of slow menarche, so it should be possible to predict when they experience early menopause. Therefore, researchers are interested in examining the relationship between the age of menarche and the age of menopause. This type of research is analytic observational, with cross sectional design, the population used is all women who have menopause as many as 200 people. The sampling technique used simple random sampling, obtained a sample size of 67 respondents. Data collection uses primary data with a check list instrument. Data analysis used the Spearman rank test, with a significance value of 5% (0.05). The results of this study showed that 14 respondents (20.9%) experienced menarche tarda and normal menopause, 17 menarche with normal menopause, 10 menarche tarda early menopause (14 9%). The results of the Spearman rank analysis of the relationship between the age of menarche and the age of menopause, the rho value is -0.388 with a tcount of 3.394 (t table = 1.998). Ho is rejected if tcount ≥ ttable. This means 3,394> 1,998. This shows that there is a relationship with a negative correlation. It is concluded that there is a relationship between the age of menarche and the age of menopause with a negative correlation. Where if someone experiences precocious menarche age, there is a tendency to experience menopause at an older age and vice versa if someone experiences menarche tarda then they tend to experience early menopause. The age of menopause is influenced by many factors, including psychological factors, heredity, number of children, age at birth, use of contraception, socioeconomic conditions, chronic disease, age of menarche. And it turns out that the age of menarche is still related to the age of menopause. This can be used as an input for a woman to prepare herself for menopause.

STUDY OBJECTIVE: To characterize typical menstrual characteristics in a large sample of secondary school girls, as well as knowledge of typical (ie, normal) menstruation, endometriosis awareness, and educational needs. To establish whether self-reported atypical period symptoms indicate menstrual characteristics suggesting the need for further clinical review for a specialist opinion. DESIGN: Cross-sectional survey. SETTING: Secondary schools in West Midlands, England. PARTICIPANTS: A total of 442 girls, aged 15-19 years. INTERVENTIONS AND MAIN OUTCOME MEASURES: The questionnaire determined demographic characteristics, age at menarche, menstrual cycle patterns and experiences, awareness of endometriosis, and preferences for learning about it. RESULTS: Period pain was common (94%), with pain reported as moderate/severe (86%). Girls reported missing school due to their menstrual periods (23%), mainly because of pain. Most believed their period was typical (63%); however, 27% were unsure, and 30% did not know whether it was regular. Self-report of atypical periods was associated with symptoms suggesting need for clinical review and with consulting a doctor [χ²(2) = 36.272, P < .001)]. Only 8% could describe endometriosis, although 86% wanted to learn more about it. CONCLUSION: Most secondary school girls report dysmenorrhea. Although most girls reporting atypical periods had seen a doctor, more than one-fourth did not know whether their period was typical or regular. The majority do not have knowledge of endometriosis, contrasting with adolescents' familiarity with other common chronic conditions such as diabetes and epilepsy. We suggest menstrual health education (MHE) to improve knowledge of typical menstruation and pain treatment, aiding earlier identification of problematic period symptoms that might indicate underlying pathology.

BACKGROUND: Female menstrual and reproductive factors, as remarkable indicators of hormone effect, were hypothesized to be associated with lung cancer risk, whereas the existed epidemiological evidence was inconsistent. Our study aims to investigate the association between menstrual and reproductive factors and lung cancer risk based on the Chinese Lung Cancer Screening Program. METHODS: This study was based on a large-scale multi-center population cohort across China recruiting individuals aged 40–74 years old between 2013–2018. Cox regression model was applied to estimate the HRs and 95% CIs. Restricted cubic spline (RCS) analysis was used to estimate dose-response relationships and test for nonlinear associations. RESULTS: Among 553,434 female participants, 1,529 incident lung cancer cases were identified with a median follow-up of 3.61 years. With adjustment for multiple covariates and all significant hormonal factors, elevated lung cancer risk was associated with later age (15, or ≥16 years) at menarche (HR =1.27, 95% CI: 1.04–1.56; HR =1.45, 95% CI: 1.19–1.76), later age (25–29, or ≥30 years) at first live birth (HR =1.27, 95% CI: 1.13–1.43; HR =1.23, 95% CI: 1.00–1.51), and benign breast disease history (HR =1.25, 95% CI: 1.10-1.41). For postmenopausal females specifically, surgical menopause (HR =1.62; 95% CI: 1.29–2.05) and other surgeries on the reproductive system (HR =1.19; 95% CI: 1.01–1.40) both appeared to be predictive of elevated lung cancer risk. Concerning age at menopause, a nonlinear association was observed (P-nonlinear =0.0126). Increased lung cancer risk was observed among females with age at menopause especially above 50. Although we observed no significant associations between longer time (≥13 months) of breastfeeding and lung cancer risk among all participants (HR =0.86; 95% CI: 0.71–1.04), significant decreased adenocarcinoma risk (HR =0.65; 95% CI: 0.53–0.81) was noted among nonsmoking females. CONCLUSIONS: Our findings add some support for the role of menstrual and reproductive factors in lung carcinogenesis. However, these relationships were complex, and required further investigations addressing the biological mechanisms.

Study Objective Evaluation of acute abdominal pain in an adolescent female patient should include consideration of all potential sources of pain, including gynecologic etiologies. The goal of our study was to determine the frequency of evaluation of gynecologic causes of abdominal pain in adolescent girls seen in a pediatric emergency department. Study Design A retrospective review was performed of girls between 12 and 21 years of age presenting to the emergency department or urgent care centers at a single pediatric institution with the chief complaint of abdominal pain during 2016. Frequency analyses of demographic and clinical characteristics are presented. Results A total of 1082 girls presented with a chief complaint of abdominal pain. Menarche was documented in 85% of patients, sexual history in 52% of patients, and assessment of contraception use in 28%. Pregnancy testing was performed in 77%. Sexually transmitted infection (STI) testing was performed in 31%, and in only 73% of patients who reported being sexually active. Imaging was performed in 52%. In the subgroup of patients who reported being sexually active and presented with abdominal pain and vaginal discharge, only 37% had a pelvic examination performed. In multivariable modeling, Black patients were significantly more likely than White patients to have STI testing performed (adjusted risk ratio [aRR] = 1.39; confidence interval [CI] = 1.13-1.70) and to undergo a pelvic examination (aRR = 2.45; CI = 1.34-4.50), and less likely to undergo imaging (aRR = 0.69; CI = 0.59-0.81). Conclusion The assessment of abdominal pain in adolescent girls should include gynecologic etiologies. Our results raise concerns that there are deficiencies in the evaluation of gynecologic sources of abdominal pain in girls treated at pediatric facilities, and evidence of potential racial disparities.

Although decades have passed since most women in the democratic world gained the right to vote and run for election, a large gender gap in political participation persists, particularly in developing countries. This short paper considers an important—and previously overlooked—factor limiting the political engagement of many women in the developing world: marriage age. Drawing on nationally representative data from India and instrumenting marriage age with menarche age, we find delaying marriage has substantial positive effects on women’s everyday political participation. A standard deviation increase in marriage age makes a woman 25 percent more likely to attend local council meetings, and 8 percent more likely to discuss politics with her husband. Exploring mechanisms, we show that education and time—rather than employment, mobility, and household decision-making power—appear to be the main channels. These findings underscore the critical role of early marriage in impeding women’s participation in the political sphere.

Background We aimed to evaluate the association between menstrual cycle irregularity and suicidal ideation in Korean women. Methods Data on 5,606 women from the 2010–2012 Korea National Health and Nutrition Examination Survey, a population-based cross-sectional study, were included. Menstrual cycle irregularity, suicidal ideation, current occupational status, age at menarche, education level, household income, and marital status were assessed through questionnaires with trained interviewers. A multivariate logistic regression analysis was performed after adjusting for age, socioeconomic status, smoking and drinking status, age at menarche, comorbid diseases, and physical activity. Results In the multivariate-adjusted models, we found significant associations between menstrual cycle irregularity and suicidal ideation (odds ratio [OR], 95% confidence interval [CI] = 1.44 [1.14–1.82]). This association was particularly noticeable in women aged 12 to 29 years (OR [95% CI] = 1.45 [1.04–2.03]), in those who had menarche at a relatively early age (aged 8–13 years) (OR [95% CI] = 1.60 [1.15–2.23]), and in those who were currently employed (OR [95% CI] = 1.46 [1.05–2.04]). Limitations Suicidal ideation was evaluated based on the participants’ self-reports, and were therefore subjective in nature. Additionally, due to the cross-sectional design and use of retrospective data, causal relationships could not be drawn. Conclusion Women with irregular menstrual cycles were 1.42 times more likely to have suicidal ideation than those with regular cycles. More attention should be paid to menstrual cycle irregularity when attempting to improve levels of suicidal ideation.

Objectives To examine factors relating to both sexual inactivity and sexual dysfunction in midlife Singaporean women. Study design Sociodemographic, medical/lifestyle factors, physical activity, BMI, handgrip strength (HGS) and physical performance data collected from healthy Chinese, Indian, and Malay women, aged 45–69 years, attending gynaecology clinics. Main outcome measures Sexual inactivity and sexual dysfunction (defined as total score ≤ 26.55) assessed using the Female Sexual Function Index (FSFI). Results 1048 women completed the FSFI. Mean (±SD) age was 56.2 (±6.2). Sexual inactivity was reported by 43.2% and was positively associated with older age [55-64 years (aOR 2.0, 95% CI 1.3-3.0) and ≥65 years (aOR 2.5, 95% CI 1.2-5.1)], younger menarche (aOR 1.8, 95% CI 1.3-2.5), lowest education (aOR 2.1, 95% CI 1.2-3.6), lowest income (aOR 1.8, 95% CI 1.1-2.8), unmarried (aOR 4.0, 95% CI 2.6-6.4), nulliparity (aOR 1.9, 95% CI 1.1-3.4), and BMI Conclusion This, the largest Singaporean sexual function study, is the first to include physical performance in a healthy population. Most were sexually active but reported dysfunction. Novel associations included underweight BMI with sexual inactivity and weaker HGS and Malay ethnicity with greater and less sexual dysfunction, respectively.

Purpose: This study aimed to evaluate the time interval to menarche after gonadotropin-releasing hormone agonist (GnRHa) treatment in females with central precocious puberty (CPP) and to identify factors contributing to timing of menarche.Methods: We retrospectively reviewed medical records of 39 females with CPP who reached menarche after GnRHa treatment (leuprolide or histrelin). CPP diagnostic criteria were breast development at

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders and causes of infertility in women in reproductive age. Diagnostic criteria of PCOS in adult women include: ovulation disorders, hyperandrogenism and polycystic ovaries. According to most recommendations, 2 out of these 3 criteria are confirm the diagnosis of PCOS. In girls during puberty and in the first years after menarche, different diagnostic criteria of menstrual disorders should be taken into account (variable length of menstrual cycles, monophasic cycles) and the limited usefulness of ultrasound examination for PCOS diagnosis within 8 years after menarche. Fairly extensive differential diagnosis is also necessary, especially – exclusion of adrenal hyperandrogenism. Moreover, the diagnostic criteria of PCOS do not take into account the metabolic disorders found in most patients (obesity, insulin resistance, type 2 diabetes), which should be diagnosed as early as possible and treated appropriately. This is especially true for teenagers, in whom the unequivocal diagnosis of PCOS or its exclusion may be very difficult. Current recommendations regard hormonal contraception as the first-line therapy in PCOS, in both adult women and adolescents. Together with its beneficial effect on the reduction of hyperandrogenism and obtaining regular bleeding (which in fact are not menstruations), the unfavorable metabolic effects of hormonal contraception are emphasized, as well as the inadequacy of its use if it is expected to achieve or restore ovulation and fertility. The latest reports indicate the legitimacy of treatment aimed at correcting disorders of carbohydrate metabolism and its greater effectiveness compared to the use of oral contraceptives in both adult women and girls with PCOS. In the pharmacotherapy of insulin resistance, metformin is of fundamental importance, the use of pioglitazone, GLP-1 receptor agonists or inositols is also proposed. Adequate lifestyle and dietary modification are of major importance in the treatment and prevention of PCOS. The mechanisms of "inheritance" of PCOS and insulin resistance with the participation of epigenetic modifications are still better understood, taking into account the effects of exposure to androgen excess in utero, intrauterine growth retardation, and maternal obesity and hyperalimentation. This creates new possibilities for PCOS prophylaxis.

Menstrual hygiene is defined as the principle of maintaining the cleanliness of the body during menstrual flow. It requires basic facilities such as appropriate clothes, soakage material, water, soap, and toilet facilities with privacy. Many studies have revealed that most adolescent girls had incomplete and inaccurate information about menstrual hygiene and physiology. It also revealed that mothers, television, friends, teachers, and relatives were the main sources that provided information on menstruation to adolescent girls. In our study, most of the girls belong to the age group of 15 – 17 that is 448 participants are from that age group which comprises about 89% and they mostly belong to intermediate which is around 442 students (88.4%). 90.6% of the girls knew that menstruation occurs only in females and 88% of the girls aware that the best sanitary products are pads and only 39.6% of girls knew about menstruation before menarche. It was observed that only 37.2% of girls knew that infection would occur if they don’t clean their vagina regularly during their menstruation. Maximum that is 304 (60.8%) girls responded for dysmenorrhoea in the present study. The majority of these responses were in the age group of 13–15 years. the knowledge on menstruation and menstrual hygiene was found to be unsatisfactory although the practices were noted to be good. The majority of girls attained menarche in the study. Menstrual hygiene is an issue that needs to be addressed at all levels. In our study majority of the mothers were found to be illiterates, as mothers are the first informant to the majority of adolescent girls the health education actives can be extended to the mothers to improve awareness.

Menarche is the first menstruation, the first menstrual cycle or the first menstrual bleeding in women. From a social and medical point of view, this condition is seen as an important event of female puberty, as a sign of fertility. Adolescents who have known about menarche will feel happy when they experience it. While negative feelings such as anxiety, fear, shame and confusion. This study aims to determine the level of knowledge of young women about menarche at SMP St.Yoseph Medan. This research method is descriptive research. The number of samples as many as 53 people, sampling using total sampling technique. From 53 respondents, the results showed that the majority of respondents' knowledge about menarche was in the sufficient category, which was 50.9%. While the good category is 37.7%, and the less category is 11.3%. Based on the age of the majority of respondents with sufficient knowledge as much as 39.6% aged 14-15 years and the minority with less knowledge 1.9% aged 12-13 years. Based on information sources, the majority of respondents obtained information from the mass media as much as 15.1% and the minority 1.9%. From the results of this study, it is hoped that the school and parents of students can play an active role in providing reproductive health, especially menarche.

Polymorphisms of the TNFRSF11A and TNFSF11 genes were reported for their association with age at menarche (AAM) and age at natural menopause (ANM). However, the biological mechanisms underlying this association remain largely unclear. The aim of the study: This study was to determine biological processes backing the observed genetic associations. Materials and methods: Fortyfour SNPs were analyzed using in silico approach and ten publicly available online databases and tools. Results: TNFRSF11A and TNFSF11 are highly pleiotropic genes that play a role in many metabolic processes. However, among that variety, lipid metabolism and cell survival and apoptosis seem the most biologically plausible mechanisms, through which these genes contribute to AAM and ANM. The analysis identified several mechanisms underlying the previously determined association of the TNFRSF11A and TNFSF11 genes with AAM and ANM and suggested RELCH/KIAA1468, LINC02341, and AKAP11 as new candidate genes for the traits.

Puberty is the process through which reproductive competence is achieved and comprises gonadarche and adrenarche. Breast development is the initial physical finding of pubertal onset in girls and typically occurs between 8 and 13 years. Menarche normally occurs 2 to 3 years after the onset of breast development. Pubertal onset is controlled by the gonadotropin-releasing hormone pulse generator in the hypothalamus; however, environmental factors such as alterations in energy balance and exposure to endocrine-disrupting chemicals can alter the timing of pubertal onset. Improvement in nutritional and socioeconomic conditions over the past two centuries has been associated with a secular trend in earlier pubertal onset. Precocious puberty is defined as onset of breast development prior to 8 years and can be central or peripheral. Delayed puberty can be hypogonadotropic or hypergonadotropic and is defined as lack of breast development by 13 years or lack of menarche by 16 years. Both precocious and delayed puberty may have negative effects on self-esteem, potentially leading to psychosocial stress. Patients who present with pubertal differences require a comprehensive assessment to determine the underlying etiology and to devise an effective treatment plan.

Menarche didefinisikan sebagai pertama kali menstruasi, yaitu keluarnya cairan darah dari alat kelamin wanita berupa luruhnya lapisan dinding dalam rahim yang banyak mengandung pembuluh darah. Tujuan penelitian adalah untuk mengetahui gambaran pengetahuan remaja putri siswi kelas IX tentang dismenorhoe di MTS Al Hikmah 1 Benda Kabupaten Brebes. Jenis penelitian yang digunakan dalam penelitian ini adalah metode penelitian deskriptif. Berdasarkan hasil penelitian mengenai Gambaran Pengetahuan Remaja Putri Siswi Kelas IX tentang Dismenorhoe di MTS Al Hikmah 1 Kabupaten Brebes, hal ini menunjukan bahwa sebagian besar dari siswi yang merupakan responden dari penelitian tentang kejadian dysminorhoe merupakan siswi yang berusia 14 tahun (59%), lalu kurang dari setengahnya dari siswi yang berusia 15 tahun berjumlah 28 orang (28%), lalu sebagian kecil dari responden berusia 13 tahun berjumlah 9 orang (9%), dan hampir tidak ada dari responden kurang dari 13 tahun atau lebih dari 15 tahun. Berdasarkan hasil penelitian yang telah diuraikan maka kesimpulan yang dapat ditarik adalah gambaran pengetahuan remaja putri siswi kelas IX MTS Al Hikmah 1 tentang dysminorhoe berdasarkan karakteristik, diketahui bahwa lebih dari setengahnya dari responden berusia 14 tahun berjumlah 59 orang dan sebagian kecilnya berusia 12 dan 16 tahun.

Menopause represents the definite end of a woman's reproductive life and the onset of a persistent hypoestrogenic state. This postmenopausal period will for most women last several decades. Although mean menopausal age seems to have increased somewhat during the last century, there is a significant individual variation in age at natural menopause. With efficient contraception, women of reproductive age can now, to some extent, choose when they want to have children. As a consequence of this and other sociodemographic changes, age at first birth has increased significantly over the last 50 years. It is well documented that long before a woman enters the menopausal transition and subsequent menopause, fertility declines and finally ceases. Being able to predict when a woman will enter menopause would therefore, from a reproductive perspective, be of major interest. Several sociodemographic, morphometric, and endocrine factors are associated with age at menopause or time to menopause. Unfortunately the sensitivity and specificity of these in predicting time to or age at menopause are low. Therefore, with the exception of anti-Müllerian hormone measurements, either alone or in combination with chronological age close to menopause, there are as of now no reliable ways of predicting when a woman will enter menopause.

Актуальність. Здоров’я дітей та підлітків є найбільш яскравим показником благополуччя нації, стану економічної та соціальної сфери. Тому особливо гостро на даний час стоїть питання щодо раннього виявлення і своєчасного лікування дівчаток з порушеннями статевого розвитку та розладами менструальної функції, особливо тих, які зазнали сильний психоемоційний вплив. Перебування людини в травматичній ситуації не обмежується розвитком психологічних наслідків, страждає також фізичне, соматичне, репродуктивне здоров’я. Все це вимагає комплексних і міждисциплінарних досліджень. Мета дослідження: вивчення особливостей фізичного, статевого розвитку та менструальної функції у дівчаток із зони військового конфлікту на сході країни, які знаходяться на лікуванні в ДУ «Інститут охорони здоров’я дітей та підлітків НАМН України». Матеріали та методи. Обстежено 192 дівчинки 7–17 років, які надійшли в різні відділення інституту. Проводились антропометричні дослідження за загальноприйнятими методиками з використанням центильних таблиць. Статевий розвиток визначався за інтенсивністю розвитку вторинних статевих ознак відповідно до класифікації J. Tanner. Оцінювалися час старту менструальної функції та особливості її становлення. Результати. Репродуктивний потенціал дівчаток із зони військового конфлікту має високий рівень відхилень, що виражається в погіршенні фізичного розвитку, розладах статевого дозрівання і порушеннях менструальної функції. Причому у дівчаток, які постраждали в результаті бойових дій на сході країни, він виглядає гірше, ніж у школярок з основної популяції. Виявлено особливості порушень фізичного, статевого розвитку та менструальної функції у дівчаток із зони безпосередньо збройного конфлікту, сірої зони і переселенців. Висновки. Вивчення і розуміння проблем дітей, які постраждали в результаті військового конфлікту, динамічна оцінка їх фізичного, статевого розвитку, становлення менструальної функції необхідні для розробки ефективних програм допомоги цим дітям. Це дасть можливість вчасно розпочати лікувальні заходи з відновлення репродуктивного потенціалу та попередити репродуктивні втрати в майбутньому.