The Demographic and Clinical Characteristics in Association with Age at Onset of Menarche in a Sample of Iraqi Adolescent Girls: A Cross Sectional Study

Abstract

Background:The onset of menstruation ―Menarche‖ is one of the neglected indicators of girls’ health in the community. In addition to its implication as a marker of transition from childhood to young adulthood, it plays an important role in identification of health including physical, nutritional and reproductive aspects. Menarche marks the initiation of reproductive activity and thus may put a girl at risk of negative reproductive and sexual outcomes including early pregnancy complications, birth outcomes and sexually transmitted infections. Aim of the study:the aim of the current study was to figure out the association between demographic and clinical characteristics of girls and age at onset of menarche. Subjects and methods:The current cross sectional study was carried out at Al-Diwaniyaha Maternity and Children Teaching Hospital and private clinic. The study has extended from January the 2nd 2019 through August the 15th 2020. The study included 207 adolescent girls from who were randomly selected from the pool of girls visiting the hospitaland private clinic during the period of study. A questionnaire form was prepared after reviewing articles dealing with onset of menarche and related outcomes in developed and underdeveloped countries and accordingly it included information about age, age of menarche, body mass index, length of menstrual cycle, the amount of menstruation and its duration, associated clinical features such as dysmenorrheal and hirsuitism, pelvic ultrasound findings, hormonal essays (luteinizing hormone (LH), follicular stimulating hormone (FSH), testosterone hormone) and treatment items. Results:The mean age at onset of menarche was 12.43 ±1.69 years with a range of 8 -15.2 years. Girls with early menarche accounted for 85 (41.1 %), girls with medium menarche accounted for 108 (52.2 %) and girls with late menarche accounted for 14 (6.8 %). There was highly significant difference in mean BMI among girls according to onset of menarche (p< 0.001) and the proportion of obese and overweight girls was significantly higher in group with late menarche in comparison with both early and medium menarche groups. Polymenorrhea was significantly associated with early menarche, whereas, Oligomenorrhea was significantly associated with late menarche. There was no significant difference in mean serum LH (p > 0.05), but high serum FSH and testosterone were significantly associated with late onset (p< 0.05). Poly cystic ovary syndrome (PCOS) was more frequently seen in association with late and medium onset in a highly significant manner (p< 0.001). Conclusion:Early menarche is common in our community. Obesity is associated with late menarche and disturbed FSH and testosterone in late onset menarche may explain the occurrence of PCOS in association with late onset menarche.