Onset Of Menarche Research Articles

Milk Consumption after Age 9 Years Does Not Predict Age at Menarche1–3

Regular milk consumption during childhood and adolescence is recommended for bone health. However, milk consumption increases circulating insulin-like growth factor I concentrations, and may also accelerate puberty. We prospectively investigated the association between milk consumption and age at menarche in the Growing Up Today Study. Study participants were 5583 US girls who were premenarcheal and ages 9-14 y in 1996. Girls were followed through 2001, at which time 97% of noncensored participants had reported menarche. Frequency of milk and meat consumption was calculated with the use of annual youth/adolescent food frequency questionnaires from 1996-1998. Intake of related nutrients was also measured. Age at menarche was self-reported annually through 2001. During follow-up, 5227 girls attained menarche over 10,555 accrued person-years. In models adjusted for dietary and sociodemographic predictors of menarche, frequency of milk consumption did not predict age at onset of menarche (for >3 glasses of milk/d vs. 1.1-4 glasses/wk, HR: 0.93; 95% CI: 0.83, 1.04). After additional adjustment for body size, premenarcheal girls consuming >3 glasses of milk daily were 13% less likely (95% CI: -3%, -23%; P-trend: <0.01) to attain menarche in the next month relative to those consuming 1.1-4 glasses/wk. Neither total meat nor red meat consumption was associated with age at menarche. Our findings suggest that regular consumption of milk in girls aged ≥9 y is unlikely to substantially affect age at onset of menarche. Studies assessing associations between diet in early childhood and pubertal timing may be more illuminating.

Are Elite Female Soccer Athletes at Risk for Disordered Eating Attitudes, Menstrual Dysfunction, and Stress Fractures?

ObjectiveTo determine the prevalence of stress fractures, menstrual dysfunction and disordered eating attitudes in elite female soccer athletes. DesignCross-sectional descriptive study. SettingFemale soccer athletes were recruited from a national level youth soccer club, an NCAA Division I university team, and a women's professional team. ParticipantsTwo hundred twenty female soccer athletes with a mean age of 16.4 ± 4 years and BMI of 20.8 ± 2 kg/m2 completed the study, representing all athletes from the included teams. MethodsOne-time surveys completed by the athletes. Main Outcome MeasurementsHeight and weight were recorded, and body mass index (BMI) was calculated for each athlete. Athletes reported age of menarche, history of missing 3 or more menses within a 12-month period and stress fracture. The Eating Attitudes Test (EAT-26) was used to assess the athlete's body perception and attitudes toward eating. ResultsOf the 220 soccer athletes, 3 athletes (1.6%) had a low BMI for their age, and 19 (8.6%) reported stress fractures of the lower extremity. Among athletes who had reached menarche, the average onset was 13 + 1 year; menstrual dysfunction were present in 21 (19.3%). On the EAT-26, 1 player scored in the high risk range (>20) and 17 (7.7%) scored in the intermediate risk range (10-19) for eating disorders. Athletes with an EAT-26 score ≥ 10 points had a significantly higher prevalence of menstrual dysfunction in the past year compared to athletes with an EAT-26 score of less than 10 (P = .02). ConclusionsElite female soccer athletes are susceptible to stress fractures and menstrual dysfunction and have delayed onset of menarche despite normal BMI and appropriate body perception and attitudes towards eating. Further studies are needed to better understand stress fracture risk in female soccer athletes and in other team sports to determine how these findings relate to long-term bone health in this population.

Remission of Pseudotumor Cerebri Syndrome after Initiating Pregnancy and Menarche: The Puzzling Role of Female Sex Hormones

Pseudotumor cerebri syndrome (PTCS) is characterized by increased intracranial pressure with normal cerebrospinal fluid components and no detectable anomalies of the brain parenchyma on magnetic resonance imaging. Presenting signs and symptoms are heterogeneous, but they commonly include headache, visual disturbances (i.e., vision loss and/or double vision), and papilledema. The etiology is uncertain, but several underlying risk factors associated with PTCS have been identified, including obesity, endocrine abnormalities (e.g., hyperaldosteronism, Cushing syndrome, hyperandrogenism, and Addison disease), medications (e.g., tetracycline, recombinant growth hormone therapy), and viral infections (e.g., chickenpox). Patients with postpubertal PTCS are more typically females in their reproductive age, thereby making crucial (although not fully understood) the role of female hormones in the pathophysiology of this condition. We describe two female patients with PTCS who were followed up at our institution. They experienced prompt (and full) remission of headache and visual disturbances during the first trimester of pregnancy and within the first 2 months after the onset of menarche (i.e., at 20 and 11 years of age), respectively. We reviewed the literature searching for similar cases and hypothesized on the pathophysiologic (and still unclear) involvement of female sex hormones in regulating intracranial pressure, making some patients prone to PTCS.

Uretero-Uterine Fistula

Primary cyclic hematuria occurring with the onset of menstruation can be a presenting symptom of a fistula between the Mullerian structures (uterus/cervix/upper vagina) and the urinary tract. When occurring, these fistulas are most often vesicovaginal connections caused by congenital Mullerian anomalies. We present a case of a fistula occurring between a bicornuate uterus and the ureteral stump that had been ligated at the time of ureteral reimplantation during childhood. The presenting symptom was cyclic hematuria beginning at the age of 14 years with the onset of menarche. Cystoscopy and retrograde pyelogram showed a fistula connecting the ureteral stump (which had been ligated at the time of ureteral reimplantation) to the small horn of the bicornuate uterus. Computed tomographic scan showed bilateral single orthotopic kidneys and collecting systems. The patient underwent successful transvaginal and transvesical surgical repair of the fistula, with complete resolution of her cyclic hematuria. We review genitourinary embryology in discussion of this unusual case.

ADENOMIOSIS UTERINA ESTUDIO CLINICO EPIDEMIOLOGICO

Se revisó 2150 histerectomías practicadas durante los años 1984 a 1986 de las cuales 547 presentaron el diagnóstico de adenomiosis uterina por examen anátomo-patológico, se seleccionó 452 casos en los que fue posible evaluar características clinico-epidemiológicas. Se demuestra un predominio en el grupo etario correspondiente a 41-50 años con una distribución preferente en edad premenopáusica (p &lt;0.05). Los antecedentes del número de partos y (p &lt; 0.05) de cirugía gineco-obstétrica, en particular la presencia de legrados uterinos va asociada a una mayor frecuencia de enfermedad (p &lt;0.05). No se ha encontrado asociación estadísticamente significativa para la presentación de adenomiosis según: edad de aparición de menarquía, edad de inicio de relaciones sexuales, número de gestaciones por paciente y antecedente quirúrgico de cesárea previa. La sintomatología clínica por la cual acudieron las pacientes fueron: hemorragia uterina anormal y dolor abdomino-pélvico. AI examen clínico se consideró con frecuencia el útero dentro de límites normales y de superficie regular. Se concluye que la presencia de adenomiosis uterina puede establecerse a partir de un alto índice de sospecha en pacientes sintomáticas, que se encuentran en edad, premenopaúsica con antecedentes de multiparidad y/o traumatismo quirúrgico directo sobre el útero.

Reply to "Accuracy of Self-Report of Sexual Activity among Adolescent Girls: Implications for Interpretation of Vaginal Flora Patterns".

We appreciate the interest of Muzny and Schwebke in our paper entitled “Vaginal microbiota of adolescent girls prior to the onset of menarche resemble those of reproductive-age women” (1, 2), in which we report the longitudinal changes in vaginal and vulvar microbial communities of adolescents that occur prior to and immediately following menarche. Muzny and Schwebke focus their comments on the occurrence of Gardnerella vaginalis in the vaginal and vulvar communities of some perimenarcheal adolescents. …

A review of the risk factors for lower extremity overuse injuries in young elite female ballet dancers.

The objective of this study was to review the evidence for selected risk factors of lower extremity overuse injuries in young elite female ballet dancers. An electronic search of key databases from 1969 to July 2013 was conducted using the keywords dancers, ballet dancers, athletes, adolescent, adolescence, young, injury, injuries, risk, overuse, lower limb, lower extremity, lower extremities, growth, maturation, menarche, alignment, and biomechanics. Thirteen published studies were retained for review. Results indicated that there is a high incidence of lower extremity overuse injuries in the target population. Primary risk factors identified included maturation, growth, and poor lower extremity alignment. Strong evidence from well-designed studies indicates that young elite female ballet dancers suffer from delayed onset of growth, maturation, menarche, and menstrual irregularities. However, there is little evidence that this deficit increases the risk of overuse injury, with the exception of stress fractures. Similarly, there is minimal evidence linking poor lower extremity alignment to increased risk of overuse injury. It is concluded that further prospective, longitudinal studies are required to clarify the relationship between growth, maturation, menarche, and lower extremity alignment, and the risk of lower extremity overuse injury in young elite female ballet dancers.

Could exposure to phthalates speed up or delay pubertal onset and development? A 1.5-year follow-up of a school-based population

PurposePhthalates may interfere with the timing of pubertal development in adolescence and existing studies have shown inconsistent results. This study aims to assess the associations of pubertal onset and progression with urinary concentrations of phthalate metabolites in school-aged boys and girls. MethodsUsing isotope-dilution liquid chromatography tandem mass spectrometry, we analyzed 6 phthalate metabolites in urine samples of 430 children (222 boys and 208 girls) aged 9.7±2.2years (age range 6.1 to 13.8years) at baseline and 18months of follow-up. The associations of exposures to phthalates with pubertal development such as the testis, breast and pubic hair were evaluated using ordered logistic regression models, adjusting for baseline development stage, current chronological age, current body fat composition, and parental education. ResultsUrinary mono-n-butyl phthalate (MnBP) was associated with a 39% increase in the odds of presenting lower pubic hair development stages in boys, and mono (2-ethylhexyl) phthalate (MEHP) (p<0.10), mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono (2-ethyl-5-oxohexyl) phthalate (MEOHP) were associated with 54%–65% increase in the odds of presenting higher breast development stages in girls (p<0.05), while MEHHP and MEOHP were also associated with a 70% increase in the odds of menarche onset (p<0.05). After adjusting for potential confounding variables, the associations of girls' pubertal onset with MnBP, MMP, MEP and MEHP were significant. The odds of girls' breast onset were 4 to 10 times higher in high MnBP, MMP, MEP or MEHP exposure group than in low exposure group. ConclusionsOur findings suggest subtle effects of phthalate metabolites associated with pubertal onset and progression. MnBP exposure may be associated with delayed pubic hair development in boys, while MnBP, MMP, MEP, and MEHP exposures may be associated with breast onset, and MEHP metabolites associated with speedup in breast development progression and earlier menarche onset in girls.

Hormonal factors and incident asthma and allergic rhinitis during puberty in girls

BackgroundAccumulating evidence is indicating that hormonal factors play a role in new-onset allergic rhinitis and asthma after puberty. ObjectiveTo determine whether age at menarche and use of hormonal contraceptives predict new-onset allergic rhinitis and asthma after puberty in young German women. MethodsA prospective community-based cohort study followed 1,191 girls 9 to 11 years old to early adulthood (19–24 years old). Self-administrated questionnaires concerning age at menarche, use of hormonal contraceptives, and status and age at onset of physician-diagnosed allergic rhinitis and asthma were collected at 16 to 18 and 19 to 24 years of age. Logistic regression models were used to analyze the incidence of asthma and allergic rhinitis after puberty and pooled estimates were obtained from the final model. ResultsEleven percent of girls developed allergic rhinitis after menarche and 3% reported new-onset asthma. Late menarche (>13 years of age) was statistically significantly inversely related to allergic rhinitis (adjusted odds ratio [OR] 0.32, 95% confidence interval [CI] 0.14–0.74) but did not reach the level of statistical significance for asthma (OR 0.32, 95% CI 0.07–1.42). Use of hormonal contraceptives was inversely associated with new-onset allergic rhinitis (OR 0.14, 95% CI 0.08–0.23) and asthma (OR 0.27, 95% CI 0.12–0.58) after puberty. ConclusionThis study shows that girls with late onset of menarche are less likely to develop allergic rhinitis after puberty compared with those who have menarche at an average age. These findings also suggest that, in addition to endogenous hormones, hormonal contraceptives play a role and might protect young women from allergies and asthma.

Adolescent Endogenous Sex Hormones and Breast Density in Early Adulthood

Abstract During adolescence the breasts undergo rapid growth and development under the influence of sex hormones. Although the hormonal etiology of breast cancer is hypothesized, it remains unknown whether adolescent sex hormones are associated with adult breast density, which is a strong risk factor for breast cancer. METHODS: Percentage of dense breast volume (%DBV) was measured in 2006 by magnetic resonance imaging in 177 women aged 25–29 years who participated in the Dietary Intervention Study in Children from 1988–1997 and had sex hormones and sex hormone binding globulin (SHBG) measured in serum collected on 1–4 occasions between 8 and 17 years of age. Multivariable linear mixed-effect regression models were used to evaluate the associations of adolescent sex hormones and SHBG with %DBV. RESULTS: Dehydroepiandrosterone sulfate (DHEAS) and SHBG measured in premenarche serum samples were significantly positively associated with %DBV (all Ptrend ≤ 0.03) but not when measured in postmenarche samples (all Ptrend ≥ 0.42). The multivariable geometric mean of %DBV across quartiles of premenarcheal DHEAS and SHBG increased from 16.7% to 22.1% and from 14.1% to 24.3%, respectively. Estrogens, progesterone, androstenedione, and testosterone were not associated with %DBV pre- or post-menarche (all Ptrend ≥ 0.16). CONCLUSIONS: Our results suggest that higher DHEAS and SHBG levels during adolescence, particularly before the onset of menarche, are associated with higher%DBV in young women. Whether this association translates into an increased risk of breast cancer later in life is currently unknown.

Vaginal microbiota of adolescent girls prior to the onset of menarche resemble those of reproductive-age women.

ABSTRACTPuberty is an important developmental stage wherein hormonal shifts mediate the physical and physiological changes that lead to menarche, but until now, the bacterial composition of vaginal microbiota during this period has been poorly characterized. We performed a prospective longitudinal study of perimenarcheal girls to gain insight into the timing and sequence of changes that occur in the vaginal and vulvar microbiota during puberty. The study enrolled 31 healthy, premenarcheal girls between the ages of 10 and 12 years and collected vaginal and vulvar swabs quarterly for up to 3 years. Bacterial composition was characterized by Roche 454 pyrosequencing and classification of regions V1 to V3 of 16S rRNA genes. Contrary to expectations, lactic acid bacteria, primarily Lactobacillus spp., were dominant in the microbiota of most girls well before the onset of menarche in the early to middle stages of puberty. Gardnerella vaginalis was detected at appreciable levels in approximately one-third of subjects, a notable finding considering that this organism is commonly associated with bacterial vaginosis in adults. Vulvar microbiota closely resembled vaginal microbiota but often exhibited additional taxa typically associated with skin microbiota. Our findings suggest that the vaginal microbiota of girls begin to resemble those of adults well before the onset of menarche.

Medico-social factors influencing the menstrual function in adolescents with overweight

Obesity is a serious medical, social and economic issue in modern society. Relevance it is determined primarily by the high prevalence of obesity. Objective: identify medical and social factors influencing the development of obesity in adolescent girls with menstrual cycle. Materials and methods: questionnaires, analysis of medical records, clinical, laboratory and instrumental examination 167 girls from 14 to 18 years with obesity I degree (28,7 %), obesity degree II (58,1 %), obesity III degree (13.2 %) and their parents, and 211 girls with normal body weight and their parents. Results: artificial feeding from birth had 23,2% of the young women of the main group, in the control group the rate was 7.4 %. The regularity of meals keep 12.5 % of adolescents in primary and 27.1 % of adolescents in the control groups. The prevalence of high-calorie foods noted 21.1 % of girls are obese and only 4.9 % of normal body weight. The average age at onset of menarche in girls with obesity was 10 years and 9 months, which is 11 months earlier than in the con-control group girls. Girls with overweight significantly more often in 80.6 % of identified disorders of lipid compared with a group of girls with normal body weight, in 13.9 % of cases respectively. In the main group was observed hormonal changes, talking about changing the gonadotropic function of the pituitary gland, disorders of the cyclical release of gonadotropins, the absence of physiological “ovulatory peak”, a chaotic secretion of FSH and LH, the violation of physiological ratio of FSH/LH. When conducting USDG in the first group identified dyscirculatory violations arterial bed, in the form of the asymmetry of the flow and signs of venous degenii in the form of increased speed of blood flow in the jugular veins, monophasic flow in the veins, the blood flow in the vertebral veins in a horizontal position. Conclusions: the menstrual cycle occurs under the action of complex factors, such as physical illness, unbalanced diet, chronic stress, bad habits, poor physical living conditions. A survey of adolescent girls who turned over the menstrual cycle and with obesity should be integrated and include in addition to the laboratory, instrumentaltion survey joint management of such patients related-governmental experts.

Timing of menarche related to carotid artery intima-media thickness in black and white young adult women: the Bogalusa Heart Study

PurposeThe early onset of menarche is related to the adulthood risk of cardiovascular (CV) disease. This study examines the relation of early onset of menarche to carotid artery intima-media thickness (IMT), which is a surrogate marker of CV disease, among asymptomatic young adult women in a black-white community. MethodsA cohort of 461 women (31% black, 69% white) aged 24 to 43 years (mean of 35.6 years) were participants in the Bogalusa Heart Study. The age at menarche was retrospectively collected. In addition to CV risk factor variable measurements B-mode ultrasound images of the far walls of carotid artery segments were obtained. The multivariate linear regression model along with mediating effect by Sobel test was applied to analyze menarcheal age effect on carotid artery IMT, adjusting for covariates. ResultsWaist to height ratio was significantly greater (P = .01) in early menarcheal age (<11 years) versus menarcheal age (≥11 years) in both black and white women. Homeostasis model assessment of insulin resistance (HOMA-IR) was significantly greater (P = .01) in early menarcheal age (<11 years) versus menarcheal age (≥11 years) in white women and also similar direction in black women. Internal carotid artery IMT was the same in early menarcheal age (<11 years) versus menarcheal age (≥11 years) in white women but higher (P = .02) in black women. Given as previously mentioned these different associations, the mediation analysis by race was performed. The effect of early menarcheal age (<11 years) versus menarcheal age (≥11 years) was mediated by waist to height ratio and HOMA-IR in white women after adjusting for parental education and age. The mediating effect of waist to height ratio (Sobel test = −2.26 and P = .02) and HOMA-IR (Sobel test = −1.85 and P = .06) on internal carotid artery IMT was noted in white women. The direct effect of early menarcheal age (<11 years) versus menarcheal age (≥11 years) on internal carotid artery IMT (β = −0.150, P = .01) was observed in black women. ConclusionsThe observed deleterious effect of early onset of menarche on carotid artery IMT in asymptomatic black and white younger adult women has biological, social, and public health implications.

Maternal passive smoking during pregnancy and age of menarche in daughters: a study of elementary and middle school students in Shanghai.

The objective of this study was to estimate the prevalence and determinants of passive smoking in pregnancy and to examine its association with an earlier age of menarche in offspring. This retrospective study enrolled 751 students 8 to 20 years old in Shanghai selected by stratified cluster sampling. Data were obtained through structured self-administered questionnaires and physical examinations. It was found that daughters with maternal tobacco exposure experienced relatively earlier menarche and had shorter cycle lengths, although both findings were not statistically significant. The unadjusted odds ratio for prenatal tobacco smoke exposure on the relatively earlier onset of menarche was 1.84 (95% confidence interval = 1.05-3.22) compared with no exposure, and the associations remained statistically significant after adjusting for birth weight, birth length, maternal age of menarche, and present height and weight. In conclusion, our study provides limited evidence supporting the hypothesis that maternal passive smoking during pregnancy leads to an earlier age of menarche of daughters.

Âge de la puberté et sexualité des jeunes femmes occidentales

The onset of menarche and age of first sexual experience have both lowered over the past century. Does the age of puberty influence the sexuality of the girl/young occidental woman? If so, to what degree? Besides, is the acquisition of reproductive function, regardless of age, a sign of sufficient maturity to engage in sexual activity? Studies show that early puberty, early sex, unprotected sexual intercourse in adolescence and number of sexual partners in early adulthood are closely related. These early sexual experiences could be stimulated by early drug use as well as by depressive disorders. The age of puberty has a real influence on sexuality but this link will be modulated by a number of social behavioral factors and it is not sustainable. The age of puberty is not a good indicator of maturity for teenage sexuality; early maturation and early sexual activity are usually associated with risky behaviors. However, other studies on the subject are required, including a consideration of the issues associated with delayed puberty, a subject virtually absent from the literature.

Relationship between body mass index and timing of maturation

Background: Menarche is the first menstrual period. The increasing incidence of overweight/obesity and decline in the median age at menarche had led investigators to hypothesize potential associations of age at menarche with body mass index (BMI). We assess these associations between reproductive and nonreproductive age females. Aim: The present study assessed the relationship between BMI and the timing of menarche among contemporary Nigerian girls. Methods: The present cross-sectional anthropometric study was performed in 2014 using 600 menstruating and 200 nonmenstruating girls aged 11–18 years in Nigeria. We classified the menarcheal age of our participants into early, ideal, and late. Participants were also categorized based on their nutritional status into underweight, normal, and overweight. Results: Mean age at menarche was 13.54 years. Age at onset of menarche was inversely associated with BMI. Precocious menarche (<12 years) when compared to ideal (12–13 years) or late (≥14 years) menarche was found to be associated with a higher BMI (F = 10.64, P < 0.05). Overweight girls also reach maturation earlier than their contemporaries with moderate to lean body status (F = 15.32, P < 0.05). Conclusion: Girls with high BMI or overweight reach menarche earlier in life than their lean or low BMI counterparts.

Prevalence of anemia and effectiveness of iron supplementation in anemic adolescent school girls at Amravati City (Maharashtra)

Introduction: In India, the prevalence of anemia in adolescent girls is estimated at 56%. The underlying sociodemographic factors and menstrual practices need to be studied in adolescent girls and a way to reduce the anemia not only by supplementation of iron and folic acid tablets and deworming but ensuring its regular consumption. Hence, the present study was undertaken to know the effectiveness of deworming and iron and folic acid supplementation in reducing the prevalence and severity of anemia in adolescent school girls. Aims and Objectives: To study the prevalence of anemia in adolescent girls in urban area and effectiveness of iron supplementation in them. Materials and Methods: The present interventional study was conducted at Sharada Kanya Vidyalaya, in Amravati city. Total 350 adolescent girls were selected by random sampling from August 2013 to November 2013. All the girls were given a single dose anthelminthic and the girls who were anemic were given iron and folic acid tablets for daily consumption. The hemoglobin was again assessed after three months. Statistical Analysis: Chi-square test of significance and standard error of difference between two means using SPSS version 16 software. Results: The overall prevalence of anemia in adolescent girls was found to be 55%. Mean and standard deviation of Hb% in adolescent girls significantly increased from 10.57 (±1.09) before to 11.78 (±0.99) after intervention. Conclusion: The contributing factors of anemia found in the present study were low socioeconomic status, onset of menarche, small family size, and vegetarian diet.

The Secular Tendency of the Age at Menarche in a Representative Sample of Mexican Girls from an Urban Zone in Central Mexico

Objective: To investigate the age at menarche, pubarche and telarche in a representative sample of residents of an urban zone of Leon, Guanajuato, Central Mexico and to evaluate the secular change of the age at menarche between 1985 and 2000. Methods: Using status quo and retrospective methods, menarcheal, pubarcheal and telarcheal status of girls 8 - 17 years of age (n = 1093) were determined. Multiple regression analysis and logistic regression were used to determine factors that were related to or predictive of age at menarche. Results: Median ages for menarche, pubarche and telarche in our studied sample were: 11.9 ± 0.04; 11.13 ± 1.25 and 10.84 ± 1.34 years, respectively. A direct correlation was found between the age of menarche of adolescents and that of their mother (p p p = 0.001), but an indirect correlation was found with the girls’ hip circumference (p = 0.004). We demonstrated a clear secular tendency towards an earlier onset of menarche by comparing our results (11.9 ± 0.04) with data from 1985 (12.8 ± 1.3) for adolescents from the same city. Conclusion: We demonstrated a clear reduction in age at menarche of approximately 0.75 year/decade, higher than Tanner’s finding in 1962, but similar than that of Malina et al. in 2004.

Knowledge and practices related to reproductive health amongst adolescent girls

Objective: To assess knowledge and practices related to menstruation and reproductive health amongst college going adolescent girls. Materials and Methods: Cross-sectional study done on 323 adolescent girls admitted in the year 2012 to professional colleges belonging to the health sciences faculty of a private university in Pune, India, using self-administered proforma. Results: Mean age of onset of menarche was 13.35 years. Many girls (86.65%) had knowledge of menstruation prior to menarche. For 68% of girls, mother was a source of menstrual information. Half of the girls reported some form of restriction in activities during menstruation due to religious reasons. 11% girls suffered from some form of reproductive tract infections (RTIs). Practices related to menstruation revealed that cloth piece is used for menstrual protection by 3% of girls. Soaked sanitary pads were disposed sanitarily by 96% of girls. Adolescent of medical faculty had significantly more knowledge than nursing faculty adolescents regarding emergency contraceptives (P < 0.05). Only four girls reported a history of sexual contact, of these, three were aware of emergency contraceptives, while one used them to prevent pregnancy. Conclusions: Adolescent girls received knowledge of menstruation prior to menarche from their mothers. Restriction in activity during menstruation due to religious reasons is practiced by many girls. Sanitary pad was used by almost all girls, and all disposed the same in a sanitary manner. More than half of the girls were aware about emergency contraceptives. Prevalence of RTI was found to be low and very few girls reported history of sexual exposure.

Thyroxine replacement promptly corrects vaginal bleeding in precocious menarche due to Van Wyk Grumbach syndrome

Van Wyk Grumbach syndrome is a rare complication of a common endocrine disorder, i.e., hypothyroidism, but occurs when it is long standing during periods of pre-pubertal growth. It can occur in both sexes, in boys it is associated with testicular enlargement and in girls, the usual presenting features are early onset menarche, enlarged bilateral multicystic ovaries and delayed skeletal growth. Diagnosing this condition is very important as unnecessary surgical intervention for ovarian enlargement is avoided. Prompt replac ement therapy with thyroxine not only corrects menstrual abnormality, but also ovaries return to normal over period of time. In this case report, we describe anunusual case of irregular vaginal bleeding, large multicystic ovaries and delayed bone age in a young girl due to autoimmune thyroiditis who promptly responded to levo-thyroxine.