Timing Of Menarche Research Articles

Residential green space and age at menarche in German and Australian adolescent girls: A longitudinal study.

A large multicentre European study reported later onset of menopause among women residing in greener areas. This influence on the timing of a reproductive event like menopause, raises the question whether similar associations can be observed with timing of menarche. We investigated whether exposure to residential green space was related to the age at menarche in German and Australian adolescent girls. The analytic samples comprised of 1706 German and 1474 Australian adolescent girls. Percentage of green space was calculated in 1000m buffers around a residential address or its surrogate at the previous follow-up. Mixed effects Cox proportional hazard models were used to explore the associations. The survival object was the occurrence of menarche at the time of follow-up (15-year follow-up of the German cohorts and the study wave at 14-15 years in the Australian cohort) and number of years since baseline (10-year follow-up in the German cohort and the study wave at 10-11 years in the Australian cohort). Participants who did not reach menarche were included as censored observations. A greener residence was not associated with the age at menarche. Null findings were consistent in the general population and in analyses stratified by socioeconomic status or urbanicity in both countries. Urban residents were more likely to have earlier menarche, and this association was consistent across Germany and Australia. The results of our analysis do not support the hypothesis that residing in places with more green space can influence timing of menarche. However, given the limitations of our study, researchers should not be discouraged to further explore environmental risk factors of early menarche.

Abstract P095: Associations Of Age At Menarche With Blood Pressures In Childhood And Adulthood

Objectives: The objective is to assess the associations of the timing of menarche with the blood pressures (BP) in childhood and adulthood. Methods: Participants of the Bogalusa Heart Study were included in this analysis (n=2,295). Our main outcome variables were systolic and diastolic BP in childhood and adulthood (≥20 years old). Incident hypertension was defined as systolic BP of 140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher in adulthood (Stage 2). Age of menarche was defined as the reported onset of menstruation. Findings: Incidence of hypertension in adulthood was 3.1% (59/1929). Younger age at menarche was associated with high systolic and diastolic BP at both childhood and adulthood after multiple adjustments (all p for trend <0.002; Table). Compared to individuals who had the onset of menarche at 12-13 years, earlier age at menarche (OR 1.65 [95% CI 0.91-2.99]) and later age at menarche (1.17 [0.56-2.42]) had a non-significant trend of higher odds ratios for stage 2 hypertension in adulthood. Conclusion: Younger age at menarche is associated with higher systolic and diastolic BP in both childhood and adulthood.

Retrospective longitudinal analysis of the effects of postnatal weight gain on the timing and tempo of puberty and menarche in a cohort of Italian girls

Objectiveover the last few decades there has been a progressive decline in the average age of onset of pubertal development stages in both sexes. The increase in the prevalence of childhood obesity seems to play an important role in this phenomenon.Designwe undertook a retrospective, longitudinal evaluation of the average age of thelarche and menarche to evaluate the relationship between BMI and weight change during the first years of life and the timing and tempo of puberty.Methodswe evaluated data for 577 Italian girls born between 1995 and 2003. We collected the main auxological and clinical parameters, including age at B2 and at menarche, BMI SDS at B2 and menarche, gestational age and birth weight and Z-score change from birth weight (BW) to BMI at B2 and menarche.Resultsthe mean age of B2 was 10.06 ± 1.03 years and the mean age of menarche was 12.08 ± 1.02 years. Age at B2 and menarche were inversely correlated with BMI SDS (p < 0.0001). Both age at menarche and at thelarche have an inverse relationship with the Z-score change from birth weight and BMI at menarche and thelarche respectively (p < 0.0001).Conclusionsour data confirm a significant relationship between BMI and age of B2 and menarche. We observed a clear relationship among weight change during the first years of life, age at thelarche and menarche and the duration of puberty, demonstrating the importance of weight and weight gain in determining the timing and tempo of pubertal changes and growth.

Catastrophe at menarche

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.

Associations between age of menarche and genetic variation in women of African descent: genome-wide association study and polygenic score analysis

IntroductionMany diseases of adulthood are associated with a woman’s age at menarche. Genetic variation affects age at menarche, but it remains unclear whether in women of African ancestry the timing...

Здоров’я дівчаток, які постраждали внаслідок збройного конфлікту

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.

Utilizing Age of Menarche to Optimize Pediatric Rhinoplasty.

Pediatric septorhinoplasty has sparked controversial debate amongst craniofacial surgeons, particularly due to its potential growth disturbances of the face and nose. The purpose of this study is (1) to conduct a systematic literature review that explores unique considerations and limitations associated with performing rhinoplasty in the pediatric population; (2) to discuss objective indicators for determining craniofacial skeleton maturation; (3) to perform a case series to further understand whether the age of menarche serves as a good proxy for estimating the time of facial growth maturation, and by extension, whether a post-menarchal patient is a suitable candidate for rhinoplasty. Systematic literature review was performed in order to assess unique considerations and limitations of pediatric rhinoplasty. Retrospective chart review and anthropometric (9 linear, 3 angular, 6 indices) measurements were performed for ten pediatric female patients who underwent open septo-rhinoplasty. Follow-up times ranged from 66 to 103 weeks. Patients were separated into 2 cohorts according to age at the time of menarche. Cohort 1 consisted of patients who had undergone menses for longer than 2 years at the time of rhinoplasty, whereas Cohort 2 comprised of patients who either had menses within 2 years of rhinoplasty or did not have menses at the time of rhinoplasty. Data included demographic factors, procedural variables, revision surgeries, and complications. Measurements were conducted using VECTRA software (Canfield Scientific, Parsippany, NJ). Differences in measurements between the 2 postoperative timepoints were compared. Literature review yielded 17 articles, which had conflicting opinions regarding pediatric rhinoplasty and ultimately, highlighting the need for a more objective tool for guiding the decision to perform rhinoplasty.Patients in Cohort 1 had minimal deviations in measurements over time, within the exception of an increase in nasal tip projection and a decrease in nasolabial angle and facial width. Patients in Cohort 2 had decreases in facial height, upper facial height, nasal tip angle, and nasofrontal angle. Nasolabial angle decreased for both cohorts. Of the ten patients, 1 in Cohort 2 underwent revision rhinoplasty. Our case series suggests that anthropometric measurements remain relatively more stable for patients who have undergone menses for more than 2 years, compared to those who have not. Although this study has limitations, further investigation is warranted in order to determine whether age of menarche may serve as a useful tool for craniofacial surgeons in guiding the decision to perform rhinoplasty.

827Early life influences on timing of menarche in racial/ethnic minority and immigrant women

Abstract Background Early life adversity and infections may theoretically affect the timing and effort of reproductive development. We examined associations of childhood adversity and exposure to tonsillitis with age at menarche in women age 40-64 years. Methods A multi-ethnic cohort of 394 women reported on exposure to parental maltreatment and maladjustment during childhood (&amp;lt;18 years) and on any diagnosis of tonsillitis, an infection primarily acquired in early life and adolescence. We used linear and logistic regression models to examine the associations of cumulative/specific childhood adversity experience(s) and history of tonsillitis with average age at menarche and early onset of menarche (&amp;lt;12 years of age). Results The average age at menarche was 12.6 years, and was significantly lower for women who lived with a mentally ill caregiver (M = 12.4 (95% CI: 11.7-13.0)) and those with a history of tonsillitis (M = 12.6 (95% CI: 12.0-13.2)). In adjusted multivariable models, living with a mentally ill caretaker (RR = 1.5, 95% CI: 1.0-2.1) and a having a history of tonsillitis (RR = 1.7, 95% CI: 1.3-2.4) were associated with increased risk of early menarche compared with women without these exposures. Cumulative and other specific adversities were not statistically associated with early menarche. Conclusions These findings support growing evidence that early life experiences may influence reproductive development. Key messages Early life adversity related to living with mentally ill caretakers and a history of tonsillitis is associated with earlier menarche in racial/ethnic minority and immigrant women.

Preterm birth and subsequent timing of pubertal growth, menarche, and voice break

BackgroundWe evaluated pubertal growth and pubertal timing of participants born preterm compared to those born at term.MethodsIn the ESTER Preterm Birth Study, we collected growth data and measured final height of men/women born very or moderately preterm (<34 gestational weeks, n = 52/55), late preterm (34–<37 weeks, 94/106), and term (≥37 weeks, 131/151), resulting in median 9 measurements at ≥6 years. Timing of menarche or voice break was self-reported. Peak height velocity (PHV, cm/year) and age at PHV (years) were compared with SuperImposition by Translation And Rotation (SITAR) model (sexes separately).ResultsAge at PHV (years) and PHV (cm/year) were similar in all gestational age groups. Compared to term controls, insignificant differences in age at PHV were 0.1 (95% CI: −0.2 to 0.4) years/0.2 (−0.1 to 0.4) for very or moderately/late preterm born men and −0.0 (−0.3 to 0.3)/−0.0 (−0.3 to 0.2) for women, respectively. Being born small for gestational age was not associated with pubertal growth. Age at menarche or voice break was similar in all the gestational age groups.ConclusionsTiming of pubertal growth and age at menarche or voice break were similar in participants born preterm and at term.ImpactPubertal growth and pubertal timing were similar in preterm and term participants in a relatively large cohort with a wide range of gestational ages.Previous literature indicates that small for gestational age is a risk for early puberty in term born children. This was not shown in preterm children.While our study had limited power for children born very preterm, all children born preterm were not at increased risk for early puberty.

Cyclical Premenstrual Psychosis - Sometimes It Is Your Hormones

Background: Menstrual psychosis is a broad term used to describe a number of disorders characterized by the acute onset of psychotic symptoms with brief duration, complete resolution of symptoms between episodes, with timing related to menses. This entity was first described in the 18th century, with only 27 confirmed cases using strict diagnostic criteria. While research into causation is limited, estrogen withdrawal is thought to precipitate psychotic symptoms. We describe a case of premenstrual psychosis successfully treated with use of transdermal hormonal contraception and extended menstrual cycling. Clinical Case: A 25-year-old non-binary biologic female (they/them/theirs) with bipolar disorder, anxiety, and psychogenic non-epileptiform seizures was referred to endocrinology for evaluation of recurrent psychotic symptoms associated with menses. They endorsed stable mental health symptoms on aripiprazole except during the seven days prior to their menstrual cycle. During this time they reported persistent auditory hallucinations along with dysmenorrhea, with symptoms resolving at the onset of menses. Timing of menarche was uncertain, however they reported oligomenorrhea until beginning oral contraceptives at age nineteen, after which they developed regular monthly cycles accompanied by psychotic symptoms. Pituitary and ovarian hormone levels were unable to be assessed due to hormonal contraception. Prolactin was 8.3 ng/mL (3-30 ng/mL). In order to limit hormonal fluctuations from daily oral contraceptive pills and monthly withdrawal, the decision was made to transition to transdermal norelgestromin and ethinyl estradiol patches changed weekly, with extended cycling to allow one menstrual cycle every three months. At follow-up visit nine months later they reported resolution of auditory hallucinations on this regimen, with symptoms recurring only during extreme stress. Conclusions: While the etiology of menstrual psychosis is unclear, described treatments include a combination of neuroleptics and hormonal therapy, including estrogen, progesterone, and GnRH agonists. As symptoms did not resolve until suppression of monthly menstrual cycles, this case supports the estrogen withdrawal hypothesis. Our case adds to the literature both in that transdermal, rather than oral or injectable therapy was used, and treatment was successful in alleviating the patient’s psychotic symptoms, improving their mental health and quality of life.

Associations between Prenatal Exposure to Phthalates and Timing of Menarche and Growth and Adiposity into Adulthood: A Twenty-Years Birth Cohort Study.

Phthalates are ubiquitous environmental chemicals with endocrine disrupting properties and potentially obesogenic effects. We hypothesised that antenatal phthalate exposure may influence growth and adiposity patterns in girls through childhood into adolescence. Among 1342 Raine Study singleton females, 462 had maternal serum and at least one outcome available up to 20 years of age. Individuals’ maternal serum collected at 18 and 34 weeks gestation was pooled and analyzed for concentrations of 32 metabolites of 15 phthalate diesters. Cox regression and linear models were used to determine associations between maternal phthalate levels and age at menarche, change in height and weight z-scores between birth and two years, height from birth to 20 years, BMI from two to 20 years, deviation from mid-parental height at age 20 and DEXA scan measures at age 20. Weak negative associations were detected with some phthalate metabolites and change in height and weight z-score during infancy. Weak positive associations between some of the high molecular weight phthalate metabolites and height z-score were detected during childhood. While still within the normal range, age at menarche was slightly delayed in girls with higher prenatal exposure to the higher molecular weight phthalate metabolites. We derived some associations between prenatal phthalate exposure with early growth patterns and age at menarche.

Grandmaternal Perinatal Serum DDT in Relation to Granddaughter Early Menarche and Adult Obesity: Three Generations in the Child Health and Development Studies Cohort.

Serum DDTs during or just after pregnancy were associated with breast cancer in mothers (F0), and with breast cancer, mammographic density, and obesity in adult daughters (F1) in the Child Health and Development Studies multi-generational cohort in prior publications. Here, we investigate F0 perinatal serum DDT associations with granddaughters'(F2) measured obesity at a median age of 26 and self-reported age at menarche. F2 weight, height and waist circumference were measured by trained examiners. o,p'-DDT, p,p'-DDT and p,p'-DDE were measured in archived F0 perinatal serum. F0 DDT associations with F2 outcomes, accounting for F1 characteristics, were estimated in log-linear models adjusted for F0 and F1 body mass index (BMI), race, and menarche timing (N = 258 triads for obesity; N = 235 triads for early menarche). Interactions between F0 BMI and DDTs were estimated. F0 o,p'-DDT was associated with F2 obesity [Odds ratio (OR), 2.6; 95% confidence interval (CI), 1.3-6.7; tertile 3 vs. 1), among normal weight F0 (70%), but not among overweight and obese F0 (P interaction = 0.03), independent of other DDTs. F0 o,p'-DDT was also associated with F2 early menarche (OR, 2.1; 95% CI, 1.1-3.9, tertile 3 vs. 1) and this association was not modified by F0 BMI. Ancestral exposure to environmental chemicals, banned decades ago, may influence the development of earlier menarche and obesity, which are established risk factors for breast cancer and cardiometabolic diseases. Discovery of actionable biomarkers of response to ancestral environmental exposures in young women may provide opportunities for breast cancer prevention.See related commentary by Fenton and Boyles, p. 1459.

Influence of Childhood Adversity and Infection on Timing of Menarche in a Multiethnic Sample of Women.

Childhood adversities (CAs) and infections may affect the timing of reproductive development. We examined the associations of indicators of CAs and exposure to tonsillitis and infectious mononucleosis (mono) with age at menarche. A multiethnic cohort of 400 women (ages 40–64 years) reported exposure to parental maltreatment and maladjustment during childhood and any diagnosis of tonsillitis and/or mono; infections primarily acquired in early life and adolescence, respectively. We used linear and relative risk regression models to examine the associations of indicators of CAs individually and cumulatively, and history of tonsillitis/mono with an average age at menarche and early onset of menarche (<12 years of age). In multivariable models, histories of mental illness in the household (RR = 1.44, 95% CI: 1.01–2.06), and tonsillitis diagnosis (RR = 1.67, 95% CI: 1.20–2.33) were associated with early menarche (<12 years), and with an earlier average age at menarche by 7.1 months (95% CI: −1.15, −0.02) and 8.8 months (95% CI: −1.26, −0.20), respectively. Other adversities indicators, cumulative adversities, and mono were not statistically associated with menarcheal timing. These findings provided some support for the growing evidence that early life experiences may influence the reproductive development in girls.

17. Should we screen for Müllerian anomalies following diagnosis of congenital renal anomaly?

<h3>Background</h3> Despite the well-established embryological relationship in the development of renal and Müllerian structures, no guidelines exist regarding screening for Müllerian anomalies (MA) in the setting of a renal anomaly (RA). Delayed diagnosis of MA can have significant reproductive consequences. The primary outcome of this study is to evaluate the prevalence and types of MA associated with various RA. <h3>Methods</h3> This is a retrospective cohort study of females age 12-35 years with a diagnosis of RA, identified by ICD-10 codes, who were followed for care between 2013-2020. Data were collected on demographics, medical history, imaging studies, and clinical presentation. MA were characterized using the American Society for Reproductive Medicine classification system. Descriptive statistics were used to summarize the data. This study was IRB approved. <h3>Results</h3> Of 490 patients identified, 365 met inclusion criteria and 264 had pelvic imaging performed. In patients with ARM, 77% had MA. Excluding patients with ARM, MA were found in 67% of patients with unilateral renal agenesis, 25% with horseshoe or fused kidneys, 25% with pelvic or ectopic kidneys, and 23% with renal hypoplasia or dysplasia. Overall 129/264 (49%) were diagnosed with MA, including 18% Müllerian agenesis, 18% unicornuate uterus, 47% uterine didelphys, 12% bicornuate uterus, and 6% septate uterus. Fifty-two patients had Müllerian obstruction at the time of diagnosis, including 36 with obstructed hemivagina and ipsilateral renal agenesis. Forty-eight underwent urgent surgery, including 2 with pyocolpos, and 4 were treated with initial hormonal suppression. The average age of RA diagnosis was 4 years, compared to 18 years for MA (range 0-36 years for both). In 3 patients, MA was diagnosed prior to RA, and in 21 cases, both anomaly diagnoses were made simultaneously. The most common imaging modality performed was pelvic ultrasound (58%), often followed by magnetic resonance imaging (32%). Imaging was most commonly performed for abdominal pain or dysmenorrhea. In 15% of cases, pelvic ultrasounds were performed for obstetric reasons. Only 5% of patients had routine screening to evaluate pelvic anatomy; a quarter of whom were pre-pubertal. <h3>Conclusions</h3> Almost half of patients with congenital RA are eventually diagnosed with MA, of whom 40% have an obstructive anomaly. Screening for MA in patients with RA near the time of menarche can prevent delays in diagnosis that could have significant implications on reproductive health and quality of life.

Sexual and Reproductive Health Information and Experiences Among Syrian Refugee Adolescent Girls in Lebanon.

Providing adolescent girls with sexual and reproductive health (SRH) information protects them from risks and improves their well-being. This qualitative study, conducted in Lebanon, examined Syrian refugee adolescent girls' access to SRH information about and experiences with puberty and menarche, sex, marriage, contraception, and pregnancy. We gathered data through three focus group discussions (FGDs) with unmarried adolescent girls, 11 in-depth interviews with early-married adolescents, and two FGDs with mothers. Our findings highlighted that adolescent participants received inadequate SRH information shortly before or at the time of menarche and sexual initiation, resulting in experiences characterized by anxiety and fear. They also revealed discordance between girls' views of mothers as a preferred source of information and mothers' reluctance to communicate with their daughters about SRH. We advance that mothers are important entry points for future interventions in this refugee population and offer recommendations aimed to improve adolescent girls' SRH and rights.

Causal relationship between the timing of menarche and young adult body mass index with consideration to a trend of consistently decreasing age at menarche.

Younger age at menarche (AAM) is associated with higher body mass index (BMI) for young women. Considering that continuous trends in decreasing AAM and increasing BMI are found in many countries, we attempted to assess whether the observed negative association between AAM and young adult BMI is causal. We included 4,093 women from the Korean Genome and Epidemiology Study (KoGES) and Healthy twin Study (HTS) with relevant epidemiologic data and genome-wide marker information. To mitigate the remarkable differences in AAM across generations, we converted the AAM to a generation-standardized AAM (gsAAM). To test causality, we applied the Mendelian randomization (MR) approach, using a genetic risk score (GRS) based on 14 AAM-associated single nucleotide polymorphisms (SNPs). We constructed MR models adjusting for education level and validated the results using the inverse-variance weighted (IVW), weighted median (WM), MR-pleiotropy residual sum and outliers test (MR-PRESSO), and MR-Egger regression methods. We found a null association using observed AAM and BMI level (conventional regression; -0.05 [95% CIs -0.10–0.00] per 1-year higher AAM). This null association was replicated when gsAAM was applied instead of AAM. Using the two-stage least squares (2SLS) approach employing a univariate GRS, the association was also negated for both AAM and gsAAM, regardless of model specifications. All the MR diagnostics suggested statistically insignificant associations, but weakly negative trends, without evidence of confounding from pleiotropy. We did not observe a causal association between AAM and young adult BMI whether we considered the birth cohort effect or not. Our study alone does not exclude the possibility of existing a weak negative association, considering the modest power of our study design.

Female reproductive function after treatment of childhood acute lymphoblastic leukemia.

The aim was to evaluate self-reported reproductive characteristics and markers of ovarian function in a nationwide cohort of female survivors of childhood acute lymphoblastic leukemia (ALL), because prior investigations have produced conflicting data. Self-reported reproductive characteristics were assessed by questionnaire among 357 adult 5-year survivors, treated between 1964 and 2002, and 836 controls. Ovarian function was assessed by serum levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B and by antral follicle count (AFC). Differences between controls and (subgroups of) survivors (total group, chemotherapy [CT]-only group, CT and radiotherapy [RT] group) were analyzed. Survivors treated with CT only do not differ from controls regarding timing of menarche, virginity status, desire for children, or pregnancy rates. Compared to controls, the CT+RT group was at significantly increased risk of a younger age at menarche (P<.01), virginity, an absent desire for children, and lower pregnancy rates (odds ratio [OR] [95% CI]: 0.3 [CI 0.1-0.6], 0.5 [0.3-0.9], and 0.4 [0.2-0.9], respectively). Survivors in the CT-only group were significantly younger at the birth of their first child. Pregnancy outcomes were not significantly different between any (sub)groups. Survivors treated with total body irradiation (TBI) or hematopoietic stem cell transplantation (HSCT) are at increased risk of abnormal markers of ovarian function. Reproductive function of ALL survivors treated with CT only does not differ from controls. However, survivors additionally treated with RT seem to be at an increased risk of certain adverse reproductive outcomes. Providing personalized counseling about (future) reproductive health risks in this group is imperative.

Influence of clinical and paraclinical variables of the patient in the failure to achieve a pregnancy after embryotransfer: statistical analysis evaluation

We conducted this observational prospective study in order to establish to what extent do the clinical and paraclinical characteristics of the patient and the factors that determine infertility also negatively influence pregnancy rate (PR) per embryotransfer. We included 79 women who underwent 145 embryotransfers and we analyzed the positive β-hCG test result. We identified that the following parameters are not statistically significantly correlated to the failure rate: smoking (p=0.7230, OR=1.23), drug use (p=0.7850, OR=1.38), BMI (p=0.4210, OR=1.04), history of infertility, family illness (p=0.3212, OR=1.64), history of miscarriages (p=0.4438, OR=0.61) or abortions (p=0.9842, OR=0.99), previous ectopic pregnancy (p=0.6880, OR=1.30), dyspareunia (p=0.5400, OR=1.43), dysmenorrhea (p=0.4232, OR=0.65), endometriosis (p=0.1150, OR=2.43), impermeable fallopian tubes (p=0.1676, OR=2.11). AMH is not an independent risk factor for pregnancy failure either (p=0.1690, OR=0.79). Age and menarche are risk factors. Age predisposes to a 3.30 times higher failure rate to obtain a pregnancy (calculated cutoff: 34 years old; p=0.0210; OR=3.30). A patient who had menarche before 13 years old (calculated cutoff) has a four times higher risk of failure to obtain a biochemical pregnancy (p=0.0126, OR=3.91). As a conclusion, after reaching the embryo transfer point, the clinical and paraclinical characteristics of the patient are not independent negative factors on PR, except for patient’s age and menarche time.

English

BACKGROUND Adolescence is the transitional phase of growth and development between childhood and adulthood. Menstruation, which is a milestone event in a girl's reproductive life begins during this period and it is also one of the major causes of stress in this stage. Adequate knowledge and good menstrual practices can help in addressing this stress and also in preventing reproductive tract infections to a great extent. This study tries to assess the awareness with regard to menstrual practice and its determinants among adolescent girls in a rural area of Central Kerala. The study also aims to explore the social taboos related to menstrual practices. METHODS This cross-sectional study was conducted at two high schools in Thrissur district of Central Kerala. The study methodology involved visiting the selected schools and questions about menstrual practices were put to students individually ensuring adequate privacy, with the aid of a semi-structured interview schedule. 196 adolescent girls participated in the study. The data was coded and entered into MS excel. Further analysis was done using the software SPSS 16.0 version. RESULTS The percentage of girls using sanitary pad is 32.1 %, clothes were used by 12.2 % girls, and 55.6 % used either cloth or sanitary pad. Most of them disposed their sanitary pads by burning them (75.6 %), but 16.3 % threw their pads / clothes in the general waste, some flushed them in the toilet (8.1 %). 64.3 % of them washed and exposed their undergarments in the sun but 35.7 % washed and kept them inside their house. 84.7 % of girls were aware about menstruation at the time of menarche. In 58.7 % of cases the source of information was their mother. Regarding social taboos during menstruation, the most common one was inability to attend social or religious functions during menstruation (76 %) followed by restrictions in going out (9.7 %), and 7.7 % in food preparation. 7 % of girls had to sleep in a corner of the room while they were menstruating. Maternal education, family income and awareness regarding menstruation had statistically significant association with usage of sanitary pads. CONCLUSIONS Majority of the adolescent girls had awareness regarding menstruation. However, there were some who followed less than ideal practices when it comes to disposal of sanitary napkins / clothes and care of undergarments. The wrong concepts like menstruation is a ‘disease of impurity’ and menstruation occurs when ‘bad blood’ collects is still prevalent among the adolescent girls. It is of concern that the social taboos regarding menstruation are still widely embraced by the society. KEYWORDS Menstrual Practices, Menstrual Awareness, Kerala, Menstruation

Pubertal development and risk of premenstrual disorders in young adulthood.

STUDY QUESTIONIs pubertal timing associated with risk of premenstrual disorders (PMDs) in young adulthood?SUMMARY ANSWERLate pubertal development is associated with decreased premenstrual symptom burden and risk of PMDs in young adulthood.WHAT IS KNOWN ALREADYPMDs, including premenstrual syndrome and premenstrual dysphoric disorder, may begin during the teenage years. Few risk factors in early life have been identified for PMD development.STUDY DESIGN, SIZE, DURATIONA prospective cohort study of 6495 female participants during 1996–2013.PARTICIPANTS/MATERIALS, SETTING, METHODSWe included participants from the Growing Up Today Study (GUTS). Pubertal development was indicated by the timing of menarche, breast and pubic hair growth. Self-reported age at menarche was longitudinally assessed at enrollment (in 1996/2004 for GUTS I/II) and onwards, and classified as early (age ≤ mean − SD, 11.64 years), normative and late menarche (age ≥ mean + SD, 13.95 years). Timing of pubic hair and breast growth were assessed multiple times during follow-up via Tanner scales, and classified into early, normative and late development according to mean ± SD. Using a validated questionnaire based on the Calendar of Premenstrual Experiences, we assessed premenstrual symptoms and identified probable cases of PMDs in 2013. We examined the associations of timing of pubertal development with premenstrual symptom score and disorders using multivariable linear and logistic regressions, respectively.MAIN RESULTS AND THE ROLE OF CHANCEIn 2013 (mean age = 26), 1001 (15.4%) individuals met criteria for a PMD. An inverse association was found between age at menarche and premenstrual symptom z-score (β −0.05 per year, 95% CI −0.07 to −0.03) and risk of PMDs (odds ratio (OR) 0.93 per year, 95% CI 0.88 to 0.99). Compared to individuals with normative menarche, individuals with late menarche had a lower risk of PMDs (OR 0.73, 95% CI 0.59 to 0.91), while individuals with early menarche had comparable odds (OR 0.98, 95% CI 0.81 to 1.18). Moreover, early growth of pubic hair was associated with increased premenstrual symptoms (z-score β 0.09 per year, 95% CI 0.02 to 0.17) and PMD risk (OR 1.28, 95% CI 1.04 to 1.56), independent of age at menarche. No associations were noted for breast development.LIMITATIONS, REASONS FOR CAUTIONOne major limitation is some misclassification of menarche due to recall. We, however, showed robust association among participants who were premenarcheal at baseline.WIDER IMPLICATIONS OF THE FINDINGSOur findings suggest that pubertal timing, particularly timing of menarche, is inversely associated with the risk of developing premenstrual symptoms in young adulthood, and that women with later menarche have significantly lower risk of PMDs. Information on PMDs should be provided to teenage girls and their parents. If these findings are confirmed in independent populations, prevention strategies and early detection programs may be considered for women with early pubertal development.STUDY FUNDING/COMPETING INTEREST(S)The work is supported by the National Institutes of Health and Swedish Research Council.TRIAL REGISTRATION NUMBERN/A