Lifelong menstrual histories are typically erratic and trending
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Menstrual cycles are composites of complex events; the data describing them are correspondingly rich. We seek to quantitatively represent menstrual histories from menarche to menopause and to evaluate the clinical belief that regular and stable cycle lengths are the most normative histories.Using prospective data from the Tremin Trust, we classified the menstrual histories of 628 women as very stable (type I), stable but with greater variability in cycle lengths (type II), oscillating and erratic with a downward trend in cycle length (type III), oscillating and erratic with no downward trend in cycle length (type IV), or highly erratic and variable (type V). Classification criteria were created by examining basic summary statistics of menstrual cycle lengths. Specifically, we identified key features describing variability of median cycle length, the mean of the interquartile range, the consistency of the interquartile range, the slope of median cycle lengths, and the number of stable 5-year intervals between ages 15 and 45+.We present the first characterization of full menstrual histories. Our taxonomy captures the essential features of menstrual bleeding patterns for a heterogeneous population. Persistently stable histories (types I and II) were seen in only 28% of the women; erratic histories (types III through V) characterized 72%. When examining all participants, significant differences were seen in age at menarche (P < 0.05), age at menopause (P < 0.01), and number of births (P < 0.01) between these stable and erratic groups.Although clinicians have traditionally thought of "normal" menstrual histories as being regular and stable, the distribution of women in our five categories suggest that variable histories are most common. Clinically, these results may suggest the need for a paradigm shift in what gynecologists view as normal and abnormal menstrual cycle histories.Keywords:
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Early natural menopause (i.e., before age 45 years) is associated with increased risk of adverse outcomes. Associations of earlier menopause with younger age at menarche and short and/or regular cycle length are suggested, but study findings are inconsistent and few address early menopause risk. To evaluate the relationship between menstrual cycle characteristics in early life with incident early natural menopause. The prospective Nurses' Health Study 2 (1989 to 2011). Women ages 25 to 42 years and premenopausal in 1989 (N = 108,811). Risk of early natural menopause not due to surgery, radiation, or chemotherapy (n = 2794) was evaluated with Cox proportional hazards models. Anti-Müllerian hormone (AMH) levels were considered in a nested case-control sample (n = 820). In adjusted models, risk was associated with earlier age at menarche (P for trend = 0.05), shorter (P for trend < 0.0001), and more-regular cycles (P for < 0.0001). The hazard ratio (HR) for women with age at menarche ≤9 (vs. 12) years was 1.28 (95% CI, 0.99 to 1.67). Women reporting usual menstrual cycle lengths <25 days at ages 18 to 22 years had substantially higher risk of early menopause (HR, 1.70; 95% CI, 1.47 to 1.96) than women with 26- to 31-day cycles, whereas women with ≥40 day cycles had lower risk (HR, 0.44; 95% CI, 0.34 to 0.58). Women with irregular cycle length had lower risk compared with women with regular cycles (HR, 0.51; 95% CI, 0.43 to 0.60). Associations with AMH concentrations among the nested case-control subset were consistent with these findings. Results from this large prospective study of early menopause suggest an influence of accelerated oocyte depletion on risk and may help clarify the etiology of early menopause.
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The purpose of this study was to review published studies on the variability of age at menarche and age at menopause throughout the world, and to identify the main causes for age variation in the timing of these events. We first present a summary table including mean (or median) values of the age at menarche in 67 countries, and of the age at menopause in 26 countries. General linear models showed that mean age at menarche was strongly linked to the mean female life expectancy, suggesting that one or several variables responsible for inequalities in longevity similarly influenced the onset of menarche. A closer examination of the data revealed that among several variables reflecting living conditions, the factors best explaining the variation in age at menarche were adult illiteracy rate and vegetable calorie consumption. Because adult illiteracy rate has some correlation with the age at which children are involved in physical activities that can be detrimental in terms of energy expenditure, our results suggest that age at menarche reflects more a trend in energy balance than merely nutritional status. In addition, we found the main determinant of age at menopause to be the mean fertility. This study thus suggests that, on a large scale, age at menarche is mainly determined by extrinsic factors such as living conditions, while age at menopause seems to be mainly influenced by intrinsic factors such as the reproductive history of individuals. Finally, these findings suggest that human patterns cannot be addressed solely by traditional, small-scale investigations on single populations. Rather, complementary research on a larger scale, such as this study, may be more appropriate in defining some interesting applications to the practical problems of human ecology.
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A cross-sectional school survey was carried out during January to February 2010 in 8 schools to investigate the age at menarche, menstrual cycle pattern among school girls in Kassala, eastern Sudan. Structured questionnaires were used to gather the socio-demographic data, age at menarche, regularity of the menstrual cycle and associated symptoms. Out of 900 schoolgirls investigated their age ranges between 9 to 19 with mean ± SD of 14.0 ± 4.7 years. Only 73% experienced menarche by the time of interview. The mean age ± SD of 13.07 ± 1.0 years, which was 0.9 year younger in the urban girls. The majority of girls (76.4%) experienced delayed menarche. The period was regular in 68.5% of these girls with the cycle length ranges between 21 to 35 days the mean ± SD duration of blood flow was 4 ± 1.2 days. The overall prevalence of dysmenorhea was 83.1 and 59.8% of the subject experienced premenstrual symptoms. In conclusion the menarcheal age was delayed in our study, it varies with residence, dysmenorrhea was a common health problem among the school girls.
Key words: Menarche, menstrual cycle, school girls, Sudan.
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SummarySummaryWomen in a Tibetan speaking population living at 3250–3560 m in Upper Chumik, Nepal, have median ages at menopause and menarche of 46·8 and 16·2 years, respectively, assessed by the status quo technique. Recalled ages at menopause and menarche yield similar results and suggest a long-term existence of a pattern of relatively accelerated age at menopause and delayed age at menarche. Variation in the length of the calculated biological reproductive span in this sample is more strongly associated with recalled age at menopause than recalled age at menarche. The age at menopause in Upper Chumik is accelerated relative to that reported for Western industrial populations; however, these data do not permit drawing conclusions about the reasons underlying the acceleration.ZusammenfassungFrauen einer tibetanisch sprechenden Bevölkerung, die im oberen Chumik, Nepal in einer Höhe von 3250–3560m leben, haben Medianwerte des Alters bei Menopause und Menarche von 46,8 und 16,2 Jahren, bestimmt nach der status-quo-Technik. Die erinnerten Alter von Menopause und Menarche ergeben ähnliche Ergebnisse und legen damit eine langfristige Existenz eines Musters relativ beschleunigten Menopausenalters und verzögerten Menarchealters dar. Die Variation in der Länge der errechneten biologischen Reproduktionsspanne in dieser Stichprobe ist stärker mit dem erinnerten Alter der Menopause als mit dem erinnerten Alter der Menarche verknüpft. Das Menopausenalter in Ober-Chumik is beschleunigt im Verhältnis zu jenem, das für westliche industrielle Bevölkerungen berichtet wird, jedoch erlauben diese Daten nicht, Schlüsse über die Gründe zu ziehen, die der Akzeleration zugrunde liegen.RésuméLes femmes d'une population de langue tibétaine résidant à 3250–3560 m dans le haut Chumik, au Népal, ont des áges médians à la ménopause et à la ménarche de 46,5 et 16,2 ans respectivement, tels qu'établis par la méthode du statu-quo. La méthode du souvenir de l'áge à la ménopause at à la ménarche donne des résultats semblables et suggère la longue existence d'un tableau de ménopause relativement précoce et de ménarche relativement tardive. La variation de l'amplitude de la périod reproductrice biologique calculée dans cet échantillon est plus fortement liée à l'áge á la ménopause qu'à l'áge à la ménarche souvenus. L'áge à la ménopause dans le Haut Chumik est précoce par comparaison à celui rapporté dans les populations industrielles occidentales; cependant, ces données ne permettent pas de tirer des conclusions sur les raisons de cette précocité.
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This investigation examined the accuracy of recall of females to questions concerning ages at menarche, natural and surgical menopause, first use of oral contraceptives and mean menstrual cycle length and variance. A sample of 160 women who had recorded their menstrual and reproductive events as they occurred were administered a questionnaire concerning these events, with responses compared to the original data. For the variables age at menarche, age at natural menopause, age at surgical menopause and age at first use of oral contraceptives, the percentage of women who correctly recalled within a year ranged from 75% to 90%. Recollection of menstrual cycle length and variability by interview was considered unreliable. These findings are encouraging regarding the ability to recall the age when certain menstrual and reproductive events occur, but not for menstrual cycle intervals or patterns. Because these women were well-educated and had once recorded study variables, these results might be considered optimal.
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Journal Article Age At Menopause in Relation to Reproductive History in Japanese, Caucasian, Chinese and Hawaiian Women Living in Hawaii Get access Madeleine J. Goodman, PhD, Madeleine J. Goodman, PhD 2Dept. of General Science and Women's Studies Program, Univ. of HawaiiHonolulu 96822. Search for other works by this author on: Oxford Academic PubMed Google Scholar John S. Grove, PhD, John S. Grove, PhD 3Pacific Health Research Inst.Honolulu 96813. Search for other works by this author on: Oxford Academic PubMed Google Scholar Fred Gilbert, Jr, MD Fred Gilbert, Jr, MD 4School of Public Health, Univ. of Hawaii and Pacific Health Research Inst.Honolulu 96813. Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Gerontology, Volume 33, Issue 5, September 1978, Pages 688–694, https://doi.org/10.1093/geronj/33.5.688 Published: 01 September 1978
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Introduction. Menopause in the human female is a developmental stage that should be understood within the context of normal aging. This paper describes the intrapopulation variation in the age of natural menopause among Polish women and identifies the female reproductive characteristics associated with the menopause. Materials and Methods. Data from 2147 naturally postmenopausal women, participants of a crosssectional population-based survey conducted in 2000–2003 in all but Eastern parts of Poland, were analyzed to determine the mean and median ages at natural menopause. Results. The mean recalled age of natural menopause among Polish women was 49.90 years and the median age obtained by probit estimate was 50.92 years. Women from small towns were likely to experience menopause earlier compared to women from the cities. The timing of menopause among rural women was very close to their counterparts from the cities (median age 50.91 and 50.98 years, respectively). The positive education gradient of the age at menopause showed the 0.87 year difference in median menopausal age between women having high and low levels of education. Moreover, rural women having the primary/vocational level of education were distinguished from their urban counterparts by a later age at menarche (13.96 and 13.44 years, respectively), earlier age at the first child-birth (21.45 years vs. 25.59 years) and earlier age at the last birth (28.96 years vs. 31.05 years). The multivariate explanatory model of a stepwise multiple regression with forward elimination revealed that the age at menarche and the length of menstrual cycle were significantly associated with the age at menopause. Along with these variables, age at first birth and the number of days of bleeding as well as the urbanization factor contributed to the variation of age at menopause. Conclusions. Age at menarche, peculiarities of menstrual cycle, age of women at first child-birth, also the education and urbanization factors could influence the variation of the age at menopause.
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Data from women who enrolled between 1935 and 1939 in a long-term prospective study of menstrual and reproductive health, in which menstrual cycles and other events were recorded as they occurred, were analyzed to examine factors associated with age at natural menopause. Analysis was restricted to 561 women who enrolled before age 25 years and recorded data through at least age 44 years. Women with a median cycle length that was less than 26 days at ages 20-35 years reached menopause 1.4 years earlier than those with cycles between 26 and 32 days. The difference in mean menopausal age between women with short cycle length (less than 26 days) and women with long cycle length (33 days or longer) was 2.2 years. Women who had ever been pregnant reached menopause slightly, but statistically significantly, later than women who had never been pregnant. Similarly, women who had ever had a live birth had a slightly later age at menopause compared with nulliparous women. A trend of later age at menopause with increasing parity was also observed. There was no association with age at menarche. Certain of these observations are consistent with proposed mechanisms of cessation of menstrual function.
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The aim of this paper is to study age at menarche and its relation to ages at marriage, first birth and menopause among resident of rural Nepalese females. Data are taken from a sample survey of Palpa and Rupandehi districts. Median ages at marriage, first birth and menopause were found to be 17, 19 and 46 years respectively. It was found that ages related events (menarche, marriage, first birth and menopause) were found to be largely inter-related. The waiting time at menarche for getting married was found to be about two years, and the correlation between age at menarche and age at marriage is statistically significant. Transition probability matrix also revealed that ages at menarche, marriage, first birth and menopause were found to be statistically associated. Finally, the onset of menarche among females signals that they will be ready for marriage and thereby giving birth of child. These findings may help planners and policy-makers for designing proper policy in improving reproductive health and reproductive rights of females along with controlling the level of fertility in a country.DOI: http://dx.doi.org/10.3126/njst.v12i0.6513 Nepal Journal of Science and Technology 12 (2011) 276-285
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