Age at Menarche in Indian Women

Age at Menarche in Indian Women

I ~ Age at Menarche in Indian Women Hannah Peters, M.D., and S. M. Shrikande, l.c.P.S. I f I that women growing up in the Orient mature earlier t...

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~ Age at Menarche in Indian Women Hannah Peters, M.D., and S. M. Shrikande, l.c.P.S.

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that women growing up in the Orient mature earlier than those living in a temperate climate. The reason for this belief is not entirely clear, but it is most likely based on a report which is almost a hundred years old. Tilt (1862) reported the average age of menarche in hot climates to be 13 years, in the temperate zones 14.3 years, and in cold countries 15.8 years. Early investigators 5 stress the variety and multiplicity of factors which might influence the age of menarche. However, these have never been clearly defined. Hamblen considers climate, racial characteristics, and the level of nutrition as some of the prominent ones. It seems that the age of maturing has decreased in Europe and in America in the last generation. Huth (1956) reports that girls mature in Germany now on the average two years earlier than they did fifty years ago. He puts the average age at menarche at twelve years and mentions that some girls mature two years earlier than the average which brings the age at the first menstruation in some cases to ten years. Bojlen, Rasch, and Weis Bentzon state that it is generally agreed that the menarche age has been decreasing in the last few generations. Hamblen gives the average age of girls at menarche as 13.5 years in the United States and mentions that girls living in the Orient are reported to begin to menstruate early. Few reports on the usual age of the first physiologic bleeding in India have been published. Devi (1955) interviewed 100 women students in Madras and found that in 23 per cent the first menses occurred at 13 years T IS COMMONLY BELIEVED

From the Medical Division, Atomic Energy Establishment, Indian Cancer Research Centre, and the Family Welfare Centre, Family Planning Association of India, Bombay. We would like to thank Dr. L. D. Sanghvi, Chief of the Human Variation Unit, Indian Cancer Research Centre, for his advice and help in the statistical evaluation. 355

356

PETERS & SHRIKANDE

fertility & Sterility

of age, in 30 per cent at 14, and in 26 per cent at 15. Purandare (1945) gives 13.6 years as the average age at menarche in a group of 100 normal women of central and western India.

PRESENT STUDY The data reported in this communication were collected on 1040 women living in Bombay. They were patients in a birth-control clinic where they were interviewed. The data concerning the age at menarche, age at the consummation of marriage, and age at the time of the first conception were recalled from memory. We are aware that information obtained by remembering occurrences in the past is not entirely reliable and liable to a certain margin of error. The interview in all cases was conducted by one of us (S. M. S.). As dates are not too well recalled in India and events are not primarily remembered by how many years ago they occurred, a particular effort was made to check the approximate accuracy of the report by relating the facts under question to well-known events (festivals, harvests, Hoods, etc. ). With this method a certain amount of cross-checking was possible, and the results are probably as accurate as those obtained with the interview method in general.

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15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 or over YEARS

Fig. 1.

Age distribution of 1040 women at the time of their first visit to the birthcontrol clinic.

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AGE AT MENARCHE IN INDIAN WOMEN

357

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NO INCOME

BELOW 100

10110105

15110200

201 10250

251 10300 OVER 300

RUPEES

Fig. 2.

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Monthly income in rupees. Five rupees equal about one dollar.

The ages of the women were determined at their first clinic visit (Fig. 1). They ranged from 15 to 40 years, the majority (69 percent) being between 20 and 29 years old. The economic situation of the family was judged by the income of the husband (Fig. 2). Three per cent of the families had no income; 31 per cent earned less than 100 rupees a month (5 rupees are approximately one dollar); 40 per cent had a monthly income of between 100 and 200 rupees; and 13 per cent recorded an income of more than 300 rupees a month. Most of the women belonged to a very low income group. A dietary survey was not undertaken, but it can be surmised that the diet in these families is quantitatively and qualitatively not very satisfactory. TABLE 1.

Years of age

No. women

%

10

3 19 102 265 323 191 98 28

0.3 2 10 26 31 18 9 2.7

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12 13 14 15 16 17 18 19 Not known TOTAL

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3 1040

0.7 0.3 100

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Fertility & Sterility

RESULTS The Age at Menarche

Three women did not know or could not recall how old they were when their first menstruation occurred, and 1037 named a definite time. Table 1 summarizes the number of women reporting the first menstruation at the different ages. The youngest age at which a first menstruation occurred was 10 years; the latest was reported to have been 19 years. A little more than 2 per cent started cyclic bleeding when they were younger than 12 years. The distribution of age (Fig. 3) at menarche shows the peak at 14 years; more than one half of the group was 13 or 14 years old and 75 per cent of all women were either 13, 14, or 15 years old when the first physiologic bleeding set in. Twelve per cent reported having started to menstruate at 16 years or later. As three-fourths of this sample began cyclic bleeding between the ages of 13 and 16 this suggests itself as the usual time of menarche in Bombay today. Age at Consummation of Marriage

As in some cases the marriage ceremony precedes the actual getting 300

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Fig. 3.

Age at first menstruation.

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AGE AT MENARCHE IN INDIAN WOMEN

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15

16

17

18.

19

20

21

22

23

24

359

25 26 ......

YEARS

Fig. 4.

Age at consummation of marriage.

together of the bride and groom by months or even years, the age was recorded at which the marriage was actually consummated (Fig. 4). Twelve per cent of the brides were 14 years or younger when they joined their husbands. About half of the group (55 per cent) were between 15 and 19 years old when they began to lead a married life, and a third were 20 years or older. Age at the First Conception

In order to try to evaluate how long it takes for a new bride to become pregnant, and to estimate whether there might be a period of physiologic sterility in the earlier years, the age at the time of the first conception was determined. No birth-control methods are used till the first child is born, as culturally the birth of the child fulfills the marriage. The time span between marriage consummation and conception can therefore be taken as an interval of probable fertility. Six per cent of the women were between 11

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YEARS

Fig. 5.

Age at first conception.

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Fig. 6.

211

IN YEARS

Time interval between marriage and conception.

and 15 years at the time of their first pregnancy (Fig. 5). Two thirds (64 per cent) were between 16 and 21 when they first conceived and 16 per cent were 22 years or older. Sixty-one women (6 per cent) had no children. In order to determine the time interval between marriage and conception at different age groups, the ages at which the woman married and conceived were plotted together on one chart (Fig. 6). Comparing the two curves it is suggested that when the woman is very young at the time of marriage there is a somewhat longer interval between marriage and conception. An interval close to 2 years before the first baby is conceived seems to be frequent if the girl marries before she is 18 years, whereas women marrying after they are 18 conceive more frequently within the first year of marriage. This suggestion of a greater time interval between consummation of marriage and first conception in the younger years will, however, need more accurate and detailed recording and evaluation before a definite conclusion can be reached. This evaluation is now in progress.

SUMMARY A survey of 1040 women at a birth-control clinic in Bombay has been made, and the age at the onset of menstruation determined. Seventy-five per cent were either 13, 14, or 15 years old at menarche. The traditional belief that women mature early in the Orient has to be revised. It has been suggested that the usual age at menarche is between 13 and 16 years in Bombay at the present time.

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Vol. 8, No.4, 1957

AGE AT MENARCHE IN INDIAN WOMEN

361

REFERENCES 1. BOJLEN, K., RASCH, G., and WEIS BEN'IZON, M. Acta obst. et gynec. scandinav. 33:405, 1954. 2. DEVI, S. P. J. Family Welfare 1 :94, 1955. 3. HAMBLEN, E. C. Endocrinology of Women. Springfield, Ill., Thomas, 1949. 4. RUTH, A. Universitas 11 :705, 1956. 5. MEYER, L. Menstruationsprocessen og dens sygelige of vigelser. Kopenhagen, 1890. Quoted by'Bojlen, K., et aU 6. PuRANnARE, B. N. Indian Physician 4:71, 1945. 7. TILT, E. J. On Uterine and Ovarian Inflammation and on the Physiology of Diseases of Menstruation. London, Churchill, 1862.

Ninth Postgraduate Assembly in Endocrinology and Metabolism Sponsored by The Endocrine Society, The Medical College of Georgia, and The Medical College of Georgia Foundation, Inc., Augusta, Ga., October 21-25, 1957 The faculty will consist of twenty-two eminent clinicians and investigators from various parts of the country in the fields of endOCrinology and metabolism. The program will cover the various endOCrinopathies, with emphasis on the clinical aspects, demonstration of laboratory tests, presentations of cases, and question-and-answer panel discussions. The course is designed to cover the main aspects of diagnosis and therapy in the field of endocrinology and metabolism for the physician in general practice and for those in other specialties who wish to have a general knowledge of this rapidly growing field. A syllabus with brief abstracts of lectures will be available to the registrants at the time of the Assembly. The course has been approved by the American Academy of General Practice for 35 credit hours in Category 1. For further information concerning the program and registration, write to DR. ROBERT B. GREENBLATT, Department of EndOCrinology, Medical College of Georgia, Augusta, Georgia. Registration is limited to 100; tuition fee is $100.00. Rooms will be reserved for the students and faculty at the Bon Air Hotel. Residents and fellows will be admitted for $35.00.