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Relationship of age at menarche and subsequent fertility
European Journal of Obstetrics & Gynecology and Reproductitie Biology, 44 (1992) 201-203 0 1992 Elsevier Science Publishers B.V. All rights reserved 0028-2243/92/$05.00
EUROBS 01331
Relationship Hiroko
Komura
of age at menarche and subsequent fertility a, Akira Miyake ‘, Chu-Fung Chen ‘, Osamu Tanizawa and Hiromichi Yoshikawa b
”
I1Department of Obstetrics and Gynecology, Osaka Unioersity Medical School and ’ Sumitomo Mutual Life Automated Multiphasic Health Test System, Osaka, Japan Accepted for publication 27 November 1991
Summary
We investigated retrospectively the relationship between the age at menarche and reproductive ability in 2278 married women. Those who had a pregnancy experienced menarche at a mean age (-t$EMl of 13.7 + 0.1 years, and those who were infertile had menarche at a mean age of 14.0 &-0.2 years, difference in the times of onset of menarche being significant (P < 0.05). Moreover, a group in whom menstruation started after the age of 18 years had a significantly higher rate of infertility (15.7%) than the others (5.0%). Irregular menstruations during the first few years after menarche was also related to decreased reproductive ability. These findings indicate the importance of menarche before the age of 18 for normal reproductive functioning. Age at menarche; Delayed menarche; Pregnancy
Introduction
The average age of menarche is about 12.8 years [1] and most girls experience menarche by the time they are 15 years old. When girls do not have menarche until they are 16 years old, they are diagnosed as having delayed menarche. The appearance of menarche is an important factor in the maturation of sexual functioning, and a late onset of menarche is supposed to indicate that the maturation of sexual functioning is disturbed. However, there are few reports on the effect of
Correspondence:
I%. Hiroko Komura, Department of Obstetrics and Gynecology, Osaka University Medical School, l-l-50 Fukushima-ku, Fukushima,, Osaka 553, Japan.
the late.onset of menarche on subsequent reproductive ability. In this study we examined the relationship between the age at menarche and subsequent fertility. We also investigated the relationship between pregnancy and the regularity of mbnstruations during the first few years after the ‘onset of menarche. Materials
and Methods
The subjects surveyed were 2281 healthy married women who received a medical chebk-up at our Health Test System between February 1986 and January 1987. They were each asked’(l) their age at menarche; (2) their history of pregnancy and delivery; and (3) whether their menstruations during the first few years after menarche had
202
- 500
3
iii!
z 2 20
3
0
l
0
- 400
a
I $ 40
l
l--L
- 300 0 - 200 -100
IO 11 12 13 14 15 16 17 16 19 20 21 22 23
Fig. 1. Age distribution of menarche. Open bars show numbers of the population with menarche at the indicated age. Closed circles show the cumulative rate of menarche.
been regular. We excluded from the analysis the following women; (1) those who have disorders that prevent pregnancy, such as chromosomal abnormality or dysgenesis of the Miillerian duct, which are included in primary amenorrhea; (2) those who had undergone hysterectomy before having a child; and (3) those who prevented conception. We also excluded those who did not have pregnancies due to male infertility. The total number analyzed was 2278. Their mean age was 45.7 & 0.18 years (range: 25-74 years). Statistical analyses were made’by Student’s t-test and the X-test. Results In the women surveyed, the age at menarche ranged from 10 to 23 years with a mean of 13.7 years. About 50% had menarche before the age of 13 years, and 95% of them before the age of 16 years (Fig. 1). Of the total 2278 women surveyed, 115 (5.0%) were infertile. The age at menarche of the fertile group was 13.7 f 0.1, which was significantly (P
12
13
14
15
16
17
18
19-C
age at menarche
Fig. 2. Relation between age at menarche and infertility. The rate of infertility was almost constant (mean 5.0%; dotted line) in women who had menarche before the age of 18, but significantly higher in those with menarche at 18 (11.4%; P < 0.05) or later (25.0%; p < 0.01).
< 0.01) earlier than that of the infertile group (14.0 f 0.2). Next we investigated whether the rate of infertility was related to the age at menarche. As shown in Fig. 2, the rate of infertility was almost constant (2.7-5.9%; mean 5.0%) in women who had menarche at 11 to 17 years of age, but the mean rates of infertility were significantly higher in women who had menarche at the age of 18 (11.4%; P < 0.05) and later than 18 (25.0%; P < 0.01). The relationship of infertility with menstrual irregularities in the first few years after menarche was investigated. A total of 2042 females (90%) had regular menstruations, and their rate of infertility was 4.7%. In contrast, among the women with irregular menstruations 8.9% were infertile. Thus women who had irregular menstruations had a significantly (P < 0.01) higher incidence of infertility. Discussion Girls, who do not have menarche by the age of 16 years, are diagnosed as having delayed menarthe. This condition indicates disturbance of the process of maturation of sexual functioning, and
203
so might affect subsequent fertility. However, few data are available about the relationship of the age at menarche and subsequent reproductive function. Sandler et al. [2] reported that the age at menarche has no relation with total fertility but is positively related to the age at first marriage and to the age at first conception. However, they did not report a detailed analysis of a group with menarche later than the age of 16. The present study is the first on the relationship between the age at menarche and subsequent reproductive functioning. Our survey showed that in women who had menarche at the age of 18 or later the incidence of infertility is significantly higher than that in those with menarche before the age of 18. Among the women who had menarche before the age of 17, there was no relationship between the age at menarche and the rate of infertility. Therefore, women who had menarche at the age of 16 or 17, had normal reproductive functioning. The exact date of menarche might be a little difficult for the women to remember. However, those who had problematically late onset of menarche should remember the data correctly. Therefore our result could not be affected largely by this problem. Menarche is delayed by genetic factors [3], undernutrition [4,5] hard physical exercise [6,71 psychological factors (anorexia nervosa) [81, or chronic general disease, such as heart disease or tuberculosis. These factors should affect not only the menarche but also subsequent fertility. We think that such factors may also have caused the difference in the infertility rates in the groups with menarche before and after the age of 18. We conclude from this study that there is no relationship between the age at menarche and
the rate of infertility in women who had menarthe before the age of 17. In other words, the occurrence of menarche by 17 years, may not affect reproductive ability. Our results also showed that irregularity of menstruations during the first few years after menarche was related with reduced reproductive ability. Therefore women who are diagnosed as having delayed menarche, or who have irregular menstruations during the first few years after menarche may require treatment to achieve normal replroductive ability. Acknowledgment
We appreciate the secretarial assistance of Ms. Sumi Tadokoro. References Wyshak G, Frisch RE. Evidence for a secular trend in age of menarche. N Engl J Med 1982;306:1033-1036. Sandier DP, Wilcox AJ. Horney LF. Age at menarche and subsequent reproductive events. Am J Epidemibl 1984;119: 165-774. Widholm 0, Kantero RL. A statistical analysis of the menstrual patterns of 8000 Finish girls and their mothers. Acta Obstet Gynecol Stand (Suppl. 14) 1971;50:1-36. Eveleth PB, Tanner JM. Worldwide variation in human growth. Cambridge: Cambridge University Press, 1976:213219, 260-261. Frisch RE, Revelle R. Height and weight at menarche and a hypothesis of menarche. Arch Dis Child 1971{46:695-701. 6 Frisch RE, Wyshak G, Vincent L. Delayed menarche and amenorrhea in ballet dancers. N Engl J Med 1980;303:1719. 7 Warren MP. The effects of exercise on pubertal progression and reproductive function in girls. J Clin Endocrinol Metab 1980;51:1150-1187. 8 Perloff WH. Lasche EM, Nodine JH, Schnneberg NG, Vieillard CB. The starvation stare and functional hypopituitarism. JAMA 1954;155:1307-1313.
EUROBS 01331
Relationship Hiroko
Komura
of age at menarche and subsequent fertility a, Akira Miyake ‘, Chu-Fung Chen ‘, Osamu Tanizawa and Hiromichi Yoshikawa b
”
I1Department of Obstetrics and Gynecology, Osaka Unioersity Medical School and ’ Sumitomo Mutual Life Automated Multiphasic Health Test System, Osaka, Japan Accepted for publication 27 November 1991
Summary
We investigated retrospectively the relationship between the age at menarche and reproductive ability in 2278 married women. Those who had a pregnancy experienced menarche at a mean age (-t$EMl of 13.7 + 0.1 years, and those who were infertile had menarche at a mean age of 14.0 &-0.2 years, difference in the times of onset of menarche being significant (P < 0.05). Moreover, a group in whom menstruation started after the age of 18 years had a significantly higher rate of infertility (15.7%) than the others (5.0%). Irregular menstruations during the first few years after menarche was also related to decreased reproductive ability. These findings indicate the importance of menarche before the age of 18 for normal reproductive functioning. Age at menarche; Delayed menarche; Pregnancy
Introduction
The average age of menarche is about 12.8 years [1] and most girls experience menarche by the time they are 15 years old. When girls do not have menarche until they are 16 years old, they are diagnosed as having delayed menarche. The appearance of menarche is an important factor in the maturation of sexual functioning, and a late onset of menarche is supposed to indicate that the maturation of sexual functioning is disturbed. However, there are few reports on the effect of
Correspondence:
I%. Hiroko Komura, Department of Obstetrics and Gynecology, Osaka University Medical School, l-l-50 Fukushima-ku, Fukushima,, Osaka 553, Japan.
the late.onset of menarche on subsequent reproductive ability. In this study we examined the relationship between the age at menarche and subsequent fertility. We also investigated the relationship between pregnancy and the regularity of mbnstruations during the first few years after the ‘onset of menarche. Materials
and Methods
The subjects surveyed were 2281 healthy married women who received a medical chebk-up at our Health Test System between February 1986 and January 1987. They were each asked’(l) their age at menarche; (2) their history of pregnancy and delivery; and (3) whether their menstruations during the first few years after menarche had
202
- 500
3
iii!
z 2 20
3
0
l
0
- 400
a
I $ 40
l
l--L
- 300 0 - 200 -100
IO 11 12 13 14 15 16 17 16 19 20 21 22 23
Fig. 1. Age distribution of menarche. Open bars show numbers of the population with menarche at the indicated age. Closed circles show the cumulative rate of menarche.
been regular. We excluded from the analysis the following women; (1) those who have disorders that prevent pregnancy, such as chromosomal abnormality or dysgenesis of the Miillerian duct, which are included in primary amenorrhea; (2) those who had undergone hysterectomy before having a child; and (3) those who prevented conception. We also excluded those who did not have pregnancies due to male infertility. The total number analyzed was 2278. Their mean age was 45.7 & 0.18 years (range: 25-74 years). Statistical analyses were made’by Student’s t-test and the X-test. Results In the women surveyed, the age at menarche ranged from 10 to 23 years with a mean of 13.7 years. About 50% had menarche before the age of 13 years, and 95% of them before the age of 16 years (Fig. 1). Of the total 2278 women surveyed, 115 (5.0%) were infertile. The age at menarche of the fertile group was 13.7 f 0.1, which was significantly (P
12
13
14
15
16
17
18
19-C
age at menarche
Fig. 2. Relation between age at menarche and infertility. The rate of infertility was almost constant (mean 5.0%; dotted line) in women who had menarche before the age of 18, but significantly higher in those with menarche at 18 (11.4%; P < 0.05) or later (25.0%; p < 0.01).
< 0.01) earlier than that of the infertile group (14.0 f 0.2). Next we investigated whether the rate of infertility was related to the age at menarche. As shown in Fig. 2, the rate of infertility was almost constant (2.7-5.9%; mean 5.0%) in women who had menarche at 11 to 17 years of age, but the mean rates of infertility were significantly higher in women who had menarche at the age of 18 (11.4%; P < 0.05) and later than 18 (25.0%; P < 0.01). The relationship of infertility with menstrual irregularities in the first few years after menarche was investigated. A total of 2042 females (90%) had regular menstruations, and their rate of infertility was 4.7%. In contrast, among the women with irregular menstruations 8.9% were infertile. Thus women who had irregular menstruations had a significantly (P < 0.01) higher incidence of infertility. Discussion Girls, who do not have menarche by the age of 16 years, are diagnosed as having delayed menarthe. This condition indicates disturbance of the process of maturation of sexual functioning, and
203
so might affect subsequent fertility. However, few data are available about the relationship of the age at menarche and subsequent reproductive function. Sandler et al. [2] reported that the age at menarche has no relation with total fertility but is positively related to the age at first marriage and to the age at first conception. However, they did not report a detailed analysis of a group with menarche later than the age of 16. The present study is the first on the relationship between the age at menarche and subsequent reproductive functioning. Our survey showed that in women who had menarche at the age of 18 or later the incidence of infertility is significantly higher than that in those with menarche before the age of 18. Among the women who had menarche before the age of 17, there was no relationship between the age at menarche and the rate of infertility. Therefore, women who had menarche at the age of 16 or 17, had normal reproductive functioning. The exact date of menarche might be a little difficult for the women to remember. However, those who had problematically late onset of menarche should remember the data correctly. Therefore our result could not be affected largely by this problem. Menarche is delayed by genetic factors [3], undernutrition [4,5] hard physical exercise [6,71 psychological factors (anorexia nervosa) [81, or chronic general disease, such as heart disease or tuberculosis. These factors should affect not only the menarche but also subsequent fertility. We think that such factors may also have caused the difference in the infertility rates in the groups with menarche before and after the age of 18. We conclude from this study that there is no relationship between the age at menarche and
the rate of infertility in women who had menarthe before the age of 17. In other words, the occurrence of menarche by 17 years, may not affect reproductive ability. Our results also showed that irregularity of menstruations during the first few years after menarche was related with reduced reproductive ability. Therefore women who are diagnosed as having delayed menarche, or who have irregular menstruations during the first few years after menarche may require treatment to achieve normal replroductive ability. Acknowledgment
We appreciate the secretarial assistance of Ms. Sumi Tadokoro. References Wyshak G, Frisch RE. Evidence for a secular trend in age of menarche. N Engl J Med 1982;306:1033-1036. Sandier DP, Wilcox AJ. Horney LF. Age at menarche and subsequent reproductive events. Am J Epidemibl 1984;119: 165-774. Widholm 0, Kantero RL. A statistical analysis of the menstrual patterns of 8000 Finish girls and their mothers. Acta Obstet Gynecol Stand (Suppl. 14) 1971;50:1-36. Eveleth PB, Tanner JM. Worldwide variation in human growth. Cambridge: Cambridge University Press, 1976:213219, 260-261. Frisch RE, Revelle R. Height and weight at menarche and a hypothesis of menarche. Arch Dis Child 1971{46:695-701. 6 Frisch RE, Wyshak G, Vincent L. Delayed menarche and amenorrhea in ballet dancers. N Engl J Med 1980;303:1719. 7 Warren MP. The effects of exercise on pubertal progression and reproductive function in girls. J Clin Endocrinol Metab 1980;51:1150-1187. 8 Perloff WH. Lasche EM, Nodine JH, Schnneberg NG, Vieillard CB. The starvation stare and functional hypopituitarism. JAMA 1954;155:1307-1313.