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Learn More. This cross-sectional study aimed to provide an updated picture of age at menarche and main menstrual cycle characteristics and complaints in an Italian population-based sample of 3, adolescents attending secondary school.
Factors associated with age at menarche and menstrual disturbances were explored by using multiple logistic models. The prevalence of polymenorrhea was about 2. The findings of the study support the levelling-off of secular trend in menarche anticipation in Italy and confirm the timing in menstrual cycle regularization.
The study provides updated epidemiological data on frequency of menstrual abnormalities to help reproductive health professionals in managing adolescent gynecology. Adolescence is roughly considered to be the period between 10 and 19 years of age. The adolescent experiences not only physical growth but also emotional, psychological, social, and mental changes. Menarche is a milestone in a woman's life as it denotes the start of reproductive capacity.
Over the past years, age at menarche has declined, the adolescent growth spurt has occurred at younger ages, and peak height growth velocity has increased. Menstrual cycles tend to be more irregular in young teenage women during the first few years after menarche, and again in the 40's, during years prior to menopause. A of medical conditions can cause irregular periods, including thyroid disease, rapid gain or loss of weight, and virtually any ificant chronic illness. Therefore, healthcare providers have two main concerns: a to timely detect conditions suggestive of ificant pathologies, such as endometriosis, polycystic ovary syndrome, coagulation disorders, and eating disorders, which can have a major impact on women's future reproductive or general health; b to adequately support the girls to be confident and informed with their sexual health.
For an effective obstetric and gynecological healthcare, pediatricians and gynecologists stress the need for preventive health visits during adolescence, between the ages of 13 and 15 years, with subsequent annual clinic assessment, to begin a dialogue and establish a confidential setting where a girl can feel good and free to show her concerns on her own reproductive health.
In some cases, this visit may be appropriate earlier, based on the concerns of the parents. This study aims to provide an updated picture of age at menarche and main menstrual cycle characteristics and complaints in an Italian population-based sample of adolescents attending secondary school. Secondary schools were randomly selected from each city.
Details of the sampling strategy have been published elsewhere. The girls were contacted at school, and those who had had menarche were recruited. All participants were informed about the nature, purpose, and procedures of the study, and informed written consent was obtained from the students and their legal guardians. The procedures followed were in accordance with the ethical standards of the local institutional responsible committee on human experimentation and with the Helsinki Declaration. Girls were asked to fill out a self-administered anonymous questionnaire prepared by a pediatric endocrinologist and a pediatric neuropsychiatrist from the Pediatric Unit of the University of Padua and was tested by the Department of Pediatrics.
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In each school, the local investigator explained the aims of the survey and the questionnaire to the science teachers who explained and handed the questionnaire to their students to fill out. In the end, the questionnaires of 3, students who reported both their birth date and their menarcheal date were included in the data set. The girls were asked to indicate their birth date day, month, and year and as accurately as possible, the date of their first menstrual bleeding at least the month and the year ; when the day was missing, the event was considered to have occurred at half month.
Age at menarche was expressed and analyzed as a decimal year. The socioeconomic class scores were categorized into four levels: was considered low;middle;high;very high. The following definitions were used to describe menstrual cycle disorders: polymenorrhea was a menstruation interval lasting less than 21 days; oligomenorrhea occurs in intervals greater than 35 days.
Onset of menstrual cycle and menses features among secondary school girls in italy: a questionnaire study on 3, students
Descriptive analyses were performed on quantitative and qualitative variables for the total sample. The prevalence of polymenorrhea, oligomenorrhea, and dysmenorrhea and of physical and psychological complaints was computed. The normality of quantitative variables was verified by the Shapiro—Wilk test.
Parametric and non-parametric one-way analyses of variance ANOVA were used to check differences between mean values of quantitative variables. Differences in proportions were analyzed using the chi square test or Fisher's exact test, as appropriate. Chi-square test was also applied to verify difference in menstrual cycle length, duration of bleeding, and premenstrual complaints across gynecological ages. In evaluating the effects of covariates on menarcheal age, simple and multiple regression models using were applied.
The same approach was applied to identify the variables associated with cycle abnormalities. Polymenorrhea, oligomenorrhea, irregular length, and bleeding lasting more than 6 days were used as outcomes in separate multivariable stepwise logistic models. The ificance level was fixed at 0. All the analyses were performed using the SAS statistical software release.
In total, 3, adolescent girls took part in the study. The demographic and clinical characteristics of the sample are described in Table 1. The mean age was Among girls, 5. Intense physical activity was declared by 9. Pill was used for contraception by 8. The mean age at menarche was Mean age at menarche of girls living in Southern cities was ificantly lower than that of those living in Northern cities More details about onset of menses have been published in a paper.
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Menarche occurred with higher frequency in summer based on ages at onset of menarche, except for ages of 15 years or more [ Figure 2 ]. Mean age at menarche was marginally different among seasons spring: Monthly distribution of menarche.
The mean and median age at menarche by BMI groups is detailed in Table 2. The data show ificant differences with menarcheal age progressively declining from Meanwhile, no relationship was observed between menarcheal age and social level, physical activity, or birth order data not shown.
The of different multiple regression models that evaluated the independent predictive role of the variables statistically associated with age at menarche are shown in Table 3. With regards to menstrual cycles abnormalities [ Table 4 ], polymenorrhea was present in 2. About Additional details on menstrual irregularities have been published ly. To describe differences across gynecological age, menstrual cycle and bleeding length along with perimenstrual disturbances are shown in Table 5.
Polymenorrhea decreased from 5. Blood flow lasting more than 6 days was found in about Among premenstrual disturbances, dysmenorrhea, mood changes, irritability, and headache showed consistently higher prevalence at least at 5 years since menarche.
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In Table 6the from different multiple logistic regression models stepwise procedure are shown. In each model, a menstrual abnormality is used as dependent condition, whilst more family and individual characteristics were tested for being independently associated. Neither gynecological age nor BMI were ificantly associated with bleeding excess. This study provides an update of knowledge about the onset of menstrual cycle and menses features among secondary school girls in Italy.
The date of first menses was retrospectively collected from girls attending secondary school, who had already had their first menses. The information was self-reported by girls through a structured questionnaire. The mean age of the girls was The short time between the event and the data collection allows to be confident on limiting the recall bias.
The indicated that the median age for all the girls at menarche was Comparisons, adjusted for age at data collection, suggest that living area North vs. South is not an independent marker.
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During the past century, age at menarche has shown a constant and gradual decrease in many countries around the world. In Europe and United States, each decade ed for a mean anticipation of about months. Several studies on different populations indicated that onset of menarche is not equally distributed during seasons. The most frequently reported pattern has been bimodal, with peak occurring both in summer and winter. Different elements have been invoked: photoperiod, phylogeneticand ontogenetic factors, and seasonal changes in food availability,[ 25 ] psychosocial stress,[ 14 ] latitude[ 26 ] and ultraviolet radiation dose,[ 27 ] and birth month.
Our study confirmed the monthly bimodal pattern of menarche in Italy, even though frequency peaks were less evident in our sample population than in Gueresi's [ Figure 2 ].