Menarche

Menarche (pronounced mə-NAR-kee; derived from the Greek words μήν mēn meaning "moon" and ἀρχή arkhē meaning "beginning") denotes the commencement of menstruation in female humans. This pivotal event is regarded as the cornerstone of female puberty, marking the onset of potential fertility.

Estrogen and progesterone levels by age during childhood and adolescence in girls

Ritual - Madmal Madime is the coming of age ceremony for girls, after menarche or first menstruation

Overview and Age of Onset

The onset of menarche varies among girls, influenced by a blend of biological, genetic, and environmental factors, notably nutritional determinants. Over the past century, the average age of menarche has seen a gradual decline, prompting discussions regarding its precise magnitude and underlying causes.

Estimating the global average age for menarche is challenging, due to significant disparities based on geographical location, race, ethnicity, and other attributes. However, generalized estimates typically place it at around 13 or 14 years. Region-specific data indicate:

• United States: Approximately 12.5 years[3]
• Canada: 12.72 years[4]
• UK: 12.9 years[5]
• Iceland: 13.06 ± 0.10 years[6]
• Istanbul, Turkey: 12.74 years (based on a localized study)[7]

Physiology

Initiation in Puberty

Menarche represents the culmination of several physiological processes that unfold during puberty:

• Achievement of an adequate body mass, usually around 17% body fat[8].
• Activation of the GnRH pulse generator in the hypothalamus's arcuate nucleus.
• Estrogen release from the ovaries, prompted by pituitary hormones.
• Over a span of 2-3 years, estrogen induces the growth of various body parts, including the uterus, height, breasts, and pelvis, and augments regional adipose tissue.
• Estrogen fosters the growth and vascularity of the endometrium, the uterine lining.
• Hormonal fluctuations can cause varying blood supply adequacy to parts of the endometrium.
• Certain endometrial tissue might undergo necrosis due to these hormonal or blood supply changes, leading to deciduation - a shedding of part of the lining followed by a minor blood discharge from the vagina.
• There is no pinpointed hormonal trigger for menarche; its occurrence appears to be an incidental outcome of continuous endometrial thickening caused by oscillating pubertal estrogen levels.

The menstrual flow, often termed the menstruum, comprises fresh and clotted blood mixed with endometrial tissue. Initial menarche flow tends to be brighter and less abundant than subsequent menstrual flows. The first flow might be limited to a brief "spotting." Accompanying symptoms might include abdominal cramps.

Celebratory ceremonies

Sekihan, a traditional Japanese dish of sticky rice steamed with azuki beans sometimes served after menarche.

Link to Fertility

Although menarche signifies the onset of menstruation, it doesn't necessarily indicate the commencement of ovulation. For postmenarchal girls:

About 80% of the cycles in the first year post-menarche are anovulatory. 50% remain anovulatory by the third year. By the sixth year, this percentage reduces to 10%[9]. Consistent ovulation typically necessitates a body fat content of at least 22%. This state of potential fertility is anthropologically termed nubility.

Contrarily, some girls might not follow the typical pattern, ovulating prior to their first menstruation. Though rare, a girl can conceive before her menarche if she has had sexual intercourse shortly before it. This would postpone her menarche until after childbirth. This occurrence challenges the prevalent notion that a woman cannot conceive pre-menarche. Yet, early menarche doesn't correlate with early initiation of sexual activities[10].

Onset Implications

Menarche's occurrence verifies that the girl has undergone a gradual, estrogen-induced growth of the uterus and that the "outflow tract" to the vagina is patent.

Rarely, menarche might onset unusually early, preceding other puberty signs like thelarche. Termed isolated premature menarche, other causes of bleeding should be ruled out. Growth typically remains unaffected[11]. This early menarche seldom acts as the first sign of precocious puberty.

A delay of over 3 years in menarche post-thelarche or its absence beyond 16 years is categorized as primary amenorrhea.

Summary

Menarche, as the herald of menstruation, holds a paramount position in a female's physiological journey. Its onset, influenced by myriad factors, not only signifies a milestone in puberty but also has sociocultural and medical implications.

In some cultures, a party, or celebration is thrown to show the girl's transition to womanhood.

Menarche Resources
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