Age at menarche and its socioeconomic determinants among female students in an urban area in Bangladesh

doi:10.1016/j.srhc.2017.03.008

Sexual & Reproductive Healthcare

Volume 12, June 2017, Pages 88-92

https://doi.org/10.1016/j.srhc.2017.03.008 Get rights and content

Highlights

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Data on age at menarche is scares in developing countries like Bangladesh.
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Age at menarche was in Bangladeshi urban school going adolescents.
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Higher education was significant predictor of age at menarche.

Abstract

This cross-sectional study aimed to determine the age at menarche and its socioeconomic determinants among urban female students (n = 680) in Bangladesh. The mean age of the respondents was 14 ± 1.43 years. Majority of the respondents were unmarried (98.4%). The mean age at menarche was 11.6 ± 3.6 years, median 12 years. Almost one-third (35.7%) of the participants had menarche at the age of 12 years. There was no statistically significant difference between age at menarche before and after 12 years with the socio-economic characteristics, except education (p = <0.001). In the multivariate model, only higher education was statistically significant predictor of age at menarche.

Introduction

Menarche marks the onset of puberty in female adolescents and is an important development milestone in the lives of young females [1]. Early onset of menarche is a well-established risk factor for breast cancer, ovarian cancer and several chronic diseases such as diabetes, metabolic syndrome and cardiovascular diseases [2], [3], [4], [5], [6]. Late menarche may, however, be positively associated with the risk of developing alzheimer’s disease [7]. Age at menarche also affect reproductive functions. Early menarche is a marker for the onset of childbearing years and may cause high fertility, sexually transmitted diseases including HIV/AIDS leading to increased mortality. Thus, age at menarche is an important indicator of reproductive health, population health and future chronic diseases.

Epidemiological evidence hinted at psychosocial and public health challenges stemming from the secular decline in age at menarche, which may have important adverse social and health consequences. A declining trend in the age at menarche has been observed in developed countries over decades commonly attributed to childhood obesity, improved socioeconomic status and sedentary life [8], [9]. A study by Hossain et al. in 2010 among 995 university students in Bangladesh reported that early menarche was associated with residence location at adolescence, religion and mother’s education [10]. However, the available information on the relationship between socioeconomic context and age at menarche is not well understood. Information about the association between socioeconomic status and age at menarche is essential for developing population health policies and action plans. Substantial data in this field is available globally, but in comparison there are few reports from developing countries [11]. Therefore, we conducted this study to determine the age at menarche of young females and its socioeconomic determinants in Bangladesh.

Section snippets

Methods

A cross sectional study carried out between June to November 2014 among the students of Modhu Sudin Tara Prasahanna (MSTP) girl's high school in Bongaon area, Jessore district in southwest Bangladesh. There are three high schools in the area which serves a total population of about 24,898. The MSPT school was purposively selected for this study as it represents the urban adolescent girls in the region. All students attending grades 5–10 with symptom of menarche were enrolled through convenient

Results

The mean age of the respondents was 14 ± 1.4 years ranging from 10 to 20 years (median = 14 years). The median family income of the respondent was 20,000 Bangladeshi Taka BDT (250 US $) per month (1 US$ = 80 BDT, 2014).

Among the respondents, 79.9% were Muslims, 20.1% Hindus, 61% from nuclear family, 33.4% from extended family and 5.6% from a joint family. A majority of the participants were unmarried (98.4%) and had father as family head (95%). The mean family size was 6.7 ± 1.32, median = 5 and ranging

Discussion

This study reported the age at menarche among adolescent girls attending a high school in an urban district in Bangladesh was 11.6 ± 3.6 years. Higher education was statistically significant predictor of age at menarche.

A study in Bangladesh among rural female adolescents reported the mean age at menarche was 12.8 ± 1.4 years in 2009 [12]. Earlier studies in Bangladesh in 1996 and 1976 reported the average age at menarche of 13.0 years and 15.8 years respectively [13], [14], which were higher than our

Conclusion

Our study showed the age at menarche among urban adolescent girls was 11.6 ± 3.6 years and suggests a declining trend of age at menarche considering findings from previous studies in Bangladesh. These findings clearly underscore the wider public health concern emanating from the secular declining trend in age at menarche, particularly in developing countries undergoing rapid epidemiological and socioeconomic transitions. Further evaluation of the effects of early menarche is warranted.

Competing interest

We declare that we have no competing interests.

Author’s contribution

MSI designed this study and wrote the first draft of the paper. SMSI provided advice on study design, data analysis and prepared the final manuscript. TB, SI, RAM helped in data analysis and improved the scientific contents of the study. MAH participated in the study design, reviewed the final manuscript and provided overall support for the study. All authors read and approved the final manuscript.

Operational definition

Age: Age of the respondents as stated by him or herself at the date of interview.

Menarche: The beginning of menstrual function especially the first menstrual period of an individual is called menarche.

Nuclear Family: A family that consists only husband, wife with their children.

Joint Family: According to K.M. Kapadia, “Joint family is a group formed not only of a couple but also other relatives either from father’s side or from mother’s side, depending on whether the joint family is patrilineal

Acknowledgements

We are grateful to the faculty and staff of Ad-Din Medical College and study participants for providing valuable data and time for this study.

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Accelerated female reproductive events represent the early onset of reproductive events involving puberty, menarche, pregnancy loss, first sexual intercourse, first birth, parity, and menopause. This study aimed to explore the association between childhood adversity and accelerated female reproductive events.
PubMed, Web of Science, and Embase were systematically searched from September 22, 2022 to September 23, 2022.
Observational cohort, cross-sectional, and case–control studies in human populations were included if they reported the time of reproductive events for female individuals with experience of childhood adversity and were published in English.
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In total, 21 cohort studies, 9 cross-sectional studies, and 3 case–control studies were identified. Overall, female individuals with childhood adversity were nearly 2 times more likely to report accelerated reproductive events than those with no adversity exposure (odds ratio, 1.91; 95% confidence interval, 1.33–2.76; I²=99.6%; P<.001). Moderation analysis indicated that effect sizes for the types of childhood adversity ranged from an odds ratio of 1.61 (95% confidence interval, 1.23–2.09) for low socioeconomic status to 2.13 (95% confidence interval, 1.14–3.99) for dysfunctional family dynamics. Among the 7 groups based on different reproductive events, including early onset of puberty, early menarche, early sexual initiation, teenage childbirth, preterm birth, pregnancy loss, and early menopause, early sexual initiation had a nonsignificant correlation with childhood adversity (odds ratio, 2.70; 95% confidence interval, 0.88–8.30; I²=99.9%; P<.001). Considerable heterogeneity (I²>75%) between estimates was observed for over half of the outcomes. Age, study type, and method of data collection could explain 35.9% of the variance.
The literature tentatively corroborates that female individuals who reported adverse events in childhood are more likely to experience accelerated reproductive events. This association is especially strong for exposure to abuse and dysfunctional family dynamics. However, the heterogeneity among studies was high, requiring caution in interpreting the findings and highlighting the need for further evaluation of the types and timing of childhood events that influence accelerated female reproductive events.
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This is a reflection of the general standard of living of a society which is attributed to the interaction of genetics and various environmental factors [32]. Our study also fails to agree to the average age of 11.6 ± 3.6 years reported by Islam et al. in Bangladesh [33], 12.4 ± 1.0 years by Al-Awhadi et al. [4] in Kuwait and 12.5 ± 0.08 years by Lalys et al. [31] in France. The difference in the study population with its difference in socio-economic indices might be responsible for the observed lower age of menarche in the above studies.
Menstruation has a variable pattern. Knowledge of age at menarche and providing accurate information to adolescent girls is necessary to allay anxiety, treat menstrual morbidities, and improve their quality of life.
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The average age at menarche was 13 ± 1.0 years. Dysmenorrhea is a major cause of morbidity amongst this age group and should be empathically addressed. It is therefore important that the students, their parents, and school managers in the study area be educated on the issues of menstrual problems that can occur in an adolescent.
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Short communicationAge at menarche and its socioeconomic determinants among female students in an urban area in Bangladesh

Highlights

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Competing interest

Author’s contribution

Operational definition

Acknowledgements

Atherosclerosis

Best Pract Res Clin Endocrinol Metab

J Adolesc Health

J Pediatr

Mol Cell Endocrinol

Determinants of menarche

Reprod Biol Endocrinol

Early menarche and the development of cardiovascular disease risk factors in adolescent girls: the Fels Longitudinal Study

J Clin Endocrinol Metab

Early age at menarche associated with cardiovascular disease and mortality

J Clin Endocrinol Metab

Age of menarche and the metabolic syndrome in China

Epidemiology

The age of menarche

ORGYN: Organon's Mag Women Health

The relation of menarcheal age to obesity in childhood and adulthood: the Bogalusa heart study

BMC Pediatr

Short communication
Age at menarche and its socioeconomic determinants among female students in an urban area in Bangladesh