Menarche and Time to Cycle Regularity Among Individuals Born Between 1950 and 2005 in the US

Abstract

Importance: Early menarche is associated with adverse health outcomes. Trends toward earlier menarche have been observed in the US, but data remain limited on differences by sociodemographic factors and body mass index (BMI). Time from menarche to cycle regularity is another understudied early-life characteristic with health implications.

Objectives: To evaluate the temporal trends and disparities in menarche and time to regularity and explore early-life BMI as a mediator.

Design, setting, and participants: This ongoing cohort study enrolled participants from an ongoing mobile application-based US cohort from November 14, 2019, to March 20, 2023.

Exposures: Birth year (categorized as 1950-1969, 1970-1979, 1980-1989, 1990-1999, and 2000-2005).

Main outcomes and measures: Main outcomes were age at menarche and time to regularity, which were self-recalled at enrollment. In addition, early (aged <11 years), very early (aged <9 years), and late (aged ≥16 years) age at menarche was assessed.

Results: Among the 71 341 female individuals who were analyzed (mean [SD] age at menarche, 12.2 [1.6] years; 2228 [3.1%] Asian, 3665 [5.1%] non-Hispanic Black, 4918 [6.9%] Hispanic, 49 518 [69.4%] non-Hispanic White, and 8461 [11.9%] other or multiple races or ethnicities), 5223 were born in 1950 to 1969, 12 226 in 1970 to 1979, 22 086 in 1980 to 1989, 23 894 in 1990 to 1999, and 7912 in 2000 to 2005. The mean (SD) age at menarche decreased from 12.5 (1.6) years in 1950 to 1969 to 11.9 (1.5) years in 2000 to 2005. The number of individuals experiencing early menarche increased from 449 (8.6%) to 1223 (15.5%), the number of individuals experiencing very early menarche increased from 31 (0.6%) to 110 (1.4%), and the number of individuals experiencing late menarche decreased from 286 (5.5%) to 137 (1.7%). For 61 932 participants with reported time to regularity, the number reaching regularity within 2 years decreased from 3463 (76.3%) to 4075 (56.0%), and the number not yet in regular cycles increased from 153 (3.4%) to 1375 (18.9%). The magnitude of the trend toward earlier menarche was greater among participants who self-identified as Asian, non-Hispanic Black, or other or multiple races (vs non-Hispanic White) (P = .003 for interaction) and among participants self-rated with low (vs high) socioeconomic status (P < .001 for interaction). Within a subset of 9865 participants with data on BMI at menarche, exploratory mediation analysis estimated that 46% (95% CI, 35%-61%) of the temporal trend in age at menarche was explained by BMI.

Conclusions and relevance: In this cohort study of 71 341 individuals in the US, as birth year increased, mean age at menarche decreased and time to regularity increased. The trends were stronger among racial and ethnic minority groups and individuals of low self-rated socioeconomic status. These trends may contribute to the increase in adverse health outcomes and disparities in the US.

Figure 1.. Temporal Trends of Age at Menarche and Time to Cycle Regularity Among 71 341 Apple Women’s Health Study Participants

Error bars indicate SDs.

Figure 2.. Temporal Trends of Age at Menarche by Birth Year, Stratified by Race and Ethnicity

Other includes American Indian or Alaska Native, Middle Eastern or North African, Native Hawaiian or other Pacific Islander, or none of these categories can fully describe the participant. Multiple races correspond to those who self-identified as more than 1 race and ethnicity category. All trends were statistically significant at P < .05. Error bars indicate 95% CIs.

Figure 3.. Temporal Trends of Age at Menarche by Birth Year, Stratified by Socioeconomic Status (SES)

All trends were statistically significant at P < .05. Error bars indicate 95% CIs.

Figure 4.. Exploratory Causal Mediation Among 9865 Participants With Body Mass Index (BMI) z Score at Menarche

The exploratory mediation analysis estimated that 46% (95% CI, 35%-61%) of the temporal trend in age at menarche was explained by BMI at menarche. Total effect represents the overall change in age at menarche per 10-year lapse in birth year, direct effect represents the proportion of this change that is independent of BMI z score at menarche, and indirect effect represents the proportion of this change mediated through BMI z score at menarche. Error bars indicate 95% CIs.