Early Menarche and Long-Term Health: What the Research Says

By Dr. Liji Thomas, MDReviewed by Danielle Ellis, B.Sc.

Early menarche
Health issues with earlier menarche
Risk factors for early menarche
Mechanisms of ill-health with early menarche
Current research findings
Long-term health management
Conclusions
References
Further reading

Early menarche

Menarche is the onset of physiological events culminating in reproductive capability in females, as demonstrated by menstruation. It is among the later events of puberty.

Typically, girls are between 12 and 14 years old at menarche. Early menarche is defined as menarche before the age of 12 years. The age at menarche showed a steady decline from 17 years in 1840 to 12 years in 2000. By this definition, the incidence of early menarche is 25-33% higher today than in earlier years.³

For instance, in one large Korean study, 50% of girls born in the 2000s had early menarche before 12 (and a quarter before ten years) compared with one-third of a 1990s birth cohort.⁴

Health issues with earlier menarche

Early puberty is associated with increasing odds of chronic disease, both physical and mental.¹ Menarche at 10 vs 11 years, for instance, roughly doubles the odds of long-term ill-health in adult life. The earlier the age at menarche, the greater the odds of stress and ill-health.⁴

With early menarche, premature closure of the epiphyses occurs, leading to stunting of height.³ Menarche before 12 years was linked to an increased prevalence of obesity, insulin resistance, and hypercholesterolemia in adulthood, resulting in a higher prevalence of hypertension, coronary heart disease, stroke, and diabetes in women. The risk of metabolic syndrome – a cluster of four conditions: obesity, hypertension, dyslipidemia, and insulin resistance – was increased by 50%.^2,3

Early menarche is also associated with higher female cancer risk. The risk of breast cancer is 19% higher, while for endometrial and ovarian cancer, it is 40% and 17% higher, respectively.¹

Coronary heart disease may also be more prevalent among women who had early menarche.^2,6 All-cause mortality rises with younger menarche, with a 3% drop per additional year of age at menarche.⁶

The risk of early sexual activity is more than doubled with menarche at ten or earlier, but not teenage pregnancy risk.⁴ Early menarche is also associated with earlier initiation of sexual activity, early marriage, early pregnancy, and certain sexually transmitted infections (STIs). This makes these girls more vulnerable to chronic diseases and subfertility, as well as earlier menopause.^8,11 

Chronic psychosocial problems associated with early menarche may include anxiety and depression, drug abuse, bulimia, bullying, smoking, and suicidal behavior during adolescence.³ Premature menopause is more likely with early menarche.

Risk factors for early menarche

The age of menarche depends on both genetic and environmental factors. Mothers and daughters typically have similar ages at menarche.³

Environmental factors include social transition, better nutrition, exposure to endocrine-disruptor chemicals (EDCs), and psychological and social factors.^3,4 Menarche before the age of 12 could be linked to a better socioeconomic status, faster childhood growth, increased body mass index (BMI), adolescent obesity, higher consumption of fructose-rich sugary drinks, a girls-only school environment, and less childhood physical activity.³

Stressful childhood environments, including family conflict and divorce, the presence of a stepfather, and lower parental education, are also associated with early menarche.^2,3,7

Mechanisms of ill-health with early menarche

In the large Korean study mentioned above, early menarche was reported in half the sample, yet lower health and well-being levels were predicted. This is mirrored in other countries where early menarche occurs in 6% to 25% of girls.⁴ Obvious body changes do not appear to mediate these associations.

Hormonal fluctuations and the mismatch between biological and brain maturation could better explain these correlations. However, common genes contribute to metabolic dysregulation as well as puberty timing, potentially confounding observed associations.¹

The accumulation of EDCs may predispose to early menarche and chronic disease.¹ In addition, increased estrogen exposure with early menarche may explain the increased risk of metabolic and cancerous disease since estrogens act on multiple tissues, including the female reproductive tract, brain, fatty tissues, and endothelium.¹

Putting a Stop to Period Stigma

Early menarche research concludes that girls who mature early encounter troubling situations inside and outside the home. Post-pubertal traumatic assault, sexual victimization, discontinuation of education, and child marriage are more common following early menarche. These may mediate the association with chronic psychological ill-health in later life.^9,10

Current research findings

Perspectives on the drivers of puberty timing include the energetics theory, the psychosocial adjustment theory, and theories relating to parental investment, stress suppression, and child development. Age at menarche thus responds to a variety of environmental factors.⁷

Adverse cardiovascular impacts with early menarche may be selective in occurrence, possibly related to a higher BMI at younger ages.² The link to depression and anxiety also requires validation studies.

The association between early menarche, fertility, and reproductive tract disorders leading to surgical menopause remains to be explored. Some data suggests that surgical menopause odds also increase with early menarche.²

Long-term health management

Preventive measures and early interventions

"Such consequences can be prevented through health education targeting a reduction in the consumption of fructose," such as by eliminating sugary beverages from vending machines.¹¹

Policy interventions for young girls in low- and middle-income countries, aiming at the prevention of child marriage and the provision of adolescent health education and facilities. These will help reduce the multiple risks associated with early menarche.⁹

Guidance for parents and healthcare providers

Parents and healthcare providers should be aware of the clinical consequences of early menarche. In some cases, early menarche can be avoided by ensuring young girls get nutritious food, enough physical activity, and supportive environments.

"Given that heart disease is the number one killer of women, identifying those women who experienced early menarche (aged younger than 12 years) may allow for earlier intervention to reduce cardiovascular risk," says Dr. Stephanie Faubion, medical director of the North American Menopause Society (NAMS).⁸ Similar monitoring is essential for timely intervention against cancers.

Conclusions

BMI and higher body fat alone do not explain the decreasing age at menarche. Recent research links chronic prolonged stress, including abuse and low socioeconomic status, to accelerated aging. These factors interact with place of stay, environmental chemicals, nutrition, and healthcare availability, impacting age at menarche.

Speaking of the same phenomenon in girls of color, Dr. Juliana Deardorff, head of the Maternal, Child and Adolescent Health program at the University of California, Berkeley, comments, "We should be thinking about this, not just normalizing these disparities." ¹²

"Early menarche can be a potential indicator of metabolic disorders and female-specific cancer and cause death in women." ¹ Physicians should heed these associations and take adequate and timely preventive action to promote longevity and good health in these women.

References

1. Lee, J.-S., Lee, Y. A., Shin, C. H., et al. 2022. Long-term health outcomes of early menarche in women: an umbrella review. QJM. doi: https://doi.org/10.1093/qjmed/hcac187. Accessed on July 1, 2024.
2. Soliman, A., Alaaraj, N., De Sanctis, V., et al. (2023). Long-term health consequences of central precocious/early puberty (CPP) and treatment with Gn-RH analogue: a short update. Acta Biomedica. doi: https://doi.org/10.23750%2Fabm.v94i6.15316. Accessed on July 1, 2024.
3. Lee, H. S. Why should we be concerned about early menarche? Clinical and Experimental Pediatrics 2021. doi: https://doi.org/10.3345%2Fcep.2020.00521. Accessed on July 1, 2024.
4. Yu, E. J., Choe, S.-A., Yun, J.-W., et al. Association of early menarche with adolescent health in the setting of rapidly decreasing age at menarche. Journal of Pediatric and Adolescent Gynecology 2020. doi: https://doi.org/10.1016/j.jpag.2019.12.006. Accessed on July 1, 2024.
5. Colditz, G. A., Willett, W. C., Stampfer, M. J et al. (1987).  A prospective study of age at menarche, parity, age at first birth, and coronary heart disease in women. American Journal of Epidemiology. doi: 10.1093/oxfordjournals.aje.a114723. Accessed on July 1, 2024.
6. Charalampopoulos, D., McLoughlin, A., Elks, C. E., et al. (2014). Age at menarche and risks of all-cause and cardiovascular death:  a systematic review and meta-analysis. American Journal of Epidemiology. doi: 10.1093/aje/kwu113. Accessed on July 1, 2024.
7. Mishra, G. D., Cooper, R., Tom, S. E., et al. (2009). Early life circumstances and their impact on menarche and menopause. Womens Health. doi: https://doi.org/10.2217/17455057.5.2.175. Accessed on July 1, 2024.
8. Women's heart health linked to age at first menstrual period. (2020). https://www.sciencedaily.com/releases/2020/09/200909114812.htm. Accessed on July 1, 2024.
9. ibitoye, M., Choi, C., Tai, H. et al. (2017). Early menarche: A systematic review of its effect on sexual and reproductive health in low- and middle-income countries. PLOS ONE. doi: https://doi.org/10.1371/journal.pone.0178884. Accessed on July 1, 2024.
10. Mendle, J., Ryan, R. M., and McKone, K. M. P. (2019). Early menarche and internalizing and externalizing in adulthood: explaining the persistence of effects. Journal of Adolescent Health. doi: https://doi.org/10.1016%2Fj.jadohealth.2019.06.004. Accessed on July 1, 2024.
11.  Zheng, Y., Wen, T., Shen, Y. (2021). Age at menarche and cardiovascular health: results from the NHANES 1999-2016. Menopause. doi: 10.1097/GME.0000000000001653. Accessed on July 1, 2024.
12. "Girls of color are getting their periods earlier. No one quite knows why. (2014). https://www.nytimes.com/2024/05/30/well/live/girls-period-menstrual-cycle-study.html. Accessed on July 1, 2024.

Further Reading

• All Puberty Content
• Premature Breast Enlargement (Premature Thelarche)
• Delayed Puberty
• Causes of Delayed Puberty
• Precocious Puberty - Early Puberty