wPływ wIEku MenARChe nA CzęSToŚć wySTęPowAnIA zAbuRzEń Cyklu MIESIąCzkowEGo u zdRowyCh STudEnTEk
1 Zakład Antropologii Instytutu Zoologii Collegium Medicum Uniwersytetu Jagiellońskiego ul. Gronostajowa 9, 30-387 Kraków
Kierownik: dr hab. Henryk Głąb
2 Katedra i Zakład Anatomii Prawidłowej i Klinicznej Pomorskiego Uniwersytetu Medycznego w Szczecinie al. Powstańców Wielkopolskich 72, 70-111 Szczecin
Kierownik: dr hab. n. med. Zbigniew Ziętek
3 Katedra i Zakład Anatomii Collegium Medium Uniwersytetu Jagiellońskiego ul. Kopernika 12, 31-034 Kraków
Kierownik: prof. dr hab. n. med. Jerzy Walocha
Streszczenie
Wstęp: Wyniki wielu badań wskazują na długotrwałe, negatywne skutki wczesnego wieku dojrzewania.
Celem pracy było określenie wpływu wczesnego i póź-nego wieku pojawienia menarche na występowanie zabu-rzeń cykli miesięcznych oraz cechy antropometryczne stu-dentek.
Materiał i metody: Badania przekrojowe zostały wyko-nane wśród 566 studentek Uniwersytetu Jagiellońskiego.
U każdej osoby dokonano pomiaru wysokości, masy ciała oraz obwodu pasa. Wiek pierwszej miesiączki ustalono metodą retrospektywną na podstawie daty podanej przez badane. Za pomocą ankiety zebrano dane dotyczące prze-biegu cykli miesięcznych.
Wyniki: Wiek menarche w badanej grupie wahał się w zakresie 10–17 lat, średnio był równy 12,71. U badanych studentek okres od pierwszej miesiączki do momentu bada-nia wynosił co najmniej 5 lat. Na podstawie wartości centy-lowych badane studentki podzielono na trzy grupy: osoby dojrzewające wcześnie, przeciętnie i późno. Stwierdzono istotne różnice w przebiegu cykli miesięcznych w zależno-ści od wieku menarche. Zarówno u wcześnie, jak i u późno
dojrzewających osób częściej niż u dojrzewających prze-ciętnie występowały nieregularne cykle. Najdłuższe cykle i najczęstsze występowanie oligomenorrhoea stwierdzono u osób późno dojrzewających. Nie stwierdzono różnic pod względem liczby dni, w których następowało krwawienie miesiączkowe, jednak osoby wcześnie dojrzewające czę-ściej deklarowały obfite krwawienia. U osób wcześnie doj-rzewających częściej występował ból w trakcie miesiączki.
Więcej studentek wcześnie dojrzewających deklarowało także częste występowanie bólu kręgosłupa oraz bólu głowy w trakcie cyklu miesięcznego.
Wnioski: Zarówno wczesny, jak i późny wiek wystąpie-nia menarche jest skorelowany z występowaniem zaburzeń cyklu miesięcznego u młodych kobiet. Znacznie częściej zaburzenia miesiączkowania stwierdza się jednak u studen-tek wcześniej dojrzewających. Ponadto, u kobiet, u których pierwsza miesiączka wystąpiła w młodszym wieku zano-towano większe ryzyko wystąpienia otyłości oraz otyło-ści brzusznej, co dodatkowo jest czynnikiem ryzyka wielu chorób.
H a s ł a: zaburzenia miesiączkowania – wiek menarche – studentki.
THE INFLUENCE OF AGE AT MENARCHE ON THE PREVALENCE OF DISORDERS OF THE MENSTRUAL CYCLE 95
Summary
Introduction: Many research findings indicate long -term health risks of early age at menarche.
The aim of the present study was to determine the effects of early and late onset of menarche on menstrual disturbances and anthropometric measures among univer-sity students.
Material and methods: The research was carried out among 566 students of the Jagiellonian University. Measure-ments of the height, weight and waist circumference were taken for each person. The age at the first menstruation was assessed by a retrospective method based on information given by the students. Data related to the pattern of the menstrual cycle were gathered by a survey.
Results: The group featured an average age at menarche of 12.71, ranging between 10 and 17 years. The -menarchal year was at least 5. According to percentiles,
the females were divided into three groups of different puberty rate. Significant differences were observed in the pattern of menstrual cycles with relation to age at menarche.
Among the early - and late -maturing group irregular cycles were more frequent than among those who reached puberty at the average age. The longest cycles and most frequent oligomenorrhoea were observed in the late -maturing group.
There were no differences observed regarding the number of days with menstrual bleeding, although the early -maturing women more frequently declared that bleeding was profuse.
Within the group of early -maturing students a significantly larger number declared to have suffered menstrual pain than in the other groups. More early -maturing students also complained of back pain and headaches during the menstrual cycle.
Conclusion: Both early and late menarche might be related to menstrual dysfunction among young women. Men-strual disturbances were more prevalent among women who experienced menarche at a younger age. Moreover, in the early -maturing group overweight and obese states, as well as abdominal obesity, were frequent, and they are known as risk factors in many illnesses.
K e y w o r d s: menstruation disorders – age at menarche – female university students.
Introduction
For many years a trends towards a younger age at menarche has been observed. As this tendency has been mainly reported in well -developed countries, where the improvement in the lifestyle and nutritional standards of chil-dren and the young is evident, it was originally considered a very positive phenomenon [1, 2, 3]. However, more and more paper show negative consequences of early puberty.
Many research findings indicate that age at menarche is significantly correlated with adult body size. In the case of
body height the results are not explicit. Some studies point out that early maturing persons are shorter than those who reach puberty later in life, whereas in many others, no such correlation was found [4, 5]. The rate of puberty is signifi-cantly correlated with fat deposition. Persons with early puberty onset feature higher body mass index (BMI) values and higher percentage of fat tissue content. Overweight and obesity are far more frequent in this group [3, 6, 7]. The differences are not only in levels of fatness but also in fat distribution. The early maturing persons present a higher prevalence of abdominal obesity, which carries the highest risk of morbidity and mortality [8].
Early puberty is associated with many illnesses, among others, breast cancer, cancers of the reproductive tem, endometriosis, and disorders of the circulatory sys-tem [9, 10, 11]. It has been observed that women with early age at menarche are more likely to develop eating disor-ders, mainly bulimia, and exhibit risky behavior i.e. early sexual contacts and the usage of stimulants [12, 13]. In general early maturing person assess their health as worse than persons maturing on time or late. Despite the fact that negative effects of early puberty have been well recognized, the mechanism of this relationships has not yet been fully explained. Hardly any studies can be found in the subject literature on the impact of puberty rate on the patterns of menstrual cycles in adult life.
The aim of the present study was to determine the effects of early and late onset of menarche on menstrual disturbances and anthropometric measures among univer-sity students.
Material and methods
Research was carried out among 711 students of the Jagiellonian University. Students who used any hormonal treatment in the preceding year and students who declare that they suffer from any chronic diseases were excluded from the current analysis and data of 566 students were qualified for further analysis. All participants were premeno-pausal women aged 19–24 years who were not pregnant or breastfeeding, had not used contraceptives in the preceding year, had menstrual cycles during that year and did not have a treatment history for menstrual irregularity or infertility.
The measurements of the height, weight and the waist cir-cumference were taken of each person. The age at the first menstruation was assessed by a retrospective method based on information given by the students in question. Data related to the pattern of menstrual cycle were gathered by a survey.
A detailed questionnaire, drawn by the author, constituted a research tool in which specific questions were asked as to menstrual cycles characteristics i.e. the length and regular-ity of cycles, the duration of menstrual flow, the occurrence of menstrual pain, headache and back pain during the cycles.
The group featured an average age at menarche 12.71, ranging between 10–17 years. The post -menarcheal year
96 IWONA WRONKA, IWONA TEUL, JUSTYNA MARCHEWKA was at least 5. According to percentiles, the females were
divided into three groups of different puberty rate, namely:
females reaching puberty before the age of 12 y. (below values of 25th percentile) make the early maturing group, average maturing group reached puberty at an age between 12–14 y. (within the range of 25th–75th percentiles) and those who reached puberty at an age older than 14 y. make a late maturing group (above values of 75th percentile). The number of students in the first group was 79 (13.95%), second – 354 (62.55%) and third – 133 (23.50%).
Statistical methods
The Shapiro–Wilk test was used to examine the nor-mality of the preliminary quantity variables. Groups com-parisons were performed with the use of one -way analysis of variance (ANOVA) or the Kruskal–Wallis test. The per-centage data were compared in χ2 test. P values < 0.05 was considered as statistically significant.
Results
Significant differences were observed in the pattern of menstrual cycles with relation to age at menarche (Table 1).
Among early and late maturing group irregular cycles were more frequent than among those reached puberty at an average age (Table 1).
T a b l e 1. Prevalence of menstrual disorders in relation to maturation rate
Variables Status Early maturing Average maturing Late maturing
n % n % n % p
Menstrual cycles regular 53 67.20 272 76.84 84 63.20
< 0.001
irregular 26 32.80 82 23.16 49 36.80
Menstrual pain
no 31 39.00 159 45.00 73 55.00
< 0.05
yes, average 36 45.50 152 42.30 48 36.08
yes, string 12 15.20 43 12.10 12 9.02
Headaches
once a week 18 22.78 67 18.98 19 14.28
< 0.01
once a month 27 34.17 106 29.90 40 30.01
rarely 33 44.89 170 48.07 60 45.20
never 1 1.26 11 3.11 14 10.52
Back pain
once a week 20 25.3 60 16.95 25 18.79
< 0.001
once a month 22 27.8 71 20.05 21 15.78
rarely 26 32.9 156 44.08 52 39.13
never 11 14.00 67 18.92 35 26.30
Females with early age at menarche more often reported menstrual pain. They were asked not only whether they experienced menstrual pain during, but also how intense the pain was. Within the group of early maturing students significantly larger number declared to have suffered severe pain than in the other groups. However, caution needs to be exercised here, as the assessment of the intensity of pain is highly subjective. More early maturing students com-plained also of back pain and headaches during the men-struation cycle.
The length of cycles was determined only for the females who said they had periods in regular time intervals. The longest cycles and most frequent oligomenorrhoea were observed in late maturing group. Cycles longer than 35 days were reported by 7% of females i.e. 4% of early, 6% of average and 9% of late maturing groups. Polymenorrhoea i.e. cycles more frequent than 21 days were declared by 4%
of early, 3% of average and 3% of late maturing groups; in total 3.5% of the group under research. There were no dif-ferences observed regarding the number of days with men-struation bleeding, however the early maturing women more frequently declared that the bleeding was profuse. Here as well it must be noted that, as with the assessment of pain intensity, this evaluation is also subjective (Table 2).
Anthropometric characteristic of surveyed women is presented in Table 3. The early maturing girls are shorter and heavier than average and late maturing. It is important
T a b l e 2. duration of menstrual cycles in relation to maturation rate
Early maturing Average maturing Late maturing p
Menstrual cycle length
x 28.88 28.67 29.52
s 3.85 2.58 2.84 NS
min–max 19–50 19–38 19–46
Duration of bleeding (days)
x 5.13 5.12 5.16
s 1.57 1.10 1.14 NS
min–max 2–12 2–8 2–8
THE INFLUENCE OF AGE AT MENARCHE ON THE PREVALENCE OF DISORDERS OF THE MENSTRUAL CYCLE 97
T a b l e 3. Antropometric characteristic of surveyed women in relation to the age at menarche
Parameters Early maturing Average maturing Late maturing p
Body height (cm)
x 164.7 166.2 167.9
< 0.01
s 4.80 6.00 5.54
min–max 154–180 148–186 156–183
BMI (kg/m2)
x 21.85 21.30 20.93
< 0.05
S 3.44 2.84 2.75
min–max 15.62–31.48 16.01–33.26 15.99–32.24
Waist circumference (cm)
x 71.44 71.28 70.88
NS
S 8.13 7.88 7.28
min–max 59–93 58–100 59–97
WHR
x 0.78 0.75 0.74
NS
S 0.05 0.06 0.06
min–max 0.64–0.90 0.64–1.01 0.64–0.93
to mention that in the early maturing group overweight and obesity as well as abdominal obesity were frequent and they are known as risk factors in many illnesses. The prevalence of overweight and obesity in early maturing group was 18.26%, in average maturing group 9.09% and in late maturing groups 8.91% (p < 0.01). The prevalence of abdominal obesity in early maturing group was 15.75%, in average maturing group 12.59% and in late maturing groups 9.09% (p < 0.05).
discussion
The course of the menstruation cycle is a -dependant process which is controlled by -pituitary -ovary axis. Any dysfunction of that system results in irregular menstruation cycles. Irregularities mainly affect bleeding periodicity and intensity, the occurrence of addi-tional blood discharge during the cycle and the experience of strong menstrual pain. It is worth remembering that irreg-ularities in menstruation cycles happen to almost every woman [14]. This is quite frequent especially within the first 2 years after menarche. It is normal and if it does not get too intense there is no need to seek medical assistance. However, if symptoms persist, the condition must be diagnosed and treated with full medical supervision and control.
The results of this study show that a significant percent-age of young women declare having experienced irregu-larities during their menstruation cycles. Irregular cycles were observed with 20% of females and these cycles were more frequent among both early and late maturing. Longest cycles as well as most frequent occurrence of cycles longer than 35 days were noted in the late puberty age. Subject lit-erature show that oligomenarhoea is noted very frequenty among females involved in sports activities [15]. On aver-age, women professionally practicing sport feature late age at menarche. In the group of women not engaged in any sports activity the association between late age at menarche and long menstrual cycles was also observed [16, 17, 18].
Long cycles and short cycles alike may be a result of early age at menarche [17, 19]. The results presented in this work show no significant differences in the average cycle length between early and average maturing groups, though in the early maturing group highest between subjects variability was spotted in terms of this parameter.
The disorder that the surveyed females most frequently reported was menstrual pain. It was declared by 60% of them and 20% stressed that pain was severe. Another study shows that this is the most common gynecological problem.
Menstrual pain is assessed to occur as frequently as in 50%
of cases [19, 20]. Research carried out in Poland showed that 56.3% of females in Warsaw aged between 15–37 complained to have suffered this condition [21]. Accord-ing to research done by Skrzypulec et al. 40% of females who actively practice sport complained of menstrual pain whereas only 12% females of the control group declared this complaint [22]. The findings of presented paper give a much higher proportion which can be explained by the fact that the sample group in question consisted mainly of young females with no children. Many studies point out that menstrual pain is most frequent among women with no childbirth experience. Studies carried out in other Euro-pean countries indicate similar results. It must be said that while researching the occurrence of menstrual pain and its frequency there are no objective methods that can be used to measure these parameters. Women are asked to state whether they experience pain during menstrual bleeding and how intense the pain is. The assessment of intensity is highly subjective. Moreover, some females may experience pain once every several months, whereas others may suffer every month. This fact, often disregarded in many stud-ies, may cause significant discrepancies in research results.
According to this study and data from subject literature review, the early age at menarche fosters the occurrence of menstrual pain [23, 24]. This indicates the -related origin of the pain problem. Early age at menarche is correlated not only with abdominal pain but also with the occurrence of headaches and back pain. Moreover, this
98 IWONA WRONKA, IWONA TEUL, JUSTYNA MARCHEWKA work and the subject literature data show that early age at
menarche constitutes a factor fostering long and profuse bleedings [24, 25].
The course of the menstrual cycle and the prevalence of pain during the cycle in particular, has a significant impact on the quality of females’ lives, often restricting the per-formance of everyday activities related to family or pro-fessional life. Irregularities in the course of the cycles are caused by the dysfunction of the hormone system and their occurrence may indicate hormone disorders.
Conclusion
Significant differences were observed in the pattern of menstrual cycles with relation to age at menarche. Men-strual disturbance were more prevalent among girls who experience menarche at younger age. Moreover, in the early maturing group overweight and obesity as well as abdomi-nal obesity were frequent and they are known as risk fac-tors in many illnesses.
Disorders of menstrual cycles, obesity and age at menarche are correlated and independently both factors are also linked with other illnesses. Further and more detailed research on the matter may help to recognize the mecha-nisms behind those relationships and contribute to early diagnosis and prevention of a variety of disorders.
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