Psychosocial pressure and menarche: a review of historic evidence for social amenorrhea.

OBJECTIVE

The age of menarche is usually considered to be affected by nutritional, health-related, social, and economic factors and has significantly decreased since the mid-19th century. The present study was performed to investigate whether the timing of menarche paralleled the general acceleration of physical development, or whether this pattern differed.

STUDY DESIGN

In all, 30 German studies on menarcheal age (n = >200) since 1848 were collected. Frequency distributions were analyzed.

RESULTS

During the second half of the 19th and the early 20th century, mean menarcheal age decreased from 18 to 12-13 years in Europe. Yet, the data fail to support the conventional hypothesis that menarcheal age mainly depends on nutritional, health, and economic factors.

CONCLUSIONS

We suggest that later than usual menarche may not necessarily be regarded as a physical illness, but in view of the apparently physiological delay of menarche in the 19th century, may be viewed as "collective social amenorrhea."

TARGET AUDIENCE

Obstetricians & Gynecologists and Family Physicians.

LEARNING OBJECTIVES

After participating in this CME activity, physicians should be better able to evaluate menarche as an indicator of developmental tempo in both historical and modern settings, compare menarche in healthy mid-19th century girls with menarche in average modern girls, and assess the marked sensitivity of full pubertal development to environmental circumstances.