Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Hum Reprod. 2021 Jan 25;36(2):455-464. doi: 10.1093/humrep/deaa309.
Is pubertal timing associated with risk of premenstrual disorders (PMDs) in young adulthood?
Late pubertal development is associated with decreased premenstrual symptom burden and risk of PMDs in young adulthood.
PMDs, including premenstrual syndrome and premenstrual dysphoric disorder, may begin during the teenage years. Few risk factors in early life have been identified for PMD development.
STUDY DESIGN, SIZE, DURATION: A prospective cohort study of 6495 female participants during 1996-2013.
PARTICIPANTS/MATERIALS, SETTING, METHODS: We included participants from the Growing Up Today Study (GUTS). Pubertal development was indicated by the timing of menarche, breast and pubic hair growth. Self-reported age at menarche was longitudinally assessed at enrollment (in 1996/2004 for GUTS I/II) and onwards, and classified as early (age ≤ mean - SD, 11.64 years), normative and late menarche (age ≥ mean + SD, 13.95 years). Timing of pubic hair and breast growth were assessed multiple times during follow-up via Tanner scales, and classified into early, normative and late development according to mean ± SD. Using a validated questionnaire based on the Calendar of Premenstrual Experiences, we assessed premenstrual symptoms and identified probable cases of PMDs in 2013. We examined the associations of timing of pubertal development with premenstrual symptom score and disorders using multivariable linear and logistic regressions, respectively.
In 2013 (mean age = 26), 1001 (15.4%) individuals met criteria for a PMD. An inverse association was found between age at menarche and premenstrual symptom z-score (β -0.05 per year, 95% CI -0.07 to -0.03) and risk of PMDs (odds ratio (OR) 0.93 per year, 95% CI 0.88 to 0.99). Compared to individuals with normative menarche, individuals with late menarche had a lower risk of PMDs (OR 0.73, 95% CI 0.59 to 0.91), while individuals with early menarche had comparable odds (OR 0.98, 95% CI 0.81 to 1.18). Moreover, early growth of pubic hair was associated with increased premenstrual symptoms (z-score β 0.09 per year, 95% CI 0.02 to 0.17) and PMD risk (OR 1.28, 95% CI 1.04 to 1.56), independent of age at menarche. No associations were noted for breast development.
LIMITATIONS, REASONS FOR CAUTION: One major limitation is some misclassification of menarche due to recall. We, however, showed robust association among participants who were premenarcheal at baseline.
Our findings suggest that pubertal timing, particularly timing of menarche, is inversely associated with the risk of developing premenstrual symptoms in young adulthood, and that women with later menarche have significantly lower risk of PMDs. Information on PMDs should be provided to teenage girls and their parents. If these findings are confirmed in independent populations, prevention strategies and early detection programs may be considered for women with early pubertal development.
STUDY FUNDING/COMPETING INTEREST(S): The work is supported by the National Institutes of Health and Swedish Research Council.
N/A.
青春期启动时间与年轻人成年期经前期障碍（PMD）风险相关吗？
青春期启动较晚与年轻人成年期经前期症状负担降低和 PMD 风险降低相关。
PMD，包括经前期综合征和经前期烦躁障碍，可能在青少年时期开始。在生命早期，已经确定了很少的 PMD 发展风险因素。
研究设计、规模、持续时间：对 6495 名女性参与者进行的前瞻性队列研究，研究时间为 1996 年至 2013 年。
参与者/材料、设置、方法：我们纳入了来自今日成长研究（GUTS）的参与者。青春期启动由初潮、乳房和阴毛生长的时间指示。自我报告的初潮年龄在入组时（GUTS I/II 为 1996/2004 年）及以后进行纵向评估，并根据年龄是否早于（年龄≤均值-标准差，11.64 岁）、正常或晚于（年龄≥均值+标准差，13.95 岁）进行分类。阴毛和乳房生长的时间通过 Tanner 量表在随访期间多次进行评估，并根据均值±标准差分为早期、正常和晚期发育。根据基于月经周期经验日历的验证性问卷，我们评估了 2013 年经前期症状和可能的 PMD 病例。我们使用多变量线性和逻辑回归分别检查了青春期启动时间与经前期症状评分和障碍之间的关系。
在 2013 年（平均年龄=26 岁），1001 名（15.4%）个体符合 PMD 标准。初潮年龄与经前期症状 Z 评分（每增加 1 年β-0.05，95%置信区间-0.07 至-0.03）和 PMD 风险（每增加 1 年 OR 0.93，95%置信区间 0.88 至 0.99）呈负相关。与正常初潮的个体相比，晚初潮的个体发生 PMD 的风险较低（OR 0.73，95%置信区间 0.59 至 0.91），而早初潮的个体具有相似的可能性（OR 0.98，95%置信区间 0.81 至 1.18）。此外，阴毛的早期生长与经前期症状增加（每年 Z 评分β 0.09，95%置信区间 0.02 至 0.17）和 PMD 风险增加（OR 1.28，95%置信区间 1.04 至 1.56）相关，独立于初潮年龄。乳房发育与经前期症状和 PMD 风险无关。
局限性、谨慎的原因：一个主要的局限性是由于回忆导致初潮的一些分类错误。然而，我们在基线时处于初潮前的参与者中表现出了稳健的关联。
我们的研究结果表明，青春期启动时间，特别是初潮时间，与年轻人成年期经前期症状发生风险呈负相关，而且晚初潮的女性发生 PMD 的风险显著降低。应向青少年女孩及其父母提供关于 PMD 的信息。如果这些发现能在独立的人群中得到证实，那么可以考虑为青春期发育较早的女性制定预防策略和早期检测计划。
研究资金/利益冲突：这项工作得到了美国国立卫生研究院和瑞典研究理事会的支持。
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