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Psychosocial Pressure and Menarche: A Review of Historic Evidence for Social Amenorrhea

Hermanussen, Michael Prof. Dr. med.*; Lehmann, Andreas MSc; Scheffler, Christiane Dr. rer. nat.

Obstetrical & Gynecological Survey: April 2012 - Volume 67 - Issue 4 - p 237–241
doi: 10.1097/OGX.0b013e31824c94ad
CME Program: CME Review Article 10

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.

*Professor of Pediatrics, Aschauhof, Altenhof, Germany; and †Physician, University of Potsdam, Human Biology, Potsdam, Germany

CHIEF EDITOR'S NOTE: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA PRA Category 1 CreditsTM can be earned in 2012. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors, faculty and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

Lippincott CME Institute has identified and resolved all conflicts of interest concerning this educational activity.

Presented partially at the 7th Berlin Symposium Kinder-und 7–9, 2011.

Supported by the German Society for Auxology (Deutsche Gesellschaft für Auxologie). None of the authors have a conflict of interest.

Correspondence requests to: Michael Hermanussen, Aschauhof 3, 24340 Altenhof, Germany. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.