title: Onset of ovulation after menarche in girls: a longitudinal study.
abstract: BACKGROUND
  Hypothalamic-pituitary axis maturity has been believed to be the rate-limiting step in the development of ovulatory menstrual cycles. We hypothesized that, given current nutritional conditions, hypothalamic-pituitary axis maturation would be relatively rapid in menarcheal girls.
  
  
  METHODS
  Daily urine and menstrual records were collected for 2 yr each from 10 girls aged 11-13 yr at study entry. Urinary excretion of LH, FSH, estradiol (E1c), and progesterone (Pdg) metabolites was measured using established ELISAs. An objective algorithm detected rises of LH, FSH, E1c, and Pdg consistent with follicular maturation and/or ovulation.
  
  
  RESULTS
  Nine of 10 girls enrolled into the study experienced the onset of menarche prior to or during the 2-yr collection period. LH and FSH surges, as well as small amplitude Pdg increments, were observed prior to menarche. Regular, ovulatory-appearing cycles with LH surges and gradually increasing and more sustained Pdg rises were observed over time after menarche, although duration of Pdg elevations remained shorter than in adult women (8.9 +/- 1.0 vs. 12.1 +/- 0.8 d, P = 0.043). E1c levels leading to LH/FSH surges were lower in perimenarcheal girls than adult controls, and bleeding episodes did not uniformly correlate with hormone patterns. Progressive increases in FSH and Pdg, but not LH or E1c, were observed in association with menarche.
  
  
  CONCLUSIONS
  Mature hormone patterns are established within several months of and even prior to menarche in normal-weight perimenarcheal girls. Factors determining menstrual bleeding in perimenarcheal girls may not be solely dependent on reproductive hormones or the neuroendocrine axis.
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, Division of Reproductive Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Zhang
authors.forename: Staci
authors.initials: S
authors.lastname: Pollack
authors.forename: Ali
authors.initials: A
authors.lastname: Ghods
authors.forename: Carrie
authors.initials: C
authors.lastname: Dicken
authors.forename: Barbara
authors.initials: B
authors.lastname: Isaac
authors.forename: Goli
authors.initials: G
authors.lastname: Adel
authors.forename: Gohar
authors.initials: G
authors.lastname: Zeitlian
authors.forename: Nanette
authors.initials: N
authors.lastname: Santoro
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D004958:Estradiol / Q000652:urine; D005260:Female; D005640:Follicle Stimulating Hormone / Q000652:urine; D006801:Humans; D008137:Longitudinal Studies; D007986:Luteinizing Hormone / Q000652:urine; D008572:Menarche / Q000502:physiology*; D010060:Ovulation; D011374:Progesterone / Q000097:blood
chemical_list: D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone