title: Menarche delay and menstrual irregularities persist in adolescents with type 1 diabetes.
abstract: BACKGROUND
  Menarche delay has been reported in adolescent females with type 1 diabetes (T1DM), perhaps due to poor glycemic control. We sought to compare age at menarche between adolescent females with T1DM and national data, and to identify factors associated with delayed menarche and menstrual irregularity in T1DM.
  
  
  METHODS
  This was a cross-sectional study and females ages 12- 24 years (n = 228) with at least one menstrual period were recruited during their outpatient diabetes clinic appointment. The National Health and Nutrition Examination Survey (NHANES) 2001-2006 data (n = 3690) for females 12-24 years were used as a control group.
  
  
  RESULTS
  Age at menarche was later in adolescent females with T1DM diagnosed prior to menarche (12.81 +/- 0.09 years) (mean+/- SE) (n = 185) than for adolescent females diagnosed after menarche (12.17 0.19 years, p = 0.0015) (n = 43). Average age of menarche in NHANES was 12.27 +/- 0.038 years, which was significantly earlier than adolescent females with T1DM prior to menarche (p < 0.0001) and similar to adolescent females diagnosed after menarche (p = 0.77). Older age at menarche was negatively correlated with BMI z-score (r = -0.23 p = 0.0029) but not hemoglobin A1c (A1c) at menarche (r = 0.01, p = 0.91). Among 181 adolescent females who were at least 2 years post menarche, 63 (35%) reported usually or always irregular cycles.
  
  
  CONCLUSIONS
  Adolescent females with T1DM had a later onset of menarche than both adolescent females who developed T1DM after menarche and NHANES data. Menarche age was negatively associated with BMI z-score, but not A1c. Despite improved treatment in recent decades, menarche delay and high prevalence of menstrual irregularity is still observed among adolescent females with T1DM.
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, The Children's Hospital Aurora, Colorado, USA. schweim@ccf.org
authors.forename: Bahareh M
authors.initials: BM
authors.lastname: Schweiger
authors.forename: Janet K
authors.initials: JK
authors.lastname: Snell-Bergeon
authors.forename: Rossana
authors.initials: R
authors.lastname: Roman
authors.forename: Kim
authors.initials: K
authors.lastname: McFann
authors.forename: Georgeanna J
authors.initials: GJ
authors.lastname: Klingensmith
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008572:Menarche / Q000502:physiology*; D008599:Menstruation Disturbances / Q000150:complications / Q000453:epidemiology*; D009749:Nutrition Surveys; D011628:Puberty, Delayed / Q000150:complications / Q000453:epidemiology*; D055815:Young Adult