title: Onset of menstrual cycle and menses features among secondary school girls in Italy: A questionnaire study on 3,783 students.
abstract: OBJECTIVE
  Healthcare professionals need updated information about what is the range of "normal" variation of menstrual cycle features to support young girls and their parents in managing reproductive health, and to detect diseases early.
  
  
  METHODS
  This cross-sectional study aimed to provide an updated picture of age at menarche and main menstrual cycle characteristics and complaints in an Italian population-based sample of 3,783 adolescents attending secondary school. Girls filled in a self-administered anonymous questionnaire including questions about demography, anthropometry, smoking and drinking habits, use of contraceptive, socioeconomic status, age at menarche, menstrual pattern, and physical/psychological menstrual complaints. Mean age at menarche and prevalence of polymenorrhea (cycle length < 21 days), oligomenorrhea (cycle length > 35 days), irregularity, dysmenorrhea, and of physical/psychological complaints were computed. Factors associated with age at menarche and menstrual disturbances were explored by using multiple logistic models.
  
  
  RESULTS
  The girls' mean age was 17.1 years (SD 1.4 years) and the mean age at menarche was 12.4 years (SD 1.3 years); menarche occurred with two monthly peaks of frequency in July-September and in December-January (P < 0.0001). Age at menarche was significantly associated with geographic genetics (as expressed by parents' birth area), mother's menarcheal age, BMI, family size, and age at data collection. The prevalence of polymenorrhea was about 2.5%, oligomenorrhea was declared by 3.7%, irregular length by 8.3%, while long bleeding (>6 days) was shown in 19.6% of girls. Gynecological age was significantly associated with cycle length (P < 0.0001) with long cycles becoming more regular within the fourth year after menarche, while frequency of polymenorrhea stabilized after the second gynecological year. Oligomenorrhea and irregularity were both significantly associated with long menstrual bleeding (adjusted OR = 2.36; 95% CI = 1.55-3.60, and adjusted OR = 2.59; 95% CI = 1.95-3.44, respectively).
  
  
  CONCLUSIONS
  The findings of the study support the levelling-off of secular trend in menarche anticipation in Italy and confirm the timing in menstrual cycle regularization. The study provides updated epidemiological data on frequency of menstrual abnormalities to help reproductive health professionals in managing adolescent gynecology.
authors.affiliation: Private Accredited Hospital Quisisana, Paediatric and Adolescent Outpatients Clinic, Ferrara, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Sanctis
authors.affiliation: Department of Pediatrics, University of Parma, Parma, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Bernasconi
authors.affiliation: Rehabilitation Centre, Associazione La Nostra Famiglia, Padua, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bianchin
authors.affiliation: Department of Mother and Child Health, Division of Pediatrics, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Bona
authors.affiliation: Internal Medicine and Therapeutics, Section of Childhood and Adolescence, University of Pavia, Foundation IRCCS San Matteo, Pavia, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bozzola
authors.affiliation: Department of Pediatrics, "Carlo Poma" Hospital, Mantova, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Buzi
authors.affiliation: Department of Pediatric and Endocrinology, Ospedale Infantile Regina Margherita, Turin, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: De Sanctis
authors.affiliation: Department of Pediatrics, University of Padua, Padova, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Rigon
authors.affiliation: Department of Pediatrics, University of Verona, Verona, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Tatò
authors.affiliation: Centre of Pediatric Diabetology, Burlo Garofolo Hospital, Trieste, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Tonini
authors.affiliation: Department of Cardiac, Thoracic, Vascular Sciences, Unit of Biostatistics, Epidemiology and Public Health, University of Padua, Padova, Italy.
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
keywords: Adolescence; cross-sectional; menarche; menstrual disorders; seasonal peaks