Age at menarche in Korean adolescents: trends and influencing factors.
BACKGROUND
An increased incidence of central precocious puberty has been recently reported in South Korea, which suggests an ongoing downward trend in pubertal development in the Korean population. We aimed to verify the trend in age at menarche in young Korean women during the last decade and associated factors.


METHODS
We analyzed a population-based sample of 3409 Korean girls, aged 10-18 years, using data from the Korean National Health and Nutrition Examination Surveys (KNHANES) II (2001), III (2005), IV (2007-2009), and V (2010 and 2011). Average age at menarche was studied using the Kaplan-Meier survival method and predictors were analyzed using Cox proportional hazards model. The percentage of subjects who had experienced menarche at each age level was compared by using the Cochran-Armitage test.


RESULTS
Overall mean age at menarche was 12.7 years. The percentage of subjects who experienced menarche before the age of 12 years was 21.4 % in 2001 but increased to 34.6 % in 2010/2011 (p < 0.01). In addition, the percentage of girls who experienced menarche before the age of 14 years increased from 76 % in 2001 to 92 % in 2010/2011 (p < 0.005). Adolescents whose mothers who had experienced early menarche (HR 1.48, 95 % CI [1.22-1.80]), and adolescents who were overweight (HR 1.24, 95 % CI [1.04-1.49]) were more likely to have experienced menarche. Additionally, underweight adolescents (HR 0.27, 95 % CI [0.12-0.60]) and adolescents who had a mother having late menarche (HR 0.68, 95 % CI [0.59-0.79]) were expected to have late menarche. None of the socioeconomic factors assessed in our study showed an association with age at menarche.


CONCLUSIONS
A downward trend in age at menarche was defined in Korean adolescents during the last decade. Furthermore, influences of genetic and nutritional parameters on individual variance in age at menarche were defined.
Department of Obstetrics and Gynecology, CHA Bundang Medical Center, School of Medicine, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Korea.
Mee-Hwa
MH
Lee
Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, 761-1 Sanggye-7-dong, Nowon-gu, 139-707, Seoul, Korea.
Shin Hye
SH
Kim
Clinical Trial Center, Busan Paik Hospital and Department of Pharmacology, Inje University College of Medicine, Busan, Korea.
Minkyung
M
Oh
Adventist Health System, Orlando, FL, USA.
Kuk-Wha
KW
Lee
Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, 761-1 Sanggye-7-dong, Nowon-gu, 139-707, Seoul, Korea. PMJ@paik.ac.kr.
Mi-Jung
MJ
Park
Adolescents; Menarche; Puberty; Secular trend
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