Article

Onset of ovulation after menarche in girls: a longitudinal study.

Department of Obstetrics, Gynecology, and Women's Health, Division of Reproductive Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
Journal of Clinical Endocrinology &amp Metabolism (impact factor: 6.5). 05/2008; 93(4):1186-94. DOI:10.1210/jc.2007-1846 pp.1186-94
Source: PubMed

ABSTRACT 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.
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.
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.
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.

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Keywords

2-yr collection period
 
adult women
 
current nutritional conditions
 
follicular maturation
 
FSH surges
 
hypothalamic-pituitary axis maturation
 
Hypothalamic-pituitary axis maturity
 
LH surges
 
LH/FSH surges
 
menarcheal girls
 
menstrual records
 
normal-weight perimenarcheal girls
 
ovulatory menstrual cycles
 
Pdg consistent
 
Pdg elevations
 
Pdg rises
 
perimenarcheal girls
 
reproductive hormones
 
small amplitude Pdg increments
 
study entry