Digestive Diseases and Sciences

, Volume 57, Issue 11, pp 2975–2981 | Cite as

Menarche in Pediatric Patients with Crohn’s Disease

  • Neera Gupta
  • Robert H. Lustig
  • Michael A. Kohn
  • Eric Vittinghoff
Original Article

Abstract

Background and Aims

The timing of menarche in Crohn’s disease (CD) is poorly described. Our objectives were to study age at menarche onset in CD, and factors associated with this.

Methods

We compared the age at menarche of 34 CD patients with that for 545 controls, using data in the National Health and Nutrition Examination Survey (NHANES).

Results

Mean chronological age (CA) of CD patients (15.6 years) did not differ from that of the NHANES cohort (15.7 years; P = 0.91). The median CA at menarche (13.9 years) in CD was older than in the NHANES sample (12.0 years) (P < 0.00005). In CD patients, the cumulative incidence of menarche was 10 % at CA 12 years, 51 % at CA 14 years, and 100 % at CA 16 years. Sixty-eight percent reached menarche by bone age (BA) 13.5 years and 100 % by BA greater than 14.0 years. Menarche occurred earliest in South Asians, followed by East Asians, and then Caucasians (P = 0.02).

Conclusions

CA at menarche is delayed in CD compared with the NHANES cohort. BA at menarche in CD is similar to BA at menarche reported for healthy children. CA at menarche in CD differs by race. If menarche has not occurred by BA greater than 14.0 years, endocrinology referral should be considered.

Keywords

Inflammatory bowel disease Puberty Menses Children Adolescents 

Abbreviations

BA

Bone age

BA-Z

Z score based on bone age

BMI

Body mass index

CA

Chronological age

CA-Z

Z score based on chronological age

CD

Crohn’s disease

IBD

Inflammatory bowel disease

NHANES

National Health and Nutrition Examination Survey

UCSF

University of California, San Francisco

References

  1. 1.
    Rosen DS. Pubertal growth and sexual maturation for adolescents with chronic illness or disability. Pediatrician. 1991;18:105–120.PubMedGoogle Scholar
  2. 2.
    Beattie RM. Symposium 6: Young people, artificial nutrition and transitional care: nutrition, growth and puberty in children and adolescents with Crohn’s disease. Proc Nutr Soc. 2010;69:174–177.PubMedCrossRefGoogle Scholar
  3. 3.
    Brain CE, Savage MO. Growth and puberty in chronic inflammatory bowel disease. Bailleres Clin Gastroenterol. 1994;8:83–100.CrossRefGoogle Scholar
  4. 4.
    Simon D. Puberty in chronically diseased patients. Horm Res. 2002;57:53–56.PubMedCrossRefGoogle Scholar
  5. 5.
    Pozo J, Argente J. Delayed puberty in chronic illness. Best Pract Res Clin Endocrinol Metab. 2002;16:73–90.PubMedCrossRefGoogle Scholar
  6. 6.
    Gupta N, Lustig R, Kohn M, et al. Sex differences in growth impairment in pediatric patients with Crohn’s disease: role of IGF-1. Inflamm Bowel Dis. 2011;17(11):2318–2325.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Smith DW. Growth and Its Disorders. Philadelphia: Saunders 1977;15:6.Google Scholar
  8. 8.
    Morris NM, Udry JR. Validation of a self-administered instrument to assess stage of adolescent development. J Youth Adolesc. 1980;9:271–280.PubMedCrossRefGoogle Scholar
  9. 9.
    Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2nd ed. Stanford, CA: Stanford University Press; 1959.Google Scholar
  10. 10.
    Ayer M, Brunk HD, Ewing GM, et al. An empirical distribution function for sampling with incomplete information. Ann Math Stat. 1995;26:641–647.CrossRefGoogle Scholar
  11. 11.
    Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2007–2008] [http://www.cdc.gov/nchs/nhanes/nhanes2007-2008/nhanes07_08.htm].
  12. 12.
    Chumlea WC, Schubert CM, Roche AF, et al. Age at menarche and racial comparisons in US girls. Pediatrics. 2003;111:110–113.PubMedCrossRefGoogle Scholar
  13. 13.
    Onat T, Bilsel E. Age at menarche: relationships to socioeconomic status, growth rate in stature and weight, and skeletal and sexual maturation. Am J Human Biol. 1995;7:741–750.CrossRefGoogle Scholar
  14. 14.
    Simmons K, Greulich WW. Menarcheal age and the height, weight and skeletal age of girls age 7 to 17 years. J Pediatr. 1943;22:518–548.CrossRefGoogle Scholar
  15. 15.
    Canavese F, Charles YP, Dimeglio A. Skeletal age assessment from elbow radiographs. Review of the literature. Chir Organi Mov. 2008;92:1–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Marshall WA, de Limongi Y. Skeletal maturity and the prediction of age at menarche. Ann Hum Biol. 1976;3:235–243.PubMedCrossRefGoogle Scholar
  17. 17.
    Weber AM, Ziegler C, Belinson JL, et al. Gynecologic history of women with inflammatory bowel disease. Obstet Gynecol. 1995;86:843–847.PubMedCrossRefGoogle Scholar
  18. 18.
    Ferguson A, Sedgwick DM. Juvenile onset inflammatory bowel disease: height and body mass index in adult life. BMJ. 1994;308:1259–1263.PubMedCrossRefGoogle Scholar
  19. 19.
    Adams Hillard PJ. Menstruation in adolescents: what’s normal, what’s not. Ann NY Acad Sci. 2008;1135:29–35.Google Scholar
  20. 20.
    Ballinger AB, Savage MO, Sanderson IR. Delayed puberty associated with inflammatory bowel disease. Pediatr Res. 2003;53:205–210.PubMedCrossRefGoogle Scholar
  21. 21.
    Biro FM, Galvez MP, Greenspan LC, et al. Pubertal assessment method and baseline characteristics in a mixed longitudinal study of girls. Pediatrics. 2010;126:e583–e590.PubMedCrossRefGoogle Scholar
  22. 22.
    Anderson SE, Must A. Interpreting the continued decline in the average age at menarche: results from the two nationally representative surveys of U.S. girls studied 10 years apart. J Pediatr. 2005;147:753–760.PubMedCrossRefGoogle Scholar
  23. 23.
    Herman-Giddens ME, Slora EJ, Wasserman RC, et al. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the pediatric research in office settings network. Pediatrics. 1997;99:505–512.PubMedCrossRefGoogle Scholar
  24. 24.
    Freedman DS, Khan LK, Serdula MK, et al. Relation of age at menarche to race, time period, and anthropometric dimensions: the Bogalusa heart study. Pediatrics. 2002;110:e43.PubMedCrossRefGoogle Scholar
  25. 25.
    Biro FM, McMahon RP, Striegel-Moore R, et al. Impact of timing of pubertal maturation on growth in black and white female adolescents: The National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2001;138:636–643.PubMedCrossRefGoogle Scholar
  26. 26.
    Anderson SE, Dallal GE, Must A. Relative weight and race influence average age at menarche: results from two nationally representative surveys of US girls studied 25 years apart. Pediatrics. 2003;111:844–850.PubMedCrossRefGoogle Scholar
  27. 27.
    Macmahon B. Age at menarche: United States, 1973. Rockville, MD: National Center for Health Statistics; 1974 (DHEW publication [HRA] 74-1615 Series 11 no. 133).Google Scholar
  28. 28.
    Adair LS, Gordon-Larsen P. Maturational timing and overweight prevalence in US adolescent girls. Am J Public Health. 2001;91:642–644.PubMedCrossRefGoogle Scholar
  29. 29.
    Koprowski C, Ross RK, Mack WJ, Henderson BE, Bernstein L. Diet, body size and menarche in a multiethnic cohort. Br J Cancer. 1999;79:1907–1911.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Zacharias L, Rand WM, Wurtman RJ. A prospective study of sexual development and growth in American girls: the statistics of menarche. Obstet Gynecol Surv. 1976;31:325–337.PubMedCrossRefGoogle Scholar
  31. 31.
    Koprowski C, Coates RJ, Bernstein L. Ability of young women to recall past body size and age at menarche. Obes Res. 2001;9:478–485.PubMedCrossRefGoogle Scholar
  32. 32.
    Johannesson M, Gottlieb C, Hjelte L. Delayed puberty in girls with cystic fibrosis despite good clinical status. Pediatrics. 1997;99:29–34.PubMedCrossRefGoogle Scholar
  33. 33.
    Neinstein LS, Stewart D, Wang CI, Johnson I. Menstrual dysfunction in cystic fibrosis. J Adolesc Health Care. 1983;4:153–157.PubMedCrossRefGoogle Scholar
  34. 34.
    Umlawska W, Sands D, Zielinska A. Age of menarche in girls with cystic fibrosis. Folia Histochem Cytobiol. 2010;48:185–190.PubMedCrossRefGoogle Scholar
  35. 35.
    Moshang T, Holsclaw DS Jr. Menarchal determinants in cystic fibrosis. Am J Dis Child. 1980;134:1139–1142.PubMedGoogle Scholar
  36. 36.
    Mitchell-Heggs P, Mearns M, Batten JC. Cystic fibrosis in adolescents and adults. Q J Med. 1976;45:479–504.PubMedGoogle Scholar
  37. 37.
    Stern RC, Boat TF, Doershuk CF, et al. Course of cystic fibrosis in 95 patients. J Pediatr. 1976;89:406–411.PubMedCrossRefGoogle Scholar
  38. 38.
    Fraser PA, Hoch S, Erlandson D, et al. The timing of menarche in juvenile rheumatoid arthritis. J Adolesc Health Care. 1988;9:483–487.PubMedCrossRefGoogle Scholar
  39. 39.
    Graham C, Maude GH, Serjeant GR. Delayed menarche in homozygous sickle cell disease. West Indian Med J. 1986;35:18–22.PubMedGoogle Scholar
  40. 40.
    Zemel BS, Kawchak DA, Ohene-Frempong K, et al. Effects of delayed pubertal development, nutritional status, and disease severity of longitudinal patterns of growth failure in children with sickle cell disease. Pediatr Res. 2007;61:607–613.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Neera Gupta
    • 1
  • Robert H. Lustig
    • 2
  • Michael A. Kohn
    • 3
  • Eric Vittinghoff
    • 3
  1. 1.Division of Gastroenterology, Hepatology, and Nutrition, Department of PediatricsUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Division of Endocrinology, Department of PediatricsUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoUSA

Personalised recommendations