Influence of physiological variables and psychosocial factors on the onset of Menarche in schoolgirls of Pakistan

Influence of physiological variables and psychosocial factors on the onset of Menarche in schoolgirls of Pakistan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Influence of physiological variables and psychosocial factors on the onset of Menarche in schoolgirls of Pakistan Hamna Mukhtar Tarar, Khadija Jameel, Abeer Shahzad, Shibrah Hameed This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2908778/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To determine the impact of physical and psychosocial factors on the age of menarche in girls from different socioeconomic backgrounds in Karachi, Pakistan. Methodology A cross-sectional study was carried out on female students aged 11 to 16 years from four different schools in urban and rural areas of Karachi district, Pakistan in 2022. Subjects who had not yet menstruated were excluded. Bilingual questionnaires were used in the study to record the responses. Height and weight were measured using calibrated instruments. The population sample size was 307, with a 95% confidence level. The Kuppuswamy scale was used for socioeconomic status (SES) measurement. Results The mean age of menarche was found to be 11.9 ± 1.1 years. The study showed a significant correlation between age at menarche and height (p = 0.000), weight (p = 0.001), BMI (p = 0.009), physical activity (p = 0.007), female siblings (p = 0.082), psychological effect of lockdown (p = 0.035), father’s occupation (p = 0.002) and abusive home environment (p = 0.015). Diet, co-education, relation with father, total number of siblings, paternal presence or absence and socioeconomic status showed insignificant correlation with age at menarche. Various factors, particularly emotional abuse, can have far-reaching effects on the growth and development of female adolescents. Conclusion The results support the significant influence of height, weight, BMI, physical activity, father’s occupation, and abusive home environment on age at menarche. Women's studies menarche physiological psychological health women INTRODUCTION The first menstrual cycle, or menarche, occurs when a female reaches sexual maturity and signifies her passage from infancy to adulthood. Menstrual age is influenced by genetics, race and physical characteristics such as body mass index (BMI). Shirazi and Rosinger ( 2021 ) concluded a significantly lower age of menarche by about 4.3, and 3.2 months, respectively, of non-Hispanic (NH) black and Hispanic girls relative to NH white girls when lifestyle and physiological factors were taken into account. The mean age at menarche in France has also decreased from 12.78 years in 1979 to 12.6 years in 1994, although it has recently stabilized at 12.5 ± 0.08 years by Lalys and Pineau ( 2014 ). Meanwhile, the mean age of menarche among Indo-Pakistani girls was found to be 13.06 years according to Ulijaszek et al. ( 1991 ). In a previously published extensive review of ages at menarche across the world of 67 countries, a huge variability was observed while some sources suggest a decline in menarcheal age (Rees M 1995 ), Papadimitriou ( 2016 ) reports an advanced trend along the years. However, Pakistan lacks data about the topic as people are reluctant to talk about menarche due to cultural norms. Karim et.al ( 2021 ) conducted a study between 2015 and 2017, to determine the age of menarche and its association with the growth status of 8–16 years old schoolgirls of the province of Punjab province of Pakistan. Another study was conducted in 2014 on school-going girls of Karachi to determine the effect of media and nutrition (Ahmed et.al 2016 ). The purpose of this study was to determine the present age of menarche for Pakistani girls under the influence of various physiological variables and psychosocial factors. Thus, the study aimed to correlate age at menarche with factors like abuse, home environment, body mass index, parents' qualifications and occupation, nutrition, socioeconomic status, COVID-19 lockdown, physical activity and psychological factors. METHODOLOGY A cross-sectional study on public and private schoolgirls from the city of Karachi, selected at random was carried out, after approval by the Altamash Institutional Review Board (IRB) at Altamash Dental Institute. The calculated sample size was 307, with a 95% confidence interval. Girls who had reached menarche were included in the study. A questionnaire was disseminated among middle and high school girls and results were collected from March to July 2021. To improve convenience and enable a better understanding of the questions, the questionnaire provided an option to answer in one ot two languages (English and Urdu). 386 responses were received of which 307 were selected which fell in the inclusion criteria. The screening questionnaire included the child’s age, class and section, name of the school, an informed consent for participating in this study which was to be signed by the student as well as the student’s date of menarche along with questions on associated factors. Socio-demographic profiles included education level, occupation and monthly income of both parents, number of siblings, nutrition, the social environment at home, stress levels during the menstrual cycle and whether they were living in an extended family system or not. Socio-economic status (SES) was determined by using the modified Kuppuswamy scale. Date of the menarche was asked for the subject by the “recall method”. Height and weight measurements were done on spot using a weighing balance and a measuring tape. The psychological stress levels were measured using APA LEVEL 2-Anxiety-Child Age 11–17 (Promis emotional distress -Pediatric Item bank). COVID-19 lockdown was also taken into consideration while assessing distress levels. Raw score was used to calculate T-score for each individual. They were then classified into four groups based on severity level. SPSS version 25 was used for data analysis. ANOVA and chi-square tests were used to find the correlation between different factors and their influence on menarcheal age. RESULTS This study included a total of 307 participants between ages 11 and 16 in the 4 schools from which data was collected. The mean age of menarche was noted as 11.93 ± 1.086. Among the physical factors, our study showed a significant correlation between BMI and age at menarche (p = 0.009). The mean BMI in our study population was calculated to be 18.7 kg/m 2 with the lowest being 10.0 and the highest being 40.0. Table 1 shows the mean values for age, weight, height and BMI. Effect of BMI as well as with socioeconomic status on menarche was also found to be statistically significant. Our study also found that girls with a higher weight and a longer height - and by extension a higher BMI - were more likely to undergo menarche later. Additionally, the mean population BMI (x) was found to have a statistically significant association with socioeconomic status. Physical Activity also showed a significant correlation with the age at menarche (p = 0.031). Detailed descriptives of physical activity are given in table 3. Chart 1 shows relationship of physical activity with age at menarche. A significant correlation was found between monthly income and diet (p value = 0.007), however, it showed no significant relation with the age at menarche. Moreover, no significant relation was found between age at menarche and a few factors i.e. co-education, relation with father, paternal presence or absence and intake of medicines. SES also showed no effect on the age at menstruation. Chart 2 shows its relationship with age at menarche. The effect of the lockdown in the wake of COVID-19 was also assessed. 43.6% of the girls reported having gotten lazy due to the lockdown while 38.4% of girls reported more level of annoyance sometimes post quarantine. The results of the ANOVA analysis show that the significance value is 0.508 (p = .508), which is greater than 0.05 so we conclude that there is a no statistically significant difference between the ages with respect to socioeconomic class. Frequencies of SES, physical activity and home environment are shown in table 2. Among psychosocial factors, a significant relationship between social environment at home and the onset of menarche was reported (p < 0.05). Chart 3 shows relationship of home environment with age at menarche. A disturbed home environment showed a 100% chance of early menarche while a secure environment had a 67.5% chance of early menarche. Moreover, the highest percentile (29.4%) of emotional abuse was found in a disturbed home environment. The abuse was also found to be associated with intense psychological effects during the lockdown. Upon further analysis association between father’s literacy and emotional abuse were found to be statistically significant (p < 0.01). Father’s occupation was found to be having significant relationship with psychological effects during lockdown (p < 0.01). And presence of female siblings has also shown an impact (p < 0.01). Detailed descriptives of home environment are given in table 3. The scores of emotional distress showed no significant results, therefore suggesting that emotional distress experienced during menses had no relation with the age of onset of menarche. However, stress experienced during menses showed significant relation with abuse (p < 0.01). DISCUSSION Menarcheal age is considered an important indicator of pubertal development in girls. Several factors have been discussed here asserting an impact on age at menarche. In this study, BMI showed a strong correlation with the onset of menarche as in prior evidences (Bralić et.al 2012 , Rosenfield et. al 2019, Al-Awadhi et.al 2013 , Lalys L and Pineau JC 2014). Body weight, height, BMI, supra iliac, and abdominal skinfolds have been shown to have a strong impact on early menarche (Moisan 1991). Different theories suggest different explanations such as leptin protein from body fat (Kaplowitz 2008 ), shorter height in girls due to earlier closure of epiphyseal plates (Oh et. al 2012 ) and increase in estrogen hormones (Georgiadis et.al 1997 ) in girls attributing to variation in menarcheal age. This study also showed that a high protein diet has no significant relation with age at menarche. A correlation however exists between dietary energy intake (Meyer et.al 1990 ) and carbohydrates and iron intake (Kissinger and Sanchez 1987 ) on the menarcheal age. On the contrary, Abioye-Kuteyi et.al ( 1997 ) showed that earlier onset of menarche was reported in girls who have a high protein diet intake. It is well known that undernutrition delays the onset of menarche (Dreizen et.al 1967 , Satyanarayana and Naidu 1979 ). This study has shown that physical activity less than 30 minutes per day or more than 60 minutes per day are associated with a higher mean age of onset of menarche. Associations have been reported for girls with high physical activity with a later age of reaching menarche (Petersen et.al 1991 , Bean et.al 1979 , Ravi et.al 2020 ). Low exercise has been observed as associated with late menarche (Ayele and Berhan 2013) whereas if the low activity is related to obesity and higher BMI, then it leads to an earlier onset of menarche. This may be due to anovulatory cycles due to increased energy expenditure (Bernstein et.al 1987 ), hypothalamic dysfunction (Pratami et.al 2020 , Huhmann 2020 ) or changed hormonal levels in blood (Duvivier 2013). No significant correlation was found between onset of menarche and SES. It is comparable to previous studies (Wu et.al 2002 , Batubara et.al 2010 , Bralić et.al 2012 , Ersoy et.al 2004 ). However contrarily, Hiatt (2021) showed a weak association between lower SES with earlier onset. Whereas Behel and Raje ( 2021 ) that used the similar scale reported in aforementioned study, a correlation between higher age of onset with lower SES. These differences may stem from the fact that they have all used different parameters to calculate SES. A standardized system for measuring socioeconomic status may resolve this issue. It is earlier reported that a father’s education is associated with earlier menarche (Wronka and Pawlińska 2005). Similarly, father’s occupation has also been observed as having strong impact on the menarcheal age of girls (Kosińska 2019). They are all in agreement with this research which showed a significant effect of a father’s education and occupation on menarcheal age. This may be due to reduced stress in the family and home environment due to a sense of security. This research shows a strong correlation between stress including abuse and disturbed home environment as in other studies where family disruption (Tither and Ellis 2008 , Graberc et.al 1995 ) and family stress (Moffitt et.al 1992 , Hill et.al 1985 , Wierson et.al 1993 , Belsky et.al 1991 ) are associated with earlier onset of menarche. This has been explained by Belsky ( 2007 ) as the psychosocial acceleration phenomenon and high cortisol levels in response to psychosocial stress (Sun et.al 2015 ) and probably the activation of reproductive centers which is still being investigated. Physical abuse speeds up the maturation process (Boynton-Jarrett et.al 2012, Mendle et.al 2011 ). This study has shown that psychological factors have no effects on the age of menarche. However Jimenez et.al ( 2022 ) has recently shown that precocious puberty is related to the impact of Covid-19 as depression, anxiety, and stress levels were seen to increase during the lockdown. Enough data is not available which compares the Covid-19 lockdown and its effects on age at menarche. CONCLUSION The results support the significant influence of height, weight, BMI, physical activity, father’s occupation, and abusive home environment on age at menarche. Socioeconomic status and other factors evaluated do not show any correlation with age at menarche. More groups may be sampled for even better outcomes of a study of this sort. Statements and Declarations No conflicts of interest to disclose. REFERENCES Abioye-Kuteyi EA, Ojofeitimi EO, Aina OI, Kio F, Aluko Y, Mosuro O 1997. The influence of socioeconomic and nutritional status on menarche in Nigerian school girls. Nutr Health 11(3):185-95. https://doi.org/10.1177/026010609701100304 Ahmed SM, Waheed MA, Ahmad F, Danish SH (2016) Factors contributing to early menarche in school girls. J Pak Med Assoc 66(5):629-33. 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Frequency Percentage 1.Socio economic status Upper Lower Class 20 6.5 Lower Middle Class 92 30 Upper Middle Class 195 63.5 2. Physical Activity Active 66 21.5 Moderately Active 137 44.6 Inactive 104 33.9 3. Home Environment Secure 224 73.0 Neutral 64 20.8 Distrubed 19 6.2 Table 3. Descriptives of physical activity and home environment with p values that indicate relationship with age at menarche. Age at Menarche Physical Activity P-Value Home environment P-value Inactive (30 minutes/) (n, %) Moderately Active (30-60 mins/day) (n, %) Active (60-150/day) (n, %) 0.007 Secure (n, %) Neutral (n, %) Disturbed (n, %) 0.015 Pre-teen (9-11) 68, 65.3 92, 67.15 57, 86.3 152, 67.5 48, 73.8 17 Teen (12-15) 36, 34.6 45, 32.8 9, 13.6 73, 32.4 17, 26.1 0 Total 104 137 66 225 65 17 Charts Charts 1 to 3 are available in the Supplementary Files section. Supplementary Files Charts1to3.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2908778","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":198373866,"identity":"6b457e80-4fc4-42f2-a3fb-60f3d8eea5c2","order_by":0,"name":"Hamna Mukhtar Tarar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACA2TOgYQKNBE8WsAU44EHZ0jUwnzwYRsRWszZT6c9+MHwR968/eyDA4nzDsubszcfYPhRsQ2nFsue3O2GPQwGhnPOpBscSNx22HBnz7EExp4zt3E77EDuNgkeBgPGGQxpDCAtjBtu5BgwM7bh0XL+7TbJPwwG9jP4nwG1zDlsT1jLjdxt0kBbEmdIgGxpOJxIhJa326RlGIyTZ0gAbUk4lp684cyxhIN4/XI+d5vkGwY52xn8acwff9RY22443nzwwY8K3FrAgPEfnNkMJg/gV48K6khRPApGwSgYBSMEAAAoZl5rlw5ePwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-1852-772X","institution":"Dow Medical College","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Hamna","middleName":"Mukhtar","lastName":"Tarar","suffix":""},{"id":198373867,"identity":"2ce5bc67-aa60-4d19-a74a-c5c1254248cb","order_by":1,"name":"Khadija Jameel","email":"","orcid":"https://orcid.org/0009-0002-9106-0414","institution":"Dow Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Khadija","middleName":"","lastName":"Jameel","suffix":""},{"id":198373868,"identity":"1e04b7c6-dd30-4dc0-b8fd-eca116959798","order_by":2,"name":"Abeer Shahzad","email":"","orcid":"https://orcid.org/0000-0001-6188-758X","institution":"Dow Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abeer","middleName":"","lastName":"Shahzad","suffix":""},{"id":198373869,"identity":"d6c6cbc5-33d0-4a5d-99b1-46e3028311fa","order_by":3,"name":"Shibrah Hameed","email":"","orcid":"","institution":"Dow Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shibrah","middleName":"","lastName":"Hameed","suffix":""}],"badges":[],"createdAt":"2023-05-08 17:16:01","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-2908778/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2908778/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":36746965,"identity":"8864b82b-df4b-4e52-b005-cb24af93a1e6","added_by":"auto","created_at":"2023-05-09 15:09:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":195661,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2908778/v1/dc710f6c-2441-46c7-81bc-5f38c665ab3b.pdf"},{"id":36746964,"identity":"1e0998e8-6ac5-43d9-9da2-1cc083818f8e","added_by":"auto","created_at":"2023-05-09 15:09:24","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18246,"visible":true,"origin":"","legend":"","description":"","filename":"Charts1to3.docx","url":"https://assets-eu.researchsquare.com/files/rs-2908778/v1/c752077de25af0fa1e10c7f7.docx"}],"financialInterests":"","formattedTitle":"\u003cp\u003e\u003cstrong\u003eInfluence of physiological variables and psychosocial factors on the onset of Menarche in schoolgirls of Pakistan\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe first menstrual cycle, or menarche, occurs when a female reaches sexual maturity and signifies her passage from infancy to adulthood. Menstrual age is influenced by genetics, race and physical characteristics such as body mass index (BMI).\u003c/p\u003e \u003cp\u003eShirazi and Rosinger (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) concluded a significantly lower age of menarche by about 4.3, and 3.2 months, respectively, of non-Hispanic (NH) black and Hispanic girls relative to NH white girls when lifestyle and physiological factors were taken into account. The mean age at menarche in France has also decreased from 12.78 years in 1979 to 12.6 years in 1994, although it has recently stabilized at 12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08 years by Lalys and Pineau (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Meanwhile, the mean age of menarche among Indo-Pakistani girls was found to be 13.06 years according to Ulijaszek et al. (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e1991\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a previously published extensive review of ages at menarche across the world of 67 countries, a huge variability was observed while some sources suggest a decline in menarcheal age (Rees M \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e1995\u003c/span\u003e), Papadimitriou (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) reports an advanced trend along the years. However, Pakistan lacks data about the topic as people are reluctant to talk about menarche due to cultural norms. Karim et.al (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) conducted a study between 2015 and 2017, to determine the age of menarche and its association with the growth status of 8\u0026ndash;16 years old schoolgirls of the province of Punjab province of Pakistan. Another study was conducted in 2014 on school-going girls of Karachi to determine the effect of media and nutrition (Ahmed et.al \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe purpose of this study was to determine the present age of menarche for Pakistani girls under the influence of various physiological variables and psychosocial factors. Thus, the study aimed to correlate age at menarche with factors like abuse, home environment, body mass index, parents' qualifications and occupation, nutrition, socioeconomic status, COVID-19 lockdown, physical activity and psychological factors.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e A cross-sectional study on public and private schoolgirls from the city of Karachi, selected at random was carried out, after approval by the Altamash Institutional Review Board (IRB) at Altamash Dental Institute. The calculated sample size was 307, with a 95% confidence interval. Girls who had reached menarche were included in the study.\u003c/p\u003e \u003cp\u003eA questionnaire was disseminated among middle and high school girls and results were collected from March to July 2021. To improve convenience and enable a better understanding of the questions, the questionnaire provided an option to answer in one ot two languages (English and Urdu). 386 responses were received of which 307 were selected which fell in the inclusion criteria.\u003c/p\u003e \u003cp\u003eThe screening questionnaire included the child\u0026rsquo;s age, class and section, name of the school, an informed consent for participating in this study which was to be signed by the student as well as the student\u0026rsquo;s date of menarche along with questions on associated factors. Socio-demographic profiles included education level, occupation and monthly income of both parents, number of siblings, nutrition, the social environment at home, stress levels during the menstrual cycle and whether they were living in an extended family system or not. Socio-economic status (SES) was determined by using the modified Kuppuswamy scale.\u003c/p\u003e \u003cp\u003eDate of the menarche was asked for the subject by the \u0026ldquo;recall method\u0026rdquo;. Height and weight measurements were done on spot using a weighing balance and a measuring tape. The psychological stress levels were measured using APA LEVEL 2-Anxiety-Child Age 11\u0026ndash;17 (Promis emotional distress -Pediatric Item bank). COVID-19 lockdown was also taken into consideration while assessing distress levels. Raw score was used to calculate T-score for each individual. They were then classified into four groups based on severity level. SPSS version 25 was used for data analysis. ANOVA and chi-square tests were used to find the correlation between different factors and their influence on menarcheal age.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThis study included a total of 307 participants between ages 11 and 16 in the 4 schools from which data was collected. The mean age of menarche was noted as 11.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.086.\u003c/p\u003e \u003cp\u003eAmong the physical factors, our study showed a significant correlation between BMI and age at menarche (p\u0026thinsp;=\u0026thinsp;0.009). The mean BMI in our study population was calculated to be 18.7 kg/m\u003csub\u003e2\u003c/sub\u003e with the lowest being 10.0 and the highest being 40.0. Table\u0026nbsp;1 shows the mean values for age, weight, height and BMI. Effect of BMI as well as with socioeconomic status on menarche was also found to be statistically significant. Our study also found that girls with a higher weight and a longer height - and by extension a higher BMI - were more likely to undergo menarche later. Additionally, the mean population BMI (x) was found to have a statistically significant association with socioeconomic status.\u003c/p\u003e \u003cp\u003ePhysical Activity also showed a significant correlation with the age at menarche (p\u0026thinsp;=\u0026thinsp;0.031). Detailed descriptives of physical activity are given in table 3. Chart 1 shows relationship of physical activity with age at menarche. A significant correlation was found between monthly income and diet (p value\u0026thinsp;=\u0026thinsp;0.007), however, it showed no significant relation with the age at menarche. Moreover, no significant relation was found between age at menarche and a few factors i.e. co-education, relation with father, paternal presence or absence and intake of medicines.\u003c/p\u003e \u003cp\u003eSES also showed no effect on the age at menstruation. Chart 2 shows its relationship with age at menarche. The effect of the lockdown in the wake of COVID-19 was also assessed. 43.6% of the girls reported having gotten lazy due to the lockdown while 38.4% of girls reported more level of annoyance sometimes post quarantine. The results of the ANOVA analysis show that the significance value is 0.508 (p\u0026thinsp;=\u0026thinsp;.508), which is greater than 0.05 so we conclude that there is a no statistically significant difference between the ages with respect to socioeconomic class. Frequencies of SES, physical activity and home environment are shown in table 2.\u003c/p\u003e \u003cp\u003eAmong psychosocial factors, a significant relationship between social environment at home and the onset of menarche was reported (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Chart 3 shows relationship of home environment with age at menarche. A disturbed home environment showed a 100% chance of early menarche while a secure environment had a 67.5% chance of early menarche. Moreover, the highest percentile (29.4%) of emotional abuse was found in a disturbed home environment. The abuse was also found to be associated with intense psychological effects during the lockdown. Upon further analysis association between father\u0026rsquo;s literacy and emotional abuse were found to be statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Father\u0026rsquo;s occupation was found to be having significant relationship with psychological effects during lockdown (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). And presence of female siblings has also shown an impact (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Detailed descriptives of home environment are given in table 3.\u003c/p\u003e \u003cp\u003eThe scores of emotional distress showed no significant results, therefore suggesting that emotional distress experienced during menses had no relation with the age of onset of menarche. However, stress experienced during menses showed significant relation with abuse (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eMenarcheal age is considered an important indicator of pubertal development in girls. Several factors have been discussed here asserting an impact on age at menarche. In this study, BMI showed a strong correlation with the onset of menarche as in prior evidences (Bralić et.al \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, Rosenfield et. al 2019, Al-Awadhi et.al \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2013\u003c/span\u003e, Lalys L and Pineau JC 2014). Body weight, height, BMI, supra iliac, and abdominal skinfolds have been shown to have a strong impact on early menarche (Moisan 1991). Different theories suggest different explanations such as leptin protein from body fat (Kaplowitz \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), shorter height in girls due to earlier closure of epiphyseal plates (Oh et. al \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) and increase in estrogen hormones (Georgiadis et.al \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e1997\u003c/span\u003e) in girls attributing to variation in menarcheal age.\u003c/p\u003e \u003cp\u003eThis study also showed that a high protein diet has no significant relation with age at menarche. A correlation however exists between dietary energy intake (Meyer et.al \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1990\u003c/span\u003e) and carbohydrates and iron intake (Kissinger and Sanchez \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e1987\u003c/span\u003e) on the menarcheal age. On the contrary, Abioye-Kuteyi et.al (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1997\u003c/span\u003e) showed that earlier onset of menarche was reported in girls who have a high protein diet intake. It is well known that undernutrition delays the onset of menarche (Dreizen et.al \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1967\u003c/span\u003e, Satyanarayana and Naidu \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e1979\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study has shown that physical activity less than 30 minutes per day or more than 60 minutes per day are associated with a higher mean age of onset of menarche. Associations have been reported for girls with high physical activity with a later age of reaching menarche (Petersen et.al \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e1991\u003c/span\u003e, Bean et.al \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e1979\u003c/span\u003e, Ravi et.al \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Low exercise has been observed as associated with late menarche (Ayele and Berhan 2013) whereas if the low activity is related to obesity and higher BMI, then it leads to an earlier onset of menarche. This may be due to anovulatory cycles due to increased energy expenditure (Bernstein et.al \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1987\u003c/span\u003e), hypothalamic dysfunction (Pratami et.al \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Huhmann \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) or changed hormonal levels in blood (Duvivier 2013).\u003c/p\u003e \u003cp\u003eNo significant correlation was found between onset of menarche and SES. It is comparable to previous studies (Wu et.al \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2002\u003c/span\u003e, Batubara et.al \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2010\u003c/span\u003e, Bralić et.al \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, Ersoy et.al \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). However contrarily, Hiatt (2021) showed a weak association between lower SES with earlier onset. Whereas Behel and Raje (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) that used the similar scale reported in aforementioned study, a correlation between higher age of onset with lower SES. These differences may stem from the fact that they have all used different parameters to calculate SES. A standardized system for measuring socioeconomic status may resolve this issue.\u003c/p\u003e \u003cp\u003eIt is earlier reported that a father\u0026rsquo;s education is associated with earlier menarche (Wronka and Pawlińska 2005). Similarly, father\u0026rsquo;s occupation has also been observed as having strong impact on the menarcheal age of girls (Kosińska 2019). They are all in agreement with this research which showed a significant effect of a father\u0026rsquo;s education and occupation on menarcheal age. This may be due to reduced stress in the family and home environment due to a sense of security.\u003c/p\u003e \u003cp\u003eThis research shows a strong correlation between stress including abuse and disturbed home environment as in other studies where family disruption (Tither and Ellis \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2008\u003c/span\u003e, Graberc et.al \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e1995\u003c/span\u003e) and family stress (Moffitt et.al \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e1992\u003c/span\u003e, Hill et.al \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1985\u003c/span\u003e, Wierson et.al \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e1993\u003c/span\u003e, Belsky et.al \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1991\u003c/span\u003e) are associated with earlier onset of menarche. This has been explained by Belsky (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) as the psychosocial acceleration phenomenon and high cortisol levels in response to psychosocial stress (Sun et.al \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and probably the activation of reproductive centers which is still being investigated. Physical abuse speeds up the maturation process (Boynton-Jarrett et.al 2012, Mendle et.al \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study has shown that psychological factors have no effects on the age of menarche. However Jimenez et.al (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) has recently shown that precocious puberty is related to the impact of Covid-19 as depression, anxiety, and stress levels were seen to increase during the lockdown. Enough data is not available which compares the Covid-19 lockdown and its effects on age at menarche.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe results support the significant influence of height, weight, BMI, physical activity, father\u0026rsquo;s occupation, and abusive home environment on age at menarche. Socioeconomic status and other factors evaluated do not show any correlation with age at menarche. More groups may be sampled for even better outcomes of a study of this sort.\u003c/p\u003e"},{"header":"Statements and Declarations ","content":"\u003cp\u003eNo conflicts of interest to disclose.\u003c/p\u003e"},{"header":"REFERENCES","content":"\u003col\u003e\n\u003cli\u003eAbioye-Kuteyi EA, Ojofeitimi EO, Aina OI, Kio F, Aluko Y, Mosuro O 1997. The influence of socioeconomic and nutritional status on menarche in Nigerian school girls. Nutr Health 11(3):185-95. https://doi.org/10.1177/026010609701100304\u003c/li\u003e\n\u003cli\u003eAhmed SM, Waheed MA, Ahmad F, Danish SH (2016) Factors contributing to early menarche in school girls. J Pak Med Assoc 66(5):629-33.\u003c/li\u003e\n\u003cli\u003eAl-Awadhi N, Al-Kandari N, Al-Hasan T, AlMurjan D, Ali S, Al-Taiar A (2013) Age at menarche and its relationship to body mass index among adolescent girls in Kuwait. BMC Public Health 13(1):1-7. https://doi.org/10.1186/1471-2458-13-29\u003c/li\u003e\n\u003cli\u003eAyele E, Berhan Y 2013. Age at menarche among in-school adolescents in Sawla Town, South Ethiopia. Ethiop J Health Sci 23(3):189-200. https://doi.org/10.4314/ejhs.v23i3.1\u003c/li\u003e\n\u003cli\u003eBatubara JR, Soesanti F, van de Waal HD 2010. Age at menarche in Indonesian girls: a national survey. Acta Med Indones 42(2):78-81.\u003c/li\u003e\n\u003cli\u003eBean JA, Leeper JD, Wallace RB, Sherman BM, Jagger H 1979. Variations in the reporting of menstrual histories. Am J Epidemiol 109(2):181-5. https://doi.org/10.1093/oxfordjournals.aje.a112673\u003c/li\u003e\n\u003cli\u003eBehel A, Raje L 2021. Age at menarche in urban school-going girls: association between socio-economic status, BMI and physical activity. Int J Community Med Public Health 8(2):666-71. https://doi.org/10.18203/2394-6040.ijcmph20210219\u003c/li\u003e\n\u003cli\u003eBelsky J 2007. Experience in childhood and the development of reproductive strategies. Acta Psychol Sin 39(3):454-68.\u003c/li\u003e\n\u003cli\u003eBelsky J, Steinberg L, Draper P 1991. Childhood experience, interpersonal development, and reproductive strategy: An evolutionary theory of socialization. Child Dev 62(4):647-70. https://doi.org/10.1111/j.1467-8624.1991.tb01558.x\u003c/li\u003e\n\u003cli\u003eBernstein L, Ross RK, Lobo RA, Hanisch R, Krailo MD, Henderson BE 1987. The effects of moderate physical activity on menstrual cycle patterns in adolescence: implications for breast cancer prevention. Br J Cancer 55(6):681-5. https://doi.org/10.1038/bjc.1987.139\u003c/li\u003e\n\u003cli\u003eBoynton-Jarrett R, Harville EW 2012. A prospective study of childhood social hardships and age at menarche. Ann Epidemiol 22(10):731-7. https://doi.org/10.1016%2Fj.annepidem.2012.08.005\u003c/li\u003e\n\u003cli\u003eBralić I, Tahirović H, Matanić D, Vrdoljak O, Stojanović-\u0026Scaron;pehar S, Kovačić V, Blažeković-Milaković S (2012) Association of early menarche age and overweight/obesity. J Pediatr Endocrinol Metab 25(1-2):57-62. https://doi.org/10.1515/jpem-2011-0277\u003c/li\u003e\n\u003cli\u003eBralić I, Tahirović H, Matanić D, Vrdoljak O, Stojanović-\u0026Scaron;pehar S, Kovačić V, Blažeković-Milaković S 2012. Association of early menarche age and overweight/obesity. J Pediatr Endocrinol Metab 25(1-2):57-62. https://doi.org/10.1515/jpem-2011-0277\u003c/li\u003e\n\u003cli\u003eDreizen S, Spirakis CN, Stone RE 1967 A comparison of skeletal growth and maturation in undernourished and well-nourished girls before and after menarche. J Pediatr 70(2):256-63. https://doi.org/10.1016/S0022-3476(67)80420-7\u003c/li\u003e\n\u003cli\u003eDuvivier BM, Schaper NC, Bremers MA, Van Crombrugge G, Menheere PP, Kars M, Savelberg HH 2013. Minimal intensity physical activity (standing and walking) of longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise (cycling) in sedentary subjects when energy expenditure is comparable. PLoS One 8(2):e55542. https://doi.org/10.1371/journal.pone.0055542\u003c/li\u003e\n\u003cli\u003eErsoy B, Balkan C, Gunay T, Onag A, Egemen A 2004. Effects of different socioeconomic conditions on menarche in Turkish female students. Early hum dev 76(2):115-25. https://doi.org/10.1016/j.earlhumdev.2003.11.001\u003c/li\u003e\n\u003cli\u003eGeorgiadis E, Mantzoros CS, Evagelopoulou C, Spentzos D 1997. Adult height and menarcheal age of young women in Greece. Ann Hum Biol 24(1):55-9. https://doi.org/10.1080/03014469700004772\u003c/li\u003e\n\u003cli\u003eGraberc JA, Brooks‐Gunn J, Warren MP 1995. The antecedents of menarcheal age: Heredity, family environment, and stressful life events. Child Dev 66(2):346-59. https://doi.org/10.1111/j.1467-8624.1995.tb00875.x\u003c/li\u003e\n\u003cli\u003eHiatt RA, Stewart SL, Deardorff J, Danial E, Abdiwahab E, Pinney SM, Teitelbaum SL, Windham GC, Wolff MS, Kushi LH, Biro FM 2021. Childhood socioeconomic status and menarche: a prospective study. J Adolesc Health 69(1):33-40. https://doi.org/10.1016/j.jadohealth.2021.02.003\u003c/li\u003e\n\u003cli\u003eHill JP, Holmbeck GN, Marlow L, Green TM, Lynch ME 1985. Menarcheal status and parent-child relations in families of seventh-grade girls. J Youth Adolesc 14(4):301-16. https://doi.org/10.1007/bf02089236\u003c/li\u003e\n\u003cli\u003ehttps://doi.org/10.1080/03014467900003501\u003c/li\u003e\n\u003cli\u003eHuhmann K 2020. Menses requires energy: a review of how disordered eating, excessive exercise, and high stress lead to menstrual irregularities. Clin Ther 42(3):401-7. https://doi.org/10.1016/j.clinthera.2020.01.016\u003c/li\u003e\n\u003cli\u003eJimenez AB, Gomez-Cardenas FJ, de la Camara Mora\u0026ntilde;o C 2022. Likely impact of COVID-19 on referrals to pediatric endocrinology: Increased incidence of precocious puberty in a third-level hospital. Endocrinol Diabetes Nutr. 69(7), 542\u0026ndash;544. https://doi.org/10.1016/j.endinu.2021.09.004\u003c/li\u003e\n\u003cli\u003eKaplowitz PB 2008. Link between body fat and the timing of puberty. Pediatr S208-17. https://doi.org/10.1542/peds.2007-1813F\u003c/li\u003e\n\u003cli\u003eKarim A, Qaisar R, Hussain MA (2021) Growth and socio-economic status, influence on the age at menarche in school going girls. J Adolesc 86:40-53. https://doi.org/10.1016/j.adolescence.2020.12.001\u003c/li\u003e\n\u003cli\u003eKissinger DG, Sanchez A 1987. The association of dietary factors with the age of menarche. Nutr Res 7(5):471-9. https://doi.org/10.1016/S0271-5317(87)80003-9\u003c/li\u003e\n\u003cli\u003eKosińska M, Liczbińska G, Gautam RK, Dubey P, Ahirwar AK, Chaurasia A 2019. Father\u0026rsquo;s social and economic position has strongest impact on age at menarche in girls from Central India. Anthropol Rev 82(4):357-71. http://dx.doi.org/10.2478/anre-2019-0027\u003c/li\u003e\n\u003cli\u003eLalys L, Pineau JC (2014) Age at menarche in a group of French schoolgirls. Pediatr Int 56(4):601-604. https://doi.org/10.1111/ped.12296\u003c/li\u003e\n\u003cli\u003eMendle J, Leve LD, Van Ryzin M, Natsuaki MN, Ge X 2011. Associations between early life stress, child maltreatment, and pubertal development among girls in foster care. J Res Adolsc 21(4):871-80. https://doi.org/10.1111%2Fj.1532-7795.2011.00746.x\u003c/li\u003e\n\u003cli\u003eMeyer F, Moisan J, Marcoux D, Bouchard C 1990. Dietary and physical determinants of menarche. Epidemiol 1(5):377-81. https://doi.org/10.1097/00001648-199009000-00007\u003c/li\u003e\n\u003cli\u003eMoffitt TE, Caspi A, Belsky J, Silva PA 1992. Childhood experience and the onset of menarche: A test of a sociobiological model. Child Dev 63(1):47-58. https://doi.org/10.1111/j.1467-8624.1992.tb03594.x\u003c/li\u003e\n\u003cli\u003eMoisan JO, Meyer FR, Gingras SU (1991) Leisure physical activity and age at menarche. Med Sci Sports Exerc 23(10):1170-5.\u003c/li\u003e\n\u003cli\u003eOh CM, Oh IH, Choi KS, Choe BK, Yoon TY, Choi JM 2012. Relationship between body mass index and early menarche of adolescent girls in Seoul. J Prev Med Public Health 45(4):227-34. https://doi.org/10.3961/jpmph.2012.45.4.227\u003c/li\u003e\n\u003cli\u003ePapadimitriou A (2016) The evolution of the age at menarche from prehistorical to modern times. J Pediatr Adolesc Gynecol 29(6):527-30. https://doi.org/10.1016/j.jpag.2015.12.002\u003c/li\u003e\n\u003cli\u003ePetersen AC, Sarigiani PA, Kennedy RE 1991. Adolescent depression: Why more girls? J Youth Adolesc 20:247-71. https://doi.org/10.1007/BF01537611\u003c/li\u003e\n\u003cli\u003ePratami M, Herawati L, Annas JY 2020. Menstrual Pattern Disorder Related to Physical Activity and Stress Psychic Soldiers Female Student of Indonesian Navy. \u003cbr\u003e Indian J Public Health Res Dev 11(5):686-91. \u003c/li\u003e\n\u003cli\u003eRavi S, Kujala UM, Tammelin TH, Hirvensalo M, Kovanen V, Valtonen M, Waller B, Aukee P, Sipil\u0026auml; S, Laakkonen EK 2020. Adolescent sport participation and age at menarche in relation to midlife body composition, bone mineral density, fitness, and physical activity. J Clin Med 9(12):3797. https://doi.org/10.3390/jcm9123797\u003c/li\u003e\n\u003cli\u003eRees M (1995) The age of menarche. ORGYN: Organon\u0026apos;s magazine on women \u0026amp; health (4):2-4.\u003c/li\u003e\n\u003cli\u003eRosenfield RL, Lipton RB, Drum ML (2009) Thelarche, pubarche, and menarche attainment in children with normal and elevated body mass index. Pediatr 123(1):84-8. https://doi.org/10.1542/peds.2008-0146\u003c/li\u003e\n\u003cli\u003eSatyanarayana K, Naidu AN 1979. Nutrition and menarche in rural Hyderabad. Ann Hum Biol 6(2):163-5.\u003c/li\u003e\n\u003cli\u003eShirazi TN, Rosinger AY (2021) Reproductive health disparities in the USA: self-reported race/ethnicity predicts age of menarche and live birth ratios, but not infertility. J Racial Ethn Heal Disparities 8:33\u0026ndash;46. https://doi.org/10.1007/s40615-020-00752-4\u003c/li\u003e\n\u003cli\u003eSun Y, Deng F, Liu Y, Tao FB 2015. Cortisol response to psychosocial stress in Chinese early puberty girls: possible role of depressive symptoms. Biomed Res Int. https://doi.org/10.1155/2015/781241 \u003c/li\u003e\n\u003cli\u003eTither JM, Ellis BJ 2008. Impact of fathers on daughters\u0026apos; age at menarche: a genetically and environmentally controlled sibling study. Dev Psychol 44(5):1409. https://doi.org/10.1037/a0013065\u003c/li\u003e\n\u003cli\u003eUlijaszek SJ, Evans E, Miller DS (1991) Age at menarche of European, Afro-Caribbean and Indo-Pakistani schoolgirls living in London. Ann Hum Biol 18(2):167-75. https://doi.org/10.1080/03014469100001502\u003c/li\u003e\n\u003cli\u003eWierson M, Long PJ, Forehand RL 1993. Toward a new understanding of early menarche: the role of environmental stress in pubertal timing. Adolesc 28(112):913\u0026ndash;924.\u003c/li\u003e\n\u003cli\u003eWronka I, Pawlińska-Chmara R 2005. Menarcheal age and socio-economic factors in Poland. Ann Hum Biol 32(5):630-8. https://doi.org/10.1080/03014460500204478\u003c/li\u003e\n\u003cli\u003eWu T, Mendola P, Buck GM 2002. Ethnic differences in the presence of secondary sex characteristics and menarche among US girls: the Third National Health and Nutrition Examination Survey, 1988\u0026ndash;1994. Pediatr, 110(4), 752\u0026ndash;757. https://doi.org/10.1542/peds.110.4.752\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Mean and standard deviation of physiological factors.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"360\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.166666666666664%\" valign=\"bottom\"\u003e\n \u003cp\u003ePhysiological factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.055555555555557%\" valign=\"bottom\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.77777777777778%\" valign=\"bottom\"\u003e\n \u003cp\u003eStandard dev.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.166666666666664%\" valign=\"bottom\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.055555555555557%\" valign=\"bottom\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.77777777777778%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.166666666666664%\" valign=\"bottom\"\u003e\n \u003cp\u003eHeight (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.055555555555557%\" valign=\"bottom\"\u003e\n \u003cp\u003e155.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.77777777777778%\" valign=\"bottom\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.166666666666664%\" valign=\"bottom\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.055555555555557%\" valign=\"bottom\"\u003e\n \u003cp\u003e45.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.77777777777778%\" valign=\"bottom\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.166666666666664%\" valign=\"bottom\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.055555555555557%\" valign=\"bottom\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.77777777777778%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2. Frequencies and percentages of SES, physical activity and home environment.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"349\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\n \u003cp\u003eFrequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.Socio economic status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003eUpper Lower Class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003eLower Middle Class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003eUpper Middle Class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\n \u003cp\u003e63.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003e2. Physical Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003eActive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003eModerately Active\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\n \u003cp\u003e44.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003eInactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\n \u003cp\u003e33.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003e3. Home Environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003eSecure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\n \u003cp\u003e73.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7163323782235%\" valign=\"bottom\"\u003e\n \u003cp\u003eDistrubed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78223495702006%\" valign=\"bottom\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.501432664756447%\" valign=\"bottom\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 3. Descriptives of physical activity and home environment with p values that indicate relationship with age at menarche.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.147265077138849%\" valign=\"top\"\u003e\n \u003cp\u003eAge at Menarche\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.58765778401122%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePhysical Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.55539971949509%\" valign=\"top\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.873772791023843%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eHome environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.835904628330995%\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.126050420168067%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.705882352941176%\" valign=\"top\"\u003e\n \u003cp\u003eInactive (30 minutes/)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.904761904761905%\" valign=\"top\"\u003e\n \u003cp\u003eModerately Active (30-60 mins/day)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.064425770308123%\" valign=\"top\"\u003e\n \u003cp\u003eActive (60-150/day)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.543417366946779%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.663865546218487%\" valign=\"top\"\u003e\n \u003cp\u003eSecure\u003c/p\u003e\n \u003cp\u003e(n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.103641456582633%\" valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003cp\u003e(n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.064425770308123%\" valign=\"top\"\u003e\n \u003cp\u003eDisturbed\u003c/p\u003e\n \u003cp\u003e(n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.823529411764707%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.305084745762713%\" valign=\"top\"\u003e\n \u003cp\u003ePre-teen (9-11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.796610169491526%\" valign=\"top\"\u003e\n \u003cp\u003e68, 65.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.40677966101695%\" valign=\"top\"\u003e\n \u003cp\u003e92, 67.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.389830508474576%\" valign=\"top\"\u003e\n \u003cp\u003e57, 86.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.694915254237289%\" valign=\"top\"\u003e\n \u003cp\u003e152, 67.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.016949152542374%\" valign=\"top\"\u003e\n \u003cp\u003e48, 73.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.389830508474576%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.305084745762713%\" valign=\"top\"\u003e\n \u003cp\u003eTeen (12-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.796610169491526%\" valign=\"top\"\u003e\n \u003cp\u003e36, 34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.40677966101695%\" valign=\"top\"\u003e\n \u003cp\u003e45, 32.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.389830508474576%\" valign=\"top\"\u003e\n \u003cp\u003e9, 13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.694915254237289%\" valign=\"top\"\u003e\n \u003cp\u003e73, 32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.016949152542374%\" valign=\"top\"\u003e\n \u003cp\u003e17, 26.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.389830508474576%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.305084745762713%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.796610169491526%\" valign=\"top\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.40677966101695%\" valign=\"top\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.389830508474576%\" valign=\"top\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.694915254237289%\" valign=\"top\"\u003e\n \u003cp\u003e225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.016949152542374%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.389830508474576%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Charts","content":"\u003cp\u003eCharts 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e "}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Dow Medical College, Karachi","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"menarche, physiological, psychological, health, women","lastPublishedDoi":"10.21203/rs.3.rs-2908778/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2908778/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo determine the impact of physical and psychosocial factors on the age of menarche in girls from different socioeconomic backgrounds in Karachi, Pakistan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was carried out on female students aged 11 to 16 years from four different schools in urban and rural areas of Karachi district, Pakistan in 2022. Subjects who had not yet menstruated were excluded. Bilingual questionnaires were used in the study to record the responses. Height and weight were measured using calibrated instruments. The population sample size was 307, with a 95% confidence level. The Kuppuswamy scale was used for socioeconomic status (SES) measurement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of menarche was found to be 11.9 ± 1.1 years. The study showed a significant correlation between age at menarche and height (p = 0.000), weight (p = 0.001), BMI (p = 0.009), physical activity (p = 0.007), female siblings (p = 0.082), psychological effect of lockdown (p = 0.035), father’s occupation (p = 0.002) and abusive home environment (p = 0.015). Diet, co-education, relation with father, total number of siblings, paternal presence or absence and socioeconomic status showed insignificant correlation with age at menarche. Various factors, particularly emotional abuse, can have far-reaching effects on the growth and development of female adolescents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results support the significant influence of height, weight, BMI, physical activity, father’s occupation, and abusive home environment on age at menarche.\u003c/p\u003e","manuscriptTitle":"Influence of physiological variables and psychosocial factors on the onset of Menarche in schoolgirls of Pakistan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-09 15:09:20","doi":"10.21203/rs.3.rs-2908778/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7835b378-b72f-4a70-a9f0-fae6bdbe4515","owner":[],"postedDate":"May 9th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":21268590,"name":"Women's studies"}],"tags":[],"updatedAt":"2023-05-09T15:09:20+00:00","versionOfRecord":[],"versionCreatedAt":"2023-05-09 15:09:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2908778","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2908778","identity":"rs-2908778","version":["v1"]},"buildId":"oE6Zbj460LM0Up2FdVbMZ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}