At what Tanner stage does menarche (menstruation) typically start?

From the Guidelines

Menses typically begins during Tanner stage 3 of puberty in females, though it can sometimes occur during late stage 2 or early stage 4. The provided evidence does not directly answer the question, but based on general medical knowledge, during Tanner stage 3, breast development continues with enlargement beyond the areola, pubic hair becomes darker and more coarse while spreading over the pubic symphysis, and the uterus and ovaries have developed sufficiently to support menstruation 1. Some key points to consider when evaluating the onset of menarche include:

• The average age for menarche is around 12-13 years, though this can vary widely from 9-16 years and still be considered normal.
• Menarche occurs approximately 2-2.5 years after the onset of puberty (Tanner stage 1) 1.
• The timing of menarche is influenced by multiple factors including genetics, body composition, nutrition, and environmental factors. Understanding the relationship between Tanner staging and menarche is important for evaluating normal pubertal progression and identifying potential developmental concerns in adolescent females. In clinical practice, monitoring growth, sexual maturation, and development (Tanner staging) is crucial for assessing normal pubertal progression and identifying potential developmental concerns in adolescent females 1.

From the Research

Tanner Stage at Menarche

• Menarche typically occurs when both breast and pubic hair development are at Tanner stage 4, as stated in the study 2.
• A study on North Indian adolescent girls found that girls who achieved menarche were mostly in Tanner stage IV and above 3.
• Another study found that menarche usually occurs when girls are at Tanner stage 4, but the exact timing can vary 4.
• The Tanner stage at menarche can be influenced by various factors, including the pace of puberty and the use of gonadotropin-suppressive therapy 5.
• However, the exact Tanner stage at menarche can vary from girl to girl, and more research is needed to fully understand the relationship between Tanner stage and menarche 6.

Factors Influencing Menarche

• The age at menarche is variable and can be influenced by factors such as genetics, nutrition, and overall health 3.
• The use of gonadotropin-suppressive therapy can delay menarche, but it does not appear to affect total pubertal growth or final height 5.
• The pace of puberty can also influence the timing of menarche, with girls who experience early and fast puberty tend to reach menarche at a younger age 5.
• However, the relationship between the pace of puberty and menarche is complex, and more research is needed to fully understand the factors that influence menarche 6.

Measurement of Pubertal Development

• Tanner stage is a commonly used measure of pubertal development, but it can be subjective and prone to error 4.
• Self-assessment of pubertal development can be misclassified, leading to random errors in studies of puberty timing 4.
• Clinical examination and other objective measures of pubertal development may be more accurate, but they can be time-consuming and expensive 4.
• More research is needed to develop reliable and accurate measures of pubertal development, including the timing of menarche 3.