When Does Linear Growth Cease After Menarche in Females?
Girls typically continue growing for approximately 2-4 years after menarche, with most height gain (approximately 6-7 cm total) occurring in the first 1-2 years post-menarche, and growth essentially complete by 4 years after the first period. 1, 2
Growth Patterns After Menarche
Expected Height Gain Timeline
Total post-menarcheal growth averages 6.6 cm (±2.5 cm) in contemporary cohorts, with the largest increment occurring in the first year after menarche (3.8 cm ±1.5 cm). 1
First year post-menarche: Girls gain approximately 3.8 cm on average, representing more than half of total post-menarcheal growth. 1
Second year post-menarche: Growth continues at a slower rate, with approximately 64% of girls still growing ≥1 cm during this period. 2
Third year post-menarche: Only 31% of girls continue to grow ≥1 cm in stature during this period. 2
Fourth year and beyond: Growth becomes minimal, though small amounts of growth (<1 cm) may persist in some girls up to 5 years post-menarche when measured with sensitive techniques. 2
Age at Menarche Significantly Affects Post-Menarcheal Growth
Girls with earlier menarche grow more in absolute centimeters after their first period, but reach a shorter final adult height compared to girls with later menarche. 1, 3
Early menarche (<11 years): These girls gain approximately 8.2 cm (±3.2 cm) over 4 years post-menarche but end up shorter as adults because they stop growing earlier. 1
Average menarche (11-13 years): These girls gain approximately 6-7 cm post-menarche. 1
Late menarche (>13 years): These girls gain only approximately 4.4 cm (±1.6 cm) post-menarche but achieve taller final adult heights because they had more pre-menarcheal growth. 1
For every 1 year delay in menarche, girls grow approximately 0.31 cm taller in final adult height (range 0.13-0.50 cm across populations). 3
Clinical Context: Pubertal Growth Dynamics
Peak Height Velocity Occurs Before Menarche
Girls achieve peak height velocity (PHV) of approximately 8.3 cm/year at a mean age of 11.5 years, which typically occurs 6-12 months before menarche. 4
Total pubertal growth from take-off to cessation averages 25 cm in girls, with the majority occurring before menarche. 4
Menarche represents a late pubertal event, occurring after peak height velocity has already passed, which explains why post-menarcheal growth is relatively limited. 4
Growth Hormone and Sex Steroid Effects
Estrogen has a biphasic effect on growth: Initially stimulating growth through GH/IGF-1 axis activation, then ultimately causing epiphyseal fusion and growth cessation. 4
The timing of pubertal induction affects final height in girls with delayed puberty or premature ovarian insufficiency, as postponing estrogen exposure allows more time for linear growth but must be balanced against bone health and psychosocial development. 4
Common Clinical Pitfalls to Avoid
Do Not Assume Growth Stops Immediately at Menarche
Clinicians often incorrectly assume growth ceases at or immediately after menarche, but substantial growth continues in most girls for at least 1-2 years. 2
More than 80% of girls continue growing in at least one dimension during the first year post-menarche, making it inappropriate to counsel families that "growth is finished" at menarche. 2
Consider Ethnic Variations
- Small but significant ethnic differences exist in post-menarcheal growth patterns: African American girls grow less in stature and sitting height post-menarche compared to white and Puerto Rican girls, while Puerto Rican girls show more sitting height growth but less leg length growth. 2
Practical Clinical Application
Predicting Final Adult Height
Girls who have reached menarche can be counseled that they will likely grow an additional 5-7 cm on average, with most growth occurring in the next 1-2 years. 1, 2
For girls with early menarche (<11 years), expect approximately 8 cm additional growth but a shorter final height overall. 1
For girls with late menarche (>13 years), expect approximately 4-5 cm additional growth but a taller final height overall. 1
Timing Considerations for Growth-Dependent Interventions
Interventions requiring growth completion (such as certain orthopedic procedures or final height predictions) should not be scheduled immediately at menarche but rather 2-4 years post-menarche when epiphyseal fusion is more likely complete. 1, 2
Bone age assessment remains more reliable than menarcheal status alone for determining growth potential, as skeletal maturation correlates more closely with remaining growth than chronological age or menarcheal age. 4, 5