Background/Aims: A worldwide decline in the age at menarche (AAM) has been reported in recent decades. This trend has been also clinically observed among Israeli women and was reported in our previous study. Methods: We reviewed the literature reporting the mean AAM in Israel during the past century. Studies were excluded if participants had been investigated due to illness or any condition which could affect sexual maturation. Mean AAM was analyzed using a simple linear regression weighted for number of participants in each birth cohort and stratified to birth cohorts before and after 1970, based on the outcome of our previous study. Results: AAM varied little among women born between 1875 and 1970, but there was a clear downwards trend from 13.4 in 1970 to 12.8 two decades later. In a stratified analysis we found a significant negative association between birth year and AAM in the birth cohort after 1970 (standardized β coefficient = -0.94 per year, R2 = 0.87; p < 0.001). Conclusion: These results suggest a significant decline in mean AAM in Israeli women born in 1970 or later.

Plotnik L, Long D (eds): Puberty and Gonadal Disorders. Philadelphia, Lippincott Williams & Wilkins, 2008.
Chodick G, Huerta M, Balicer RD, Davidovitch N, Grotto I: Secular trends in age at menarche, smoking, and oral contraceptive use among Israeli girls. Prev Chronic Dis 2005;2:A12.
Johnston L, O'Malley P, Bachman J, Schulenberg J: Monitoring the future: national survey results on drug use, 1975-2007. Bethesda, NIH, 2008.
Downing J, Bellis MA: Early pubertal onset and its relationship with sexual risk taking, substance use and anti-social behaviour: a preliminary cross-sectional study. BMC Public Health 2009;9:446.
Komura H, Miyake A, Chen CF, Tanizawa O, Yoshikawa H: Relationship of age at menarche and subsequent fertility. Eur J Obstet Gynecol Reprod Biol 1992;44:201-203.
Golub MS, Collman GW, Foster PM, Kimmel CA, Rajpert-De Meyts E, Reiter EO, Sharpe RM, Skakkebaek NE, Toppari J: Public health implications of altered puberty timing. Pediatrics 2008;121(suppl 3):S218-S230.
Kaplowitz P: Pubertal development in girls: secular trends. Curr Opin Obstet Gynecol 2006;18:487-491.
Sorensen K, Mouritsen A, Aksglaede L, Hagen CP, Mogensen SS, Juul A: Recent secular trends in pubertal timing: implications for evaluation and diagnosis of precocious puberty. Horm Res Paediatr 2012;77:137-145.
Helm P, Helm S: Decrease in menarcheal age from 1966 to 1983 in Denmark. Acta Obstet Gynecol Scand 1984;63:633-635.
Mul D, Fredriks AM, van Buuren S, Oostdijk W, Verloove-Vanhorick SP, Wit JM: Pubertal development in the Netherlands 1965-1997. Pediatr Res 2001;50:479-486.
Morris DH, Jones ME, Schoemaker MJ, Ashworth A, Swerdlow AJ: Secular trends in age at menarche in women in the UK born 1908-93: results from the breakthrough generations study. Paediatr Perinat Epidemiol 2012;25:394-400.
Hermanussen M, Lehmann A, Scheffler C: Psychosocial pressure and menarche: a review of historic evidence for social amenorrhea. Obstet Gynecol Surv 2012;67:237-241.
Hosokawa M, Imazeki S, Mizunuma H, Kubota T, Hayashi K: Secular trends in age at menarche and time to establish regular menstrual cycling in Japanese women born between 1930 and 1985. BMC Womens Health 2012;12:19.
Cabanes A, Ascunce N, Vidal E, Ederra M, Barcos A, Erdozain N, Lope V, Pollan M: Decline in age at menarche among Spanish women born from 1925 to 1962. BMC Public Health 2009;9:449.
Herman-Giddens ME, Slora EJ, Wasserman RC, Bourdony CJ, Bhapkar MV, Koch GG, Hasemeier CM: 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.
Ma HM, Du ML, Luo XP, Chen SK, Liu L, Chen RM, Zhu C, Xiong F, Li T, Wang W, Liu GL: Onset of breast and pubic hair development and menses in urban Chinese girls. Pediatrics 2009;124:e269-e277.
Malina RM, Pena Reyes ME, Tan SK, Little BB: Secular change in age at menarche in rural Oaxaca, southern Mexico: 1968-2000. Ann Hum Biol 2004;31:634-646.
Jones LL, Griffiths PL, Norris SA, Pettifor JM, Cameron N: Age at menarche and the evidence for a positive secular trend in urban South Africa. Am J Hum Biol 2009;21:130-132.
Cho GJ, Park HT, Shin JH, Hur JY, Kim YT, Kim SH, Lee KW, Kim T: Age at menarche in a Korean population: secular trends and influencing factors. Eur J Pediatr 2009;169:89-94.
Gross R, Brammli-Greenberg S, Gordon B, Rabinowitz J, Afek A: Population-based trends in male adolescent obesity in Israel 1967-2003. J Adolesc Health 2009;44:195-198.
Meydan C, Afek A, Derazne E, Tzur D, Twig G, Gordon B, Shamiss A: Population-based trends in overweight and obesity: a comparative study of 2,148,342 Israeli male and female adolescents born 1950-1993. Pediatr Obes 2012;8:98-111.
Currie C, Ahluwalia N, Godeau E, Nic Gabhainn S, Due P, Currie DB: Is obesity at individual and national level associated with lower age at menarche? Evidence from 34 countries in the health behaviour in school-aged children study. J Adolesc Health 2012;50:621-626.
Mandel D, Zimlichman E, Mimouni FB, Grotto I, Kreiss Y: Age at menarche and body mass index: a population study. J Pediatr Endocrinol Metab 2004;17:1507-1510.
Stark O, Peckham CS, Moynihan C: Weight and age at menarche. Arch Dis Child 1989;64:383-387.
Kauli R, Kornreich L, Laron Z: Pubertal development, growth and final height in girls with sexual precocity after therapy with the GnRH analogue D-TRP-6-LHRH. A report on 15 girls, followed after cessation of gonadotrophin suppressive therapy. Horm Res 1990;33:11-17.
Lazar L, Kauli R, Bruchis C, Nordenberg J, Galatzer A, Pertzelan A: High prevalence of abnormal adrenal response in girls with central precocious puberty at early pubertal stages. Eur J Endocrinol 1995;133:407-411.
Weintrob N, Dickerman Z, Sprecher E, Galatzer A, Pertzelan A: Non-classical 21-hydroxylase deficiency in infancy and childhood: the effect of time of initiation of therapy on puberty and final height. Eur J Endocrinol 1997;136:188-195.
Lazar L, Kauli R, Pertzelan A, Phillip M: Gonadotropin-suppressive therapy in girls with early and fast puberty affects the pace of puberty but not total pubertal growth or final height. J Clin Endocrinol Metab 2002;87:2090-2094.
Lazar L, Padoa A, Phillip M: Growth pattern and final height after cessation of gonadotropin-suppressive therapy in girls with central sexual precocity. J Clin Endocrinol Metab 2007;92:3483-3489.
De Vries L, Kauschansky A, Shohat M, Phillip M: Familial central precocious puberty suggests autosomal dominant inheritance. J Clin Endocrinol Metab 2004;89:1794-1800.
Schneider D, Halperin R, Maymon R, Bukovsky I, Herman A: Localized and diffuse ovarian cancer: Is it the same entity? Eur J Gynaecol Oncol 1997;18:379-382.
Kaduri L, Gibs M, Hubert A, Sagi M, Heching N, Lerer I, Uziely B, Weinberg N, Abeliovich D, Peretz T: Genetic testing of breast and ovarian cancer patients: clinical characteristics and hormonal risk modifiers. Eur J Obstet Gynecol Reprod Biol 1999;85:75-80.
Halperin R, Zehavi S, Dar P, Habler L, Hadas E, Bukovsky I, Schneider D: Clinical and molecular comparison between borderline serous ovarian tumors and advanced serous papillary ovarian carcinomas. Eur J Gynaecol Oncol 2001;22:292-296.
Halperin R, Zehavi S, Langer R, Hadas E, Bukovsky I, Schneider D: Primary peritoneal serous papillary carcinoma: a new epidemiologic trend? A matched-case comparison with ovarian serous papillary cancer. Int J Gynecol Cancer 2001;11:403-408.
Sade RB, Chetrit A, Figer A, Papa MZ, Flex D, Rizel S, Friedman E: Hormone replacement therapy is more prevalent among Jewish BRCA1/2 mutation carriers. Eur J Cancer 2006;42:650-655.
Eliakim R, Sherer DM: Celiac disease: fertility and pregnancy. Gynecol Obstet Invest 2001;51:3-7.
Yeshaya A, Orvieto R, Dicker D, Karp M, Ben-Rafael Z: Menstrual characteristics of women suffering from insulin-dependent diabetes mellitus. Int J Fertil Menopausal Stud 1995;40:269-273.
Ben-Rafael Z, Blankstein J, Sack J, Lunenfeld B, Oelsner G, Serr DM, Mashiach S: Menarche and puberty in daughters of amenorrheic women. JAMA 1983;250:3202-3204.
Zimran A, Morris E, Mengel E, Kaplan P, Belmatoug N, Hughes DA, Malinova V, Heitner R, Sobreira E, Mrsic M, Granovsky-Grisaru S, Amato D, vom Dahl S: The female Gaucher patient: the impact of enzyme replacement therapy around key reproductive events (menstruation, pregnancy and menopause). Blood Cells Mol Dis 2009;43:264-288.
Eckstein M, Vered I, Ish-Shalom S, Shlomo AB, Shtriker A, Koren-Morag N, Friedman E: Vitamin D and calcium-sensing receptor genotypes in men and premenopausal women with low bone mineral density. Isr Med Assoc J 2002;4:340-344.
De Vries L, Karasik A, Landau Z, Phillip M, Kiviti S, Goldberg-Stern H: Endocrine effects of valproate in adolescent girls with epilepsy. Epilepsia 2007;48:470-477.
Lazar L, Pollak U, Kalter-Leibovici O, Pertzelan A, Phillip M: Pubertal course of persistently short children born small for gestational age (SGA) compared with idiopathic short children born appropriate for gestational age (AGA). Eur J Endocrinol 2003;149:425-432.
Maayan C, Sela O, Axelrod F, Kidron D, Hochner-Celnikier D: Gynecological aspects of female familial dysautonomia. Isr Med Assoc J 2000;2:679-683.
Oron T, Lebenthal Y, de Vries L, Yackobovitch-Gavan M, Phillip M, Lazar L: Interrelationship of extent of precocious adrenarche in appropriate for gestational age girls with clinical outcome. J Pediatr 2012;160:308-313.
Constantini NW, Warren MP: Menstrual dysfunction in swimmers: a distinct entity. J Clin Endocrinol Metab 1995;80:2740-2744.
Finney D: Probit Analysis: A Statistical Treatment of the Sigmoid Response Curve, ed 2. London, Cambridge University Press, 1964.
Steinberg N, Siev-Ner I, Peleg S, Dar G, Masharawi Y, Hershkovitz I: Growth and development of female dancers aged 8-16 years. Am J Hum Biol 2008;20:299-307.
Kohen-Raz R: Physiological maturation and mental growth at pre-adolescence and puberty. J Child Psychol Psychiatry 1974;15:199-213.
Zohar E, Rieber E: The age of menarche in girls of different Jewish communities in Israel. Harefuah 1960;59:309.
Bergman E: Letter to the editor. Harefuah 1961;60:32.
Morabia A, Costanza MC: Reproductive factors and incidence of breast cancer: an international ecological study. Soz Praventivmed 2000;45:247-257.
Revel-Vilk S, Paltiel O, Lipschuetz M, Ilan U, Hyam E, Shai E, Varon D, Revel A: Underdiagnosed menorrhagia in adolescents is associated with underdiagnosed anemia. J Pediatr 2011;160:468-472.
Shiloh A: A study of the menarche among Jerusalem schoolgirls. Harefuah 1960;59:305.
Hauser GA, Obiri JA, Valaer M, Erb H, Mueller T, Remen U, Vanaanen P: The effect of menarche age on menopausal age (in German). Gynaecologia 1961;152:279-286.
Karapanou O, Papadimitriou A: Determinants of menarche. Reprod Biol Endocrinol 2010;8:115.
Berman T, Levine H, Gamzu R, Grotto I: Trends in reproductive health in Israel: implications for environmental health policy. Isr J Health Policy Res 2012;1:34.
Euling SY, Selevan SG, Pescovitz OH, Skakkebaek NE: Role of environmental factors in the timing of puberty. Pediatrics 2008;121(suppl 3):S167-S171.
Wu T, Mendola P, Buck GM: Ethnic differences in the presence of secondary sex characteristics and menarche among us girls: the Third National Health and Nutrition Examination Survey, 1988-1994. Pediatrics 2002;110:752-757.
Elks CE, Perry JR, Sulem P, Chasman DI, Franceschini N, et al: Thirty new loci for age at menarche identified by a meta-analysis of genome-wide association studies. Nat Genet 2010;42:1077-1085.
Lalwani S, Reindollar RH, Davis AJ: Normal onset of puberty have definitions of onset changed? Obstet Gynecol Clin North Am 2003;30:279-286.
Shiloh A, Goldberg R: A study of the menarche among Tel Aviv schoolgirls. Harefuah 1965;68:163.
Neri A, Bider D, Lidor Y, Ovadia J: Menopausal age in various ethnic groups in Israel. Maturitas 1982;4:341-348.
Zarow R, Cichocka BA: A comparative analysis of estimation of age at menarche by various methods in women participating in the Krakow Longitudinal Growth Study, Poland. Am J Hum Biol 2008;20:146-148.
Henneberg M, Louw GJ: Average menarcheal age of higher socioeconomic status urban Cape coloured girls assessed by means of status quo and recall methods. Am J Phys Anthropol 1995;96:1-5.
Belmaker E: Sexual maturation of jerusalem schoolgirls and its association with socio-economic factors and ethnic group. Ann Hum Biol 1982;9:321-328.
Saar E, Shalev C, Dalal I, Sod-Moriah UA: Age at menarche: the influence of environmental conditions. Int J Biometeorol 1988;32:33-35.
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