![]() The average age of menarche is 12.4 years but varies with ethnic or racial background. The information can be useful for both pregnancy planning and pregnancy prevention. Tracking menstruation on a paper calendar or using a smartphone app can help determine if menstrual periods are becoming more regular for adolescents and for predicting when ovulation is most likely to occur. Many of these irregular cycles may be nonovulatory due to poor early regulation of the hormonal interactions between hypothalamic, pituitary, and gonadal hormones. In the first 2 to 3 years after the initial onset of menses, it is common for irregular cycles to occur, with adolescents often having several months of missed menses. Secondary amenorrhea is the cessation of menstruation for 3 months or more after it has started. Primary amenorrhea is the complete absence of any menstruation by 15 years of age. The absence of normal menstrual periods, not related to pregnancy, is called amenorrhea. It is a marker of normal female reproductive health and wellness. Most females recognize menarche as their body’s critical declaration of fertility. It relies on the following processes: normal hypothalamic and pituitary function, normal female reproductive anatomy, normal nutrition, and the general absence of other intervening chronic illnesses. Menarche occurs in the setting of a maturing hypothalamic-pituitary-ovarian (HPO) axis. ![]()
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