Family composition and age at menarche: Findings from the international Health Behaviour in School-aged Children study

Reprod Health. 2019 Dec 5;16(1):176. doi: 10.1186/s12978-019-0822-6.


Background: Early menarche has been associated with father absence, stepfather presence and adverse health consequences in later life. This article assesses the association of different family compositions with the age at menarche. Pathways are explored which may explain any association between family characteristics and pubertal timing.

Methods: Cross-sectional, international data on the age at menarche, family structure and covariates (age, psychosomatic complaints, media consumption, physical activity) were collected from the 2009-2010 Health Behaviour in School-aged Children (HBSC) survey. The sample focuses on 15-year old girls comprising 36,175 individuals across 40 countries in Europe and North America (N = 21,075 for age at menarche). The study examined the association of different family characteristics with age at menarche. Regression and path analyses were applied incorporating multilevel techniques to adjust for the nested nature of data within countries.

Results: Living with mother (Cohen's d = .12), father (d = .08), brothers (d = .04) and sisters (d = .06) are independently associated with later age at menarche. Living in a foster home (d = -.16), with 'someone else' (d = -.11), stepmother (d = -.10) or stepfather (d = -.06) was associated with earlier menarche. Path models show that up to 89% of these effects can be explained through lifestyle and psychological variables.

Conclusions: Earlier menarche is reported amongst those with living conditions other than a family consisting of two biological parents. This can partly be explained by girls' higher Body Mass Index in these families which is a biological determinant of early menarche. Lower physical activity and elevated psychosomatic complaints were also more often found in girls in these family environments.

Keywords: Age at menarche; Body mass index; Family structure; Life history theory; Psychological and psychosomatic problems; Pubertal timing.

MeSH terms

  • Adolescent
  • Age Factors
  • Body Mass Index
  • Child
  • Cross-Sectional Studies
  • Family Characteristics*
  • Fathers / statistics & numerical data
  • Female
  • Global Health*
  • Health Behavior*
  • Humans
  • Male
  • Menarche / physiology*
  • Mothers / statistics & numerical data
  • Schools
  • Surveys and Questionnaires