Age at menarche may signal health risks

Findings from The Brazilian Longitudinal Study of Adult Health (ELSA-Brazil) presented at ENDO 2025 demonstrate an association between early and late age at menarche and distinct cardiometabolic and reproductive health risks.

“We now have evidence from a large Brazilian population that confirms how both early and late puberty can have different long-term health impacts,” noted study author Dr Flávia Rezende Tinano from the University of São Paulo in Brazil, in the ENDO 2025 press release.

“While early menarche (<10 years of age) increases the risk for multiple metabolic and heart problems, late menarche (>15 years of age) may protect against obesity but increase certain heart and menstrual issues,” said Rezende Tinano.

On univariate analysis, women who had their first period before the age of 10 had a higher odds of obesity (odds ratio [OR], 2.18), hypertension (OR, 1.38), type 2 diabetes (T2D; OR, 1.85), metabolic syndrome (OR, 1.58), elevated uric acid (OR, 1.47), pre-eclampsia (OR, 1.71), self-reported angina (OR, 1.76), myocardial infarction (MI; OR, 2.33), and heart failure (HF; OR, 2.50; p<0.05 for all).

These patterns were sustained on multivariate analysis: obesity (OR, 2.08), hypertension (OR, 1.36), T2D (OR, 1.92), metabolic syndrome (OR, 1.57), elevated uric acid (OR, 1.48), pre-eclampsia (OR, 1.67), angina (OR, 1.68), MI (OR, 2.59), and HF (OR, 2.60; p<0.05 for all). [ENDO 2025, abstract OR15-08]

Central obesity was also associated with early age at menarche on univariate analysis (OR, 1.52; p=0.02), with a trend toward significance on multivariate analysis (OR, 1.44; p=0.053).

Women who had their first period beyond 15 years of age were less likely to be obese on multivariate analysis (OR, 0.69; p=0.002). However, they were more likely to have oligomenorrhoea and myocardial revascularization (MR) on both univariate (ORs, 1.47 and 3.20, respectively) and multivariate analyses (ORs, 1.62 and 2.40, respectively; p<0.05 for all).

The associations between late age at menarche and T2D, metabolic syndrome, angina, and HF were only significant on univariate analyses (OR, 1.30, 1.24, 1.60, and 2.06, respectively, p<0.05 for all).

An important cardiometabolic, reproductive health marker

Initiated in 2008, the ELSA-Brazil trial includes cross-sectional and prospective cohort analyses of 15,105 civil servants from six centres across Brazil. Participants underwent longitudinal evaluations, including interviews, anthropometric assessments, and biochemical tests.

This study included 7,623 women aged 35–74 years who participated in the second evaluation. Metabolic outcomes evaluated included obesity, central obesity, T2D, dyslipidaemia, hypertension, metabolic syndrome, and hepatic steatosis on ultrasound. Reproductive outcomes included oligomenorrhoea, hirsutism, self-reported polycystic ovary syndrome, pre-eclampsia, gestational diabetes, and infertility/subfertility. Cardiovascular outcomes included self-reported MI, angina, MR, stroke, and HF.

“Most women can remember when they had their first period, but they might not realize that it could signal future health risks … Our findings suggest that knowing a woman’s age at her first period can help doctors identify those at higher risk for certain diseases,” Rezende Tinano said. “Understanding these links can help women and their doctors be more proactive about preventing conditions like diabetes, high blood pressure, and heart disease.”

She added that the study provides valuable insight into an issue that has been studied mostly in wealthier countries and underscores the effect of early and late puberty on women’s long-term health, specifically in underrepresented populations.

“This information could guide more personalized screening and prevention efforts [and] emphasizes the importance of early health education for young girls and women, especially in developing countries,” Rezende Tinano said.