Age of thelarche and menarche in contemporary US females: a cross-sectional analysis

Susanne M. Cabrera 1 , George M. Bright 2 , James W. Frane 3 , Sandra L. Blethen 4 , and Peter A. Lee 5
  • 1 Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
  • 2 San Mateo, CA, USA
  • 3 Vann-Frane Statistical Consulting, Santa Monica, CA, USA
  • 4 Belmont, CA, USA
  • 5 Department of Pediatrics, Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033, USA
Susanne M. Cabrera, George M. Bright, James W. Frane, Sandra L. Blethen and Peter A. Lee


Aim: A recent secular trend towards earlier thelarche has been suggested. The aim of this study is to examine normative ages of thelarche and menarche in contemporary US females.

Methods: Trained physicians documented Tanner breast stage by observation in a cross-sectional cohort. Age of menarche was self-reported. The subjects were healthy female children and adolescents. The mean age of thelarche was determined by probit analysis and the mean age of menarche was determined by using a normal time-to-event model.

Results: Mean age of thelarche was 9.7 years among 610 females aged 3.0–17.9 years (70% non-Hispanic Caucasian (NHC), 14% African-Americans, 7% Hispanic, 9% “other”). The mean age of menarche was 12.8 years for NHC, with African-Americans having menarche 0.6 years earlier.

Conclusions: Thelarche occurred earlier than recently reported, while age of menarche remained unchanged, this supported a persistent secular trend towards earlier thelarche but stable age of menarche. This suggests that the observed thelarche is gonadotropin-independent or the tempo of pubertal advancement has slowed.

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