Menarche and Mental Health

Menarche is defined as the first occurrence of the menstrual cycle in an individual. Typically, the average age for menarche has been approximated to be around 12.4 years, with some discrepancies based on racial and cultural differences (Lacroix & Langaker, 2021). Menarche indicates the beginning of the monthly shedding of the endometrial lining of the uterus. However, taking a deep dive into the implications of menarche would reveal that menarche actually has a lot more implications than just biological. Menarche has various cognitive, psychological and physical effects on the menstruator.

Menarche is characterised by various lifestyle, biological and psychological changes in the individual. It is characteristic of a sudden transition in life, and is intricately woven with social practices and expectations. Often seen as the body’s loud and clear statement declaring fertility (Lacroix & Langaker, 2021), it is also considered as a “rite of passage” or transition into womanhood. It goes without saying that this period is often laden with multiple apprehensions, changes and novelty. Studies have in fact established that the onset of menarche can be associated with increased anxiety levels. The young menstruator might experience the whole package of emotions, starting from surprise and panic, to confusion and embarrassment (Natsauki, Leve & Mendle, 2010). This is further aggravated due to the ambiguity and change that menarche brings with it (since menarche is known to mark a “different stage” in the life of the menstruator). Simultaneously, most individuals are also going through multiple physical and biological changes through the period: from skin changes to growth spurts and growth of body hair. So it goes without saying that this period is marked by a large amount of change and a substantial amount of emotional discontinuity for young menstruators (Natsauki, Leve & Mendle, 2010). A menstruator might also find it hard to cope with fellow peers who might not be going through similar developmental and menstrual trajectories. Late-onset menarche may also be characterised by similar levels of anxiety and confusion. Pubertal and menarchal age has also been correlated with lower self-esteem and self-concept. Early menarchal and pubertal age has also been found to be correlated with body dissatisfaction and higher risk of substance abuse (Stice et. al., 2001, as cited by Mendle, Turkheimer & Emery, 2006).

This period is also laden with large amounts of stigma and cultural taboo surrounding the topic of menstruation. This can potentially lead to increased levels of isolation and, hence, higher levels of mental distress. Young menstruators often also have to navigate through overwhelming amounts of information, and might also be strongly influenced by the social and economic factors that persist in their environments.

However, the good news is that studies have also indicated that these feelings of worry and anxiousness often stabilise or reduce as the individual transitions through menarche (Natsauki, Leve & Mendle, 2010). The effects of menarche are confounded by various other factors like the timing or age of onset (Natsauki, Leve & Mendle, 2010). Early-onset menarche has been characterised by higher levels of anxiety. Hence, it is through this particular period of menarche, that individuals need support since the pre and post menarchal period generally seems to be characterised by a reduction of concerns, making the experience manageable. Through this dialogue, we believe that it is important to urge various stakeholders within the field: mental health professionals, gynaecologists and organisations/individuals working within the area of menstrual health to be cognizant of the changes and transition menstruators might be going through the brief period of menarche. While various issues and concerns may seem trivial, it is integral to help and support menstruators through this process by building active conversation on the topic in the premenstrual phase itself. Young individuals can be made more aware of the possibility of menarche, and the various emotions and changes that might accompany it. They can be told about the self-care strategies that can be employed, and be provided with the resources to navigate the large amounts of information they might be met with. Though the concerns through menarche might just be transitory, it is important to foster a comfortable and safe space for young menstruators to grow within.

References

1. Mendle, J., Turkheimer, E., & Emery, R. E. (2007). Detrimental Psychological Outcomes Associated with Early Pubertal Timing in Adolescent Girls. Developmental review: DR, 27(2), 151–171. https://doi.org/10.1016/j.dr.2006.11.001

2. Natsuaki, M. N., Leve, L. D., & Mendle, J. (2011). Going through the rites of passage: timing and transition of menarche, childhood sexual abuse, and anxiety symptoms in girls. Journal of youth and adolescence, 40(10), 1357–1370. https://doi.org/10.1007/s10964-010-9622-6

3. Lacroix AE, Gondal H, Langaker MD. Physiology, Menarche. (2021). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29261991