INTRODUCTIONEarly age at menarche is a universal trend nowadays, and determining the correlating factors and associated consequences is important.Early menarche has biomedical, emotional, and sociocultural consequences, including predisposition to diseases such as cancer and heart disease and early participation in risky behaviours, such as cigarette smoking, drug abuse, and sexual activity. Early pubertal development is also linked with slightly decreased adult height and an increased risk for obesity, compared to later age of menarche.The aims and objectives of this study were to evaluate the age of menarche in adolescent girls, to detect the factors affecting age at menarche and to find the association of these factors with the age at menarche.The exact causes of a changing age at menarche are indefinite and multifactorial. Age at menarche depends ABSTRACT Background: Present study highlights that the worldwide trend of declining age at menarche is also seen in urban Indian girls. The aim of the study was to evaluate the age of menarche and to find out the factors associated with the timing of menarche. Methods: The study was an observational cross sectional study. 258 healthy, menstruating, adolescent girls aged 10-16 years, were selected by simple random sampling. Pre-designed structured questionnaires were distributed after taking informed consent. Anthropometric measurements were taken using standard techniques. The average age of menarche was calculated. The association of the age at menarche with the proposed factors was analyzed using chi square test and Pearson's correlation coefficient. "P value" less than 0.05 was considered as significant. Results:The mean age at menarche was found to be 12.23±1.09 years. The study found a strong association between the respondent's age at menarche and her sister's age at menarche (p=0.002). The study also found a strong association between age at menarche and the socioeconomic status (p=0.021). This study however found no association of menarcheal age with factors like birth weight, type of diet, frequency of milk intake, body mass index, waist hip ratio, amount of exercise, unstable environment at home and psychosocial stress. Conclusions: The worldwide trend of declining age at menarche is also seen in urban Indian girls. This trend underlines the importance of investigating the factors associated with it and studying the future implications of a lower age at menarche.

Our objective of this case report is to highlight the value of uterine artery embolization as a means of conservative management of uterine arteriovenous malformation in patients wanting preservation of fertility. A 24 years old woman, P1L1A2 presented with complaints of heavy menstrual bleeding for two months. She had a previous term caesarean section in 2014, followed by curettage twice, in 2016 and 2017. The first episode of heavy bleeding occurred two months after the last curettage. Previous menstrual cycles were regular with moderate flow. The patient was started on combined oral contraceptive pills but she did not respond to medical treatment. Transvaginal scan and Doppler showed uterine AVM and endometrial thickness of 7.7mm. Beta hCG was less than 1.2. Digital subtraction angiography and bilateral uterine artery embolization was done. Patient conceived spontaneously a year after the procedure and delivered a healthy baby at term by elective caesarean section. Angiography and uterine artery embolization has revolutionized the management of AVM and contrary to popular belief, the pregnancy outcome after UAE was good.