Outcome of Isolated Premature Menarche: A Retrospective and Follow-Up Study

Abstract

Background and Aims: Isolated premature menarche is isolated or recurrent vaginal bleeding in a female in the absence of appropriate secondary sexual characters. Methods: Retrospective chart review of patients with premature menarche, followed by a telephone questionnaire. Charts of patients evaluated in the Pediatric Endocrine Clinic for premature vaginal bleeding from 1982-2013 were reviewed. Results: Of 21 patients identified, 17 could be contacted. Five newly diagnosed patients were recruited during the course of the study. The median age at initial presentation was 7 years. Most patients presented with Tanner I sexual development. Some had more advanced breast staging, which regressed later. All had prepubertal baseline and stimulated gonadotropins. Most of the patients reported a single or few episodes of menses. Two reported continuation of irregular bleeding into adulthood. All reported an adult height within the midparental target height. Conclusion: Premature menarche in the absence of other appropriate secondary sexual characteristics is a benign entity. Most patients have a few isolated episodes of menses that stop spontaneously; some may continue to have periods into adulthood. Unlike true puberty, these patients do not demonstrate advanced skeletal maturation, and the adult height is normal. Fertility appears to be normal.

Precocious menarche in a 9 years old girl due to autonomous ovarian cyst treated with letrozole

“…PPP is caused by the peripheral production of sex steroids independent of gonadotropin stimulation [1]. Symptomatology can range from breast enlargement, axillary and pubic hair development, changes of external genitalia, vaginal discharge or even bleeding [1,3]. In normal puberty, uterine bleeding usually occurs at breast Tanner stage 3-4, 2-2.5 years after the first sign of breast enlargement [3].…”

“…Symptomatology can range from breast enlargement, axillary and pubic hair development, changes of external genitalia, vaginal discharge or even bleeding [1,3]. In normal puberty, uterine bleeding usually occurs at breast Tanner stage 3-4, 2-2.5 years after the first sign of breast enlargement [3]. A discordant pubertal development suggests peripheral causes of precocious puberty such as ovarian follicular cysts, MAS, estrogen secreting ovarian or adrenal tumors and exposure to estrogenic endocrine disrupting chemicals or contact with estrogen containing creams [1,3].…”

“…The hormonal profile usually consists of elevated estrogen levels with low or undetectable basal levels of FSH and LH [1]. A GnRH stimulation test will show a prepubertal or even suppressed response [1,3]. This test will help us differentiate PPP from CPP leading to a different therapeutic management.…”

“…The incidence of precocious puberty is estimated between 1:5000 and 1:10000, with prevalence 10 times higher in girls [1,2]. Isolated premature menarche is the apparition of menstrual like bleeding in prepubertal girls in the absence of secondary sex characteristics, usually before the age of 10 [1, 3,4].…”

“…Autonomous ovarian cysts are usually benign single cysts that function autonomously and produce estrogens [2]. They can lead to peripheral precocious puberty (PPP) or isolated metrorrhagia with inconsistent response to the gonadotropin releasing hormone (GnRH) test [1][2][3]. Autonomous ovarian cysts may develop at any age, but their mechanism of production is unknown [2].…”