The association between age at menarche and polycystic ovary syndrome among reproductive-aged women in the US.
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OBJECTIVE: To examine the association between age at menarche and polycystic ovary syndrome (PCOS) diagnosis among US women aged 20-49 years. STUDY DESIGN: Our retrospective cross-sectional analysis used data from the 2022-2023 National Survey of Family Growth. The primary outcome was self-reported PCOS diagnosis, and the primary exposure was self-reported age at menarche, categorized in the primary analysis as early (<12 years), normal (12-13 years), or late (>13 years). Multivariable logistic regression modeled the association between age at menarche and PCOS. All analyses adjusted for the survey's complex sampling design. RESULTS: Our sample had 4,254 respondents, with a weighted PCOS prevalence of 9%. Weighted prevalence estimates of early and late menarche were 25% and 24% respectively. On multivariable analysis, there was no significant association between early (adjusted odds ratio [aOR]: 1.18; 95% confidence interval [CI]: 0.85, 1.62; p = 0.312) or late (aOR: 1.19; 95% CI: 0.85, 1.68; p = 0.307) age at menarche and odds of PCOS diagnosis, compared to normal age at menarche. On post hoc analysis using an optimal dichotomized age cutoff, age at menarche ≥16 years was associated with increased odds of PCOS, compared to <16 years. CONCLUSIONS: Our analysis found no significant association between a conventional classification of age at menarche and PCOS in a survey of US women aged 20-49 years, although delayed menarche at age >16 years was associated with PCOS prevalence. The null findings in the primary analysis may be attributed to challenges in accurately diagnosing PCOS or environmental factors affecting PCOS incidence in the US.