Higher Total Body Fat Associated With Menarche Differences in Girls

Protective menstrual pads and calendar of menstruation cycle (period) on orange background. The concept of women gynecological health and intimate hygiene. Close up copy space for text.
Researchers investigate the role body fat may play in the timing of puberty in both normal weight and overweight girls.

The following article is part of our coverage of the Endocrine Society’s annual meeting (ENDO 2021) that is being held virtually from March 20-23, 2021. Endocrinology Advisor‘s staff will report on the top research in hormone science and clinical care. Check back for the latest news from ENDO 2021.


Does weight determine timing and pace of puberty? Perhaps. Girls with higher total body fat (TBF) may demonstrate a delay in standard markers of growth during puberty compared with girls with lower TBF, according to research recently presented at the Endocrine Society’s ENDO 2021 conference held virtually from March 20 to 23, 2021.

To determine whether overweight and obese girls enter puberty at a younger or older age than normal weight girls, the researchers studied 90 premenarche girls between the ages of 8.2 and 14.7 years. Of the 90 girls, 26 were overweight or obese. The girls were followed over the course of 4 years. Each visit included Tanner staging, pelvic ultrasound, reproductive hormone testing, hand radiograph to test for bone age, breast ultrasound for morphologic staging (stages A-E), and dual-energy x-ray absorptiometry to calculate TBF percentage.

Menstrual status was determined at each visit and through follow-up questionnaires. Cox proportorphology stage at visit 1. ional hazards, mixed, or multi-state models were used to evaluate the effect of TBF on age at menarche, hormonal and estrogen markers, and pace of breast maturation, respectively. Both Cox and mixed models controlled for race and breast maturation.

Normal weight girls were generally older than overweight/obese girls (11.3 vs 10.2 years, respectively; P <.01), had more advanced breast morphologic staging (P <.01), and were more likely to be non-Hispanic white (66% vs 40%; P =.03). After a year, the levels of certain markers (follicle stimulating hormone [FSH], estradiol, inhibin B [INHB], total and free testosterone, and androstenedione) increased among those with higher TBF, leveled off among those with mid-range TBF, and decreased among those with lower TBF.

Among girls with higher TBF, breast maturation was slower than among girls with lower TBF, though menarche occurred at a younger age, with a risk factor of 1.04 per 1 unit TBF increase.

The study authors concluded that girls with higher TBF show preserved ovarian and neuroendocrine reproductive components, but that “subtle differences in standard hormonal (eg, serum FSH, INHB, and androgen) and clinical (eg, delayed growth of breast bud) markers of puberty” appear in late puberty. The authors indicated that the mechanisms behind these differences, as well as their health consequences, merit further study.

Visit Endocrinology Advisor‘s conference section for more coverage from ENDO 2021.



Ortega MT, McGrath J, Carlson L, et al. Longitudinal investigation of pubertal milestones and hormones as a function of body fat in girls. Poster presented at: ENDO 2021 Virtual Conference; March 20-23, 2021. Session OR15.