JOURNAL OF ADOLSSCENT HEALTH CARE 1!390;11:40447

Premenarcheal Predictors of the Menarche: A Prospective Study

JILL RIERDAN, Ph.D., AND ELISSA KOFF, Ph.D.

Experience of

The goals of this study were (1) to assess, with a pro- spective design, the impact of premenarcheal menstrual attitudes and personality attributes for menarcheal ex- perience and (2) to assess the relative strength of these variables, in relation to menarcheal timing and prepa- ration for menarche, for predicting menarcheal experi- ence. The subjects were 92 girls, who changed from pre- to postmenarcheal between two test occasions, 6 months apart. When premenarcheal menstrual attitudes and per- sonality attributes were examined independently, results revealed that affirmation, a menstrual attitude, and de- pression significantly predicted emotional response to menarche. When these two variables were examined, to- gether with preparation and timing variables, the two significant predictors of menarcheal experience were preparation and affirmation. The results provide direc- tion for, and optimism about, the potential efficacy of menstrual education in promoting more positive men- archeal experience.

KEY WORDS:

Menarche Menstruation Adolescent girls’ health care

Research concerned with the impact of menarche in girls’ lives sought initially to characterize in general terms emotional and cognitive components of men- archeal experience in normative samples (1); more recently, the iocus has turned to prediction of in- dividual differences in the experience of menarche. Studies with the latter focus (2) have clarified the

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Manascript accepted Febrtrnry 1.2, 1990.

404

role of preparation for menstruation as a determi- nant of menarcheal experience and have demon- strated the importance of the timing of menarche, especially the subjective sense of being an early maturer.

In this body of research, it has been rare for in- vestigators to utilize a prospective design, assessing aspects of girls’ psychobiological states prior to men- arche and relating these aspects to girls’ experience of menarche at some later date. Yet, it is only through prospective investigations that one can be confident of findings about premenarcheal deter- minants of the experience of menarche. Moreover, in this research domain, the kinds of variables in- vestigated as possible determinants of menarcheal experience have been limited. Although aspects of menarcheal timing and preparation have received close examination, other variables such as attitudes toward menstruation (3) and various aspects of per- sonality have received scant attention. The goals of this study, therefore, were (1) to assess, with a pro- spective design, the impact of premenarcheal men- strual attitudes and personality attributes for menarcheal experience, and (2) to assess the relative strength of these variables, in relation to timing and preparation, for predicting menarcheal experience.

It is important to examine the impact of premen- archeal attitudes about menstruation on subsequent menarcheal experience, especially in comparison to the demonstrated impact of preparation (2); we need to know whether menstrual attitudes constitute an independent psychological dimension affecting the experience of menarche, separate from cognitive and emotional preparedness, requiring focal attention in menstrual education. It also is important to assess the impact of personality characteristics for menar- cheal experience. If premenarcheal variations in per-

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September 1990 PREDICTING MENARCHEAL EXPERIENCE 405

sonality attributes contribute to variations in the experience of menarche, menstrual education would need to be refined so as to be more sensitive to individual differences in girls’ personalities.

Method

Subjects

The subjects were 92 girls, in grades 6-9, who reached menarche during a 6-month period between two test occasions. Subjects were a subset of 587 white, middle-class girls in a prospective study of adolescent development; this subset included all who reached menarche during the course of the study.

Measures and Procedure

Questionnaires were administered to groups of girls within school settings. Test procedures met ethical guidelines for use of human subjects, as established by Welleslity College and as approved by the Na- tional Institute of Child Health and Human Devel- opment. Measures analyzed for this report, save one, were from the first test occasion, when girls were premenarcheal. Girls’ rating of their experience of menarche was obtained at the second test occa- sion. Measures were as follows:

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Menstrual attifudes were assessed by use of the Brooks-Gunn and Ruble Menstrual Attitudes Questionnaire, Adolescent Form (4,5), with scor- ing modified in keeping with procedures de- scribed by Stubbs et al. (6), who found two orthogonal attitude components, affirmation and worry, to be reliable and valid in a large sample of early adolescent girls. The affirmation com- ponent contains items reflective of messages di- rected to girls about menstruation as a healthy sign of womanhood; the items making up the worry component focus attention on more trou- blesome aspects of menstruation. The individual items making up these two components appear in Stubbs et al. (6). Depressiun was measured with the Beck Depres- sion Inventory, short form (BDIs), a scale that assesses level of depression in individuals from early adolescence through adulthood in terms of degree to which 13 symptoms are en- dorsed (7). Anxiety was assessed by the Children’s Manifest Anxiety Scale (8), a 42-item scale with a true-false format.

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Self-esteem was assessed with the Rosenberg Self- Esteem Scale (9), a lo-item measure of global self-esteem, used extensively in adolescent research. Locus of control, measured by the Bialer Locus of Control Scale (lo), a 23-item measure, using a true-false format, assessed the degree to which life events are experienced as relatively within one’s control (internal locus of control) or out of one’s control (external locus of control). Body satisfaction was measured by the Body Ca- thexis Scale, Modified Form (ll), an index of how satisfied girls are with 17 body parts. Sex roles were measured by the Bern Sex-Role Orientation Inventory (12), an instrument com- posed of 60 adjectives, which are each rated on a 7-point scale in terms of how well they describe the individual. Independent scores are derived for femininity and masculinity. Preparation for menstruation is indicated on a 7- point scale, ranging from 1 (completely unpre- pared) to 7 (completely prepared). This measure has been used in previous research (2). Subjective timing, inferred from premenarcheal girls’ estimation of the number of their grade mates who had reached menarche before them (2), refers to a girl’s subjective sense of herself as an early, average, or late maturer. Subjective timing is correlated with, but dis- tinct from, a girl’s objective status as early, average, or late. Objective timing is indexed by grade at menarche. Menarcheul experience is assessed in terms of emo- tional response to menarche. As in previous re- search (2), girls indicated on a 7-point scale, the poles of which were “completely positive, happy, and pleased” and “completely negative, unhappy, and upset,” how they felt when they got their first period.

Results To determine the significance of menstrual attitudes and personality attributes, an initial set of nine regression analyses was undertaken, in each of which girls’ scores on one premenarcheal measure were regressed onto the measure of menarcheal ex- perience. Subsequently, a more complex regression analysis was undertaken to determine the relative power of premenarcheal menstrual attitudes and personality variables, along with timing and prep- aration variables, as predictors of menarcheal experience.

406 RIERDAN AND KOFF JOURNAL OF ADOLESCENT HEALTH CARE Vol. 11, No. 5

Simple Regression Analyses

Examination of the predictive power of the two men- strual attitudes, affirmation and worry, revealed that the more affirmative girls were about menstruation before its onset, the more positively they rated the experience of menarche (B = - 1.03, t = -6.53, p < 0.001; R2 = 0.38). In contrast, there was no relationship between premenarcheal worry and menarcheal experience.

Examination of the predictive power of the per- sonality attributes revealed only one significant pre- dictor: depression. The less depressed girls were before menarche, the more positively they rated their menarcheal experience (B = 0.09, t = 3.05, p C 0.01, R2 = 0.12.

Forced-Entry Regression Analysis

A more complex regression analysis was then per- formed (after examining correlations among vari- ables to rule out multicollinearity) to determine the relative power of affirmation and depression, along with preparation and subjective timing, which were found previously (2) to predict menarcheal experi- ence. Because a goal of this study was to clarify appropriate educational interventions for rendering menarche a more positive experience, the four pre- dictor variables were ordered, based on assumptions about how amenable each variable was to change through educational intervention. Based on this or- dering-preparation, affirmation, subjective timing, depression-the four variables were then entered into a forced-entry regression analysis, with men- archeal experience being the outcome variable. The equation was significant (F = 10.71, p < 0.001, R2 = 0.42). Reparation (B = -0.20, t = - 1.94, p < 0.05, R2 = 0.07) and affirmation (B = -0.81, t = -3.91, p < 0.001, increment to R’ = 0.32) were significant at the first and second steps. Sub- jective timing and depression were not significant predictors after preparation and affirmation were controlled. This same pattern of results was found when objective timing was entered first as a control variable and found to be nonsignificant. Thus, in- dependent of a girl’s status as an early, average, or laie r;iatrtreer; preparation and affirmation are sig- nificant predictors of menarcheal experience.

Discussion These results expand our knowledge of the deter- minants of menarcheal experience, and in so

doing, they provide direction for, and optimism about, the potential efficacy of menstrual educa- tion in promoting more positive menarcheal expe- rience. Examination of four sets of premenarcheal variables indicated that girls who were better pre- pared for and more affirming of menstruation had more positive menarcheal experiences, indepen- dent of their menarcheal timing and premenar- cheal personality attributes. These findings imply that preparation for menstruation and menstrual attitudes-at least that of affirmation-are inde- pendent psychological dimensions. Moreover, the findings imply that variables that are most ame- nable to change though education are more im- portant predictors of menarcheal experience than variables that are less likely to change with in- structional efforts.

The findings that the menstrual attitude of worry and personality attributes such as depres- sion did not predict menarcheal experience does not mean that they are unrelated to menstrual life. This study focused on one aspect of menarcheal ex- perience--emotional response-and conceived of “positive” and “negative” emotional reactions as opposite poles along the same continuum. It may be that with a more multifaceted approach to as- sessing menarcheal experience-including dimen- sions related to cognition (e.g., surprise, confusion) and bodily experience (e.g., pain), and indepen- dent assessments of positive and negative emo- tional reactions (13)-the attitude of worry might be found to be significant. Furthermore, although personality attributes did not predict menarcheal experience, there is nevertheless evidence to sug- gest that they do predict girls coping in the months following menarche (14). Finally, although girls reaching menarche in grades 6-9 did not show an impact of objective or subjective timing, it may be that very early maturers, i.e., those who reach menarche at the earliest ages of the normal age range, would show timing effects independent of preparation and affirmation.

Further prospective study of these three issues, as well as of the generalizability of the reported find- ings to girls of different races and socioeconomic statuses (15), would contribute important additional information. Nevertheless, it is clear from the results of this study that teachers and providers addressing issues of adolescent health care need not only be concerned with imparting information about men- arche and menstruation but also with helping girls to develop more self-affirming attitudes toward menstrual life.

September 1990 PREDICTING MENARCHEAL EXPERIENCE 487

This research was supported by grant 16034 from the National Institute of Child Health and Human Development. We thank Margaret L. Stubbs, Ph.D., for her expert assistance in all phases of data collection and Faith Ferguson and Nancy Clark-C?iareEi for their help in data analysis.

Whisnant L, Vegans, L. A study of attitudes toward menarche in white middle-class American adolescent girls. Am J Psy- chiatry 1975; 132809-14.

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