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Critics note his historical data were based on small samples of girls in orphanages, and likely did not represent the population as a whole [54]. Other historic records from ancient Rome to medieval Europe are more in line with an average age of menarche around 13. Tanner also reviewed available data from countries around the world, and there was a trend towards later onset of puberty in association with poorer nutrition and economic standards. In 1997 a study was published evaluating the age of menarche and appearance of secondary sexual characteristics in over 17,000 girls seen in pediatric offices across the USA [55].

For example, African American girls have been found to have an increased insulin response to a glucose challenge compared to Caucasian girls, which leads to increased levels of free ILGF-1, which is critical to skeletal growth and maturation [59]. The trend towards earlier pubertal development has generally been attributed to improved nutritional status and the associated increases in body weight and composition at earlier ages in developed countries over the last century. As BMI has increased, age at menarche and appearance of secondary sexual characteristics has dropped, suggesting a critical body mass that must be achieved to trigger puberty.

Plant TM. Hypothalamic control of the pituitary-gonadal axis in higher primates: key advances over the last two decades. J Neuroendocrinol. 2008;20(6):719–26. 6. Plant TM. Puberty in primates. In: Knobil E, Neill JD, editors. The physiology of reproduction. 2nd ed. New York: Raven; 1994. p. 453–85. 7. Campbell B. Adrenarche and the evolution of human life history. Am J Hum Biol. 2006; 18(5):569–89. 8. Belchetz PE, Plant TM, Nakai Y, Keogh EJ, Knobil E. Hypophysial responses to continuous and intermittent delivery of hypopthalamic gonadotropin-releasing hormone.

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