Menstrual cycle patterns of Indonesian adolescents

Main Article Content

Imasari Aryani
Ulfa Puspita Rachma
Evie Rokhayati
Annang Giri Moelyo


Background Adolescents often experience menstrual irregularity in the first few years after menarche. Abnormal menstrual cycles may increase the risk of polycystic ovary syndrome.

Objective To determine the menstrual cycle patterns of adolescent females in Indonesia and associated factors.

Methods This cross-sectional study was conducted at two senior high schools in Surakarta, Central Java, from September to October 2016. Subjects were healthy female students whose parents have given written informed consent. Girls taking hormonal drugs or with chronic diseases were excluded. Subjects filled questionnaires on menstrual cycle, diet, ethnicity, and physical activity. All subjects underwent anthropometric measurements (height and weight). Kruskal-Wallis test was used for data analysis.

Results Four hundred and forty-four subjects met the inclusion criteria. Mean age at menarche was 12.27 (SD 1.08) years. Mean menstrual cycle length was 31.1 (SD 6.5) days. Abnormal menstrual cycle occurred in 30.6% of subjects (24.5% oligomenorrhea, 5.9% polymenorrhea, and 0.2% amenorrhea). Ethnicity (Javanese, Chinese, or Arab) was significantly associated with menstrual cycle category (P<0.05). Girls with Chinese ethnicity having the largest proportion of oligomenorrhea. Other factors (body mass index, age, age at menarche, nutritional status, physical activity, and fat intake) were not found to be associated with menstrual cycle abnormalities.

Conclusion Menstrual abnormalities, especially oligomenorrhea, are common in Indonesian adolescent girls. Oligomenorrhea is more frequent in girls of Chinese ethnicity, compared to those of Javanese or Arab ethnicity.

Article Details

How to Cite
Aryani I, Rachma U, Rokhayati E, Moelyo A. Menstrual cycle patterns of Indonesian adolescents. PI [Internet]. 31May2018 [cited 15Jun.2021];58(3):101-. Available from:
Pediatric Endocrinology
Received 2018-01-30
Accepted 2018-05-25
Published 2018-05-31


1. American Academy of Pediatrics Committee on Adolescence; American College Of Obstetricians And Gynecologists Committee on Adolescent Health Care, Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics. 2006;118:2245-50.
2. Adams HPJ. Menstruation in adolescents what’s normal, what’s not. Ann N Y Acad Sci. 2008;1135:29-35.
3. Ibáñez L, Oberfield SE, Witchel SF, Auchus RJ, Chang RJ, Codner E, et al. An International Consortium Update: pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence. Horm Res Paediatr. 2017;88:371-95.
4. Witchel SF, Oberfield SE, Rosenfield RL, Codner E, Bonny A, Ibanez L, et al. The diagnosis of polycystic ovary syndrome during adolescence. Horm Res Paediatr. 2015;83:376-89.
5. de Onis M, Onyango AW, Borghi E, Siyam A, Nishidaa C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660-7.
6. Hastuti J. Anthropometry and body composition of Indonesian adults: an evaluation of body image, eating behaviours, and physical activity [thesis]. Brisbane; Queensland University of Technology; 2013.
7. Supariasa IDN, Bakri B, Fajar I. Penilaian Status Gizi. Jakarta: Penerbit Buku Kedokteran EGC; 2002. p. 88-117
8. Batubara JRL, Soesanti F, van de Waal HD. Age at menarche in Indonesian girls: a national survey. Acta Med Indones. 2010;42:78-81.
9. Rigon F, De Sanctis V, Bernasconi S, Bianchin L, Bona G, Bozzzola M, et al. Menstrual pattern and menstrual disorders among adolescents: an update of the Italian data. Ital J Pediatr. 2012;38:1-8.
10. Abdelmoty HI, Youssef MA, Abdallah S, Abdel-Malak K, Hashish NM, Samir D, et al. Menstrual patterns and disorders among secondary school adolescents in Egypt. A cross-sectional survey. BMC Womens Health. 2015;15:70.
11. Esen I, Oguz B, Serin HM. Menstrual characteristics of pubertal girls: a questionnaire-based study in Turkey. J Clin Res Pediatr Endocrinol. 2016;8:192-6.
12. Gumanga SK, Kwame-Aryee RA. Menstrual characteristics in some adolescent girls in Accra, Ghana. Ghana Med J. 2012;46:3-7.
13. Nishihama Y, Yoshinaga J, Iida A, Konishi S, Imai H. Menstrual cycle length and source of its variation in female university students majoring in nursing sciences. Nihon Eiselgaku Zasshi. 2015;70:139-148.
14. Cakir M, Mungan I, Karakas T, Girisken L, Okten A. Menstrual pattern and common menstrual disorders among university students in Turkey. Pediatr Int. 2007;49:938-42.
15. Dars S, Sayed K, Yousufzai Z. Relationship of menstrual irregularities to BMI and nutritional status in adolescent girls. Pak J Med Sci. 2014;30:140-4.
16. Dambhare DG, Wagh SV, Dudhe JY. Age at menarche and menstrual cycle pattern among school adolescent girls in Central India. Glob J Health Sci. 2012;4:105-11.
17. Lee LK, Chen PC, Lee KK, Kaur J. Menstruation among adolescent girls in Malaysia: a cross-sectional school survey. Singapore Med J. 2006;47:869-74.
18. Radivojevic UD, Lazovic GB, Kravic-Stevovic TK, Puzigaca ZD, Canovic FM, Nikolic RR, et al. Original study differences in anthropometric and ultrasonographic parameters between adolescent girls with regular and irregular menstrual cycles: a case-study of 835 cases. J Pediatr Adolesc Gynecol. 2014;27:227-31.
19. Peña AS, Doherty DA, Atkinson HC, Hickey M, Norman RJ, Hart R. The majority of irregular menstrual cycles in adolescence are ovulatory: results of a prospective study. Arch Dis Child. 2018;103:235-9.
20. Sharma S, Deuja S, Saha CG. Menstrual pattern among adolescent girls of Pokhara Valley: a cross sectional study. BMC Womens Health. 2016;16:74.
21. Zhang Q, Wang YY, Zhang Y, Zhang HG, Yang Y, He Y, et al. The influence of age at menarche, menstrual cycle length and bleeding duration on time to pregnancy: a large prospective cohort study among rural Chinese women. BJOG. 2017;124:1654-62.
22. Paramsothy P, Harlow D, Elliott MR, Yosef M, Lisabeth LD, Greendale GA, et al. Influence of race/ethnicity, body mass index, and proximity of menopause on menstrual cycle patterns in the menopausal transition: the Study of Women’s Health Across the Nation. Menopause. 2015;22:159-65.
23. Duckworth JC, Anderson, Wayne P. MMPI interpretation manual for counselors and clinicians. 3rd edition. Muncie: Accelerated Devevelopment Inc, 1986. p. 39-46.