Age at menarche in South Asia: an interplay of sociodemographic, nutritional, lifestyle, anthropometric, biological, and environmental factors-a systematic review.

BACKGROUND

Age at menarche is a dynamic indicator of a female's health trajectories. Despite its relevance, the cohesive synthesis of its multifactorial determinants in South Asia is lacking, limiting the targeted public health strategies. This review examines the sociodemographic, nutritional, lifestyle, anthropometric, biological, and environmental determinants of age at menarche among females aged 8-21 years across South Asia.

METHODS

A systematic review of observational studies on determinants of age at menarche was conducted. Adhering to PRISMA guidelines, articles published between January 2014 and May 2025 were identified from ScienceDirect, PubMed, Web of Science, and Google Scholar. Methodological quality of eligible studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Due to significant heterogeneity across the studies, findings were narratively synthesized precluding meta-analysis.

RESULTS

Out of 729 articles, 18 studies from South Asian countries were included. The mean age at menarche clustered between 12 and 13 years across the studies. Menarche <12 years of age was associated with urban residence, a higher socioeconomic status, higher BMI, inadequate sleep and physical activity, higher consumption of fruits, vegetables, and non-vegetarian diet, excessive screen time, low birth weight, absence of biological father, mothers' age at menarche and exposure to environmental factors. On the contrary, the age of menarche >14 years of age was associated with rural residence, lower socioeconomic status, stunting and underweight.

CONCLUSION

While heredity, demographics, and early-life programming influence age at menarche, modifiable nutrition and lifestyle factors are critical determinants in South Asia. Targeted interventions focusing on these determinants could reduce the burden of metabolic and growth-related disorders among adolescent females. Paucity of studies in South Asian countries is a critical evidence gap that needs attention to better inform policies for adolescent health.

SYSTEMATIC REVIEW REGISTRATION

INPLASY, Identifier: INPLASY202610051.

Copyright © 2026 Mohile, Waghode, Padhye, Khatwani, Ainapure and Hedaoo.