Age of menarche (AOM), or the first menstrual cycle, is one indicator of female puberty. The timing of AOM can be influenced by social determinants of health (SDOH). This study examined associations between SDOH and AOM over the past two decades in the United States.

US National Health and Nutrition Examination Survey data (1999-early 2020) were analyzed. Multinomial logistic regression analyses examined associations between AOM (early [11.99 years and younger], typical [12-13 years], and late [13.01 years and older]) and race/ethnicity, insurance coverage, education, family income to poverty ratio, money management, and home status.

AOM remained consistent over the past two decades (Mean=12.50 years, SE 0.02) for the aggregate sample. Females identifying as Hispanic (excluding Mexican Americans) were 63% more likely (adjusted Odds Ratios [aOR] 1.63, 95% confidence interval [CI] 1.13-2.36) to report early menarche. Those identifying as other/multi-race were 46% more likely to report late menarche (aOR 1.46, 95% CI 1.13-1.89) versus non-Hispanic whites. Financial and home status instability was associated with early menarche (aOR 1.46, 95% CI 1.17-1.83; aOR 1.25, 95% CI 1.05-1.48). Less than 9th grade education was associated with late menarche (aOR 1.47, 95% CI 1.14-1.89).

While the average AOM has remained stable in the US over the past 20 years, identifying as Hispanic (excluding Mexican Americans) and financial/home instability are associated with early AOM and lower education levels are associated with late AOM. Identifying programming and policy options targeting SDOH may help improve current and future reproductive health.