Relationship Between Obesity, Stress, and Age of Menarche Among Adolescent Female Students in Al-Madinah, Saudi Arabia

Background Menarche marks a pivotal milestone in a girl's life, signaling the onset of puberty and triggering psychological and physiological changes. Recent evidence suggests that factors such as body weight and psychological stress may influence menarcheal timing, yet limited local data exist in Al-Madinah, Saudi Arabia. Objective This study aimed to determine relationships between obesity, perceived stress, and menarcheal age among middle school female students in Al-Madinah, Saudi Arabia, while investigating menstrual health patterns and regional variations. Methods A cross-sectional study was conducted among 349 randomly selected middle school female students in Al-Madinah between September 2023 and September 2024. Data collection involved self-administered questionnaires, including menstrual history and the Perceived Stress Scale (PSS). Anthropometric measurements (height, weight, waist circumference) were obtained, and body mass index (BMI) was calculated. Results Among participants, 4.9% were obese and 12.9% overweight. Early menarche (10-12 years) occurred in 74.8% of students, with a mean menarcheal age of 11.53 ± 1.6 years. High perceived stress affected 9.7% of students, with 23.5% of obese students experiencing high stress compared to 9% of non-obese students (p=0.049). A significant negative correlation existed between perceived stress and menarcheal age (r=-0.11, p=0.027). Extended menstrual flow (>7 days) occurred in 43.3% of students, premenstrual symptoms in 65%, and dysmenorrhea in 79.9%. High stress was associated with irregular cycles (p=0.005). Multivariate analysis identified perceived stress, marital status, and non-academic stressors as independent obesity predictors. Conclusion Higher perceived stress levels were significantly associated with earlier menarche among Al-Madinah adolescents. The study revealed complex relationships between stress, obesity, and menstrual health patterns, with notable regional variations. These findings highlight the need for integrated approaches addressing both physical and psychosocial factors in adolescent health programs.