Intergenerational Pattern and Cultural Beliefs on Menarche: A Mixed-method Cross-sectional Study among Mothers and Adolescent Girls in Puducherry, India

Introduction: Several studies have reported a declining trend in the age at menarche among adolescent girls in both developed and developing countries. However, there is a dearth of community-based studies in India that compare the age at menarche between adolescent girls and their mothers. Aim: To estimate the mean age at menarche among adolescent girls and compare it with that of their mothers. In addition, to explore the cultural beliefs surrounding menarche among adolescent girls. Materials and Methods: A cross-sectional, community-based mixed-method study was conducted at the Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India, from November 2021 to December 2022 among 340 participants (adolescent girls and their mothers) using a multistage sampling method. Adolescent girls aged 10-19 years residing in the service areas of the Urban Health Training Centre (Lawspet) and the Rural Health Training Centre (Karikalampakkam) of Indira Gandhi Medical College and Research Institute (IGMC&RI), Puducherry, were included. The Mann-Whitney U test was applied to compare differences in age at menarche, and a p-value of <0.05 was considered statistically significant. Focus Group Discussions (FGDs) with adolescent girls and their mothers were conducted using purposive sampling, and qualitative data were analysed using content analysis. Results: The mean age at menarche among adolescent girls in urban and rural areas was 12.49±1.067 years and 12.62±1.187 years, respectively. Similarly, the mean age at menarche among mothers in urban and rural areas was 14.07±1.541 years and 14.21±1.227 years, respectively. A declining trend in age at menarche was observed among adolescent girls, with a reduction of 1.59 years compared to their mothers. Content analysis revealed that inadequate access to accurate information, cultural stigmatisation of open discussions surrounding menarche, and internalised anxiety related to conforming to traditional practices—often unquestioned due to fear of social or familial repercussions—contributed to a heightened sense of vulnerability among participants. Conclusion: The observed downward shift in the age at menarche highlights the need for timely awareness regarding early puberty among adolescent girls, parents, and school teachers, as well as the importance of addressing the cultural silence surrounding menstruation.