Temporal trends in age at menarche among Sri Lankan girls: A review of published evidence (1950–2009)

Mean age at menarche (MAM) is a sensitive biological indicator of childhood nutrition and broader socio-economic conditions of a population, and its decline over time is well documented in developed countries. Several studies have been conducted in Sri Lanka since 1950 to estimate the MAM in different regions, ethnic groups and socio-economic strata, but the published evidence has not previously been collated. PubMed, Google Scholar, ResearchGate and the Sri Lanka Journals Online platform were searched and primary Sri Lankan publications reporting MAM were retrieved for the period 1950 to 2009; no further primary Sri Lankan study reporting MAM after 2009 was identified. The review is therefore limited to publications from 1950 to 2009. Wilson and Sutherland (1950) reported MAM of 12.84 ± 0.07 years for Colombo urban girls and 14.39 ± 0.16 years for rural Ceylon. Studies between 1957 and 1976 reported MAM values between 12.9 and 14.7 years, the higher values being observed among disadvantaged tea estate populations of Nuwara Eliya. From 1984 onwards, probit-based estimates from Colombo declined progressively to 13.06 ± 0.18 years (Jayasekara and Goonewardene, 1987), 11.78 years in high socio-economic-status private schools in 1988 (Godawatta and Wikramanayake), 11.48 years in Ragama in 2008 (Abeysuriya et al.) and 11.20 years in Colombo and Kalutara in 2009 (Wickramasinghe et al.). Overall, MAM in Sri Lanka has fallen by approximately 1.5 to 2.0 years over six decades, paralleling secular declines reported from India, China, the United States and the United Kingdom. A nationally representative contemporary study using standardised methodology is overdue and is essential to inform adolescent reproductive health policy in Sri Lanka.