Age at menarche and depression: an updated systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies (cohort and cross-sectional)
PubMed 40175773 · doi:10.1007/s00737-025-01582-1
What was done
The authors performed an updated systematic review and random-effects meta-analysis of studies published between 2013 and 2023 across PubMed, Embase, and the Cochrane Library. They evaluated observational studies examining associations between early or late menarche (versus on-time menarche, defined per individual study) and depressive outcomes or symptoms measured by validated tools or diagnostic criteria. Evidence quality was assessed using the GRADE approach.
What was found
Eleven studies were included (8 cohort and 3 cross-sectional studies; 138,819 total participants). Early menarche was associated with higher odds of depression later in life compared to on-time menarche (OR = 1.11, 95% CI: 1.03 to 1.20; I² = 44.5%). Late menarche showed a null association with depression compared to on-time menarche (OR = 1.00, 95% CI: 0.87 to 1.15; I² = 73.2%). The quality of the available evidence was rated as very low using GRADE.
Why it matters
This review provides updated pooled observational evidence that early pubertal onset in females is associated with a modest increase in depression risk later in life, whereas late menarche shows no such link.
Limits
All included evidence is observational (including three cross-sectional studies), preventing causal inference. Definitions of early, on-time, and late menarche varied across individual studies, depression assessment methods differed, and there was substantial statistical heterogeneity in the late menarche analysis (I² = 73.2%). The overall certainty of evidence was rated very low.