MENARCHEAL AGE AND BREAST DEVELOPMENT
IN PURWOKERTO
ARVINA OKTAVIANI
DEPARTMENT OF BIOLOGY
FACULTY OF MATHEMATICS AND NATURAL SCIENCE BOGOR AGRICULTURAL UNIVERSITY
STATEMENT ABOUT UNDERGRADUATE THESIS,
INFORMATION SOURCES, AND ACT OF SPILLING OVER
COPYRIGHTS*
By this writing I clarify that the undergraduate thesis Cognitive Style and Working Memory of the First Year Undergraduate IPB Student is my own work under the supervisions of the advising committee and hasn’t been proposed for any institution. Copied information source of published and unpublished writing of other author has been mentioned in the text and incorporated in the references at the last part of this thesis.
By this writing I hand over the copyright of my thesis to Bogor Agricultural University.
Bogor, April 2014
ABSTRACT
ARVINA OKTAVIANI. Menarcheal Age and Breast Development in Purwokerto. Supervised by BAMBANG SURYOBROTO and PUJI RIANTI.
Puberty is a transition from childhood into adulthood. It occurs as a result of the hypothalamic pituitary gonadal axis activity which stimulates the central inhibitory feedback and lifts the Gonadotropin Releasing Hormone (GnRH). The activation of GnRH increasingly stimulates the secretion of Follicle Stimulating Hormone (FSH) and Lutenizing Hormone (LH) from the pituitary gland. Both of these hormones stimulate the production of estrogen, which allows for menarche and the development of secondary sexual characteristics. The aim of this research is determine the menarcheal age and breast development in Purwokerto. I used 99 individual subject aged 8-14 years old which contained 28 menarche subjects. The result showed that the menarcheal age average in Purwokerto was 12.4 years old. In this study, the breast measurement showed three stages of breast development. The youngest and the average age of Tanner stage two were 9 and 10 years old. The youngest and average age of Tanner stage three were 10.8 and 12.5 years old. Based on the result, menarche has correlated with the breast development stage three. The present study had similar result between Bogor, Jakarta, but differ with Pekalongan. This maybe because the samples from Purwokerto, Bogor, and Jakarta came from urban areas whereas samples from Pekalongan came from rural area.
Keywords: breast development, menarche, nutrition status, puberty, and socioeconomic status
ABSTRAK
ARVINA OKTAVIANI. Menarcheal Age and Breast Development in Purwokerto. Dibimbing oleh BAMBANG SURYOBROTO and PUJI RIANTI.
Pubertas adalah masa transisi dari kanak-kanak menjadi dewasa. Hal ini terjadi sebagai akibat dari aktivitas hipofisis gonad sumbu hipotalamus yang merangsang umpan balik hambat pusat dan menstimulasi Gonadotropin Releasing Hormone (GnRH). Aktivasi GnRH merangsang sekresi Follicle Stimulating Hormone (FSH) dan Lutenizing Hormone ( LH ) dari kelenjar pituitari. Kedua hormon ini merangsang produksi estrogen yang memungkinkan untuk menarke dan perkembangan karakteristik seksual sekunder. Tujuan dari penelitian ini untuk menentukan umur menarke dan perkembangan payudara di Purwokerto. Saya menggunakan 99 subyek usia 8-14 tahun yang terdiri dari 28 subjek yang telah menarke. Hasil penelitian menunjukkan bahwa rata-rata usia menarke di Purwokerto adalah 12.4 tahun. Pengukuran payudara menunjukkan tiga tahap perkembangan payudara. Usia termuda dan rata-rata Tanner tahap dua adalah 9 dan 10 tahun. Usia termuda dan rata-rata Tanner tahap tiga adalah 10.8 tahun dan 12.5 tahun. Berdasarkan hasil, menarke berkorelasi dengan perkembangan payudara tahap tiga. Penelitian ini memiliki hasil yang sama antara Bogor dan Jakarta tetapi berbeda dengan Pekalongan. Hal ini mungkin karena sampel Purwokerto, Bogor, dan Jakarta berasal dari daerah perkotaan sedangkan sampel Pekalongan berasal dari daerah pedesaan.
An Undergraduate Thesis Intended to Acquire Bachelor Degree In Faculty of Mathematics and Natural Science
MENARCHEAL AGE AND BREAST DEVELOPMENT
IN PURWOKERTO
ARVINA OKTAVIANI
DEPARTMENT OF BIOLOGY
FACULTY OF MATHEMATICS AND NATURAL SCIENCE BOGOR AGRICULTURAL UNIVERSITY
Undergraduate Thesis Title : Menarcheal Age and Breast Development in Purwokerto
Name : Arvina Oktaviani
NIM : G34090077
Approved by
Dr Bambang Suryobroto Supervisor I
Puji Rianti, MSi Supervisor II
Acknowledged by
Dr Ir Iman Rusmana, MSi Head of Department Biology
FOREWORDS
All praise to Allah SWT for all the hope and gift I’ve got this far. This research is made through an experiment entitled Menarcheal Age and Breast Development in Purwokerto City and Surroundings which was conducted from February until June 2013 on IPB.
Biggest acknowledgements are sending to Dr Bambang Suryobroto and Puji Rianti, MSi as my supervisor for the advice and supervisions. Special acknowledgment are sending to Mama, Bapak, Vandavinaz, Yujum, Bunda, Panda, Tante Danti, Om Agus, Mas Yaya and Ade, and also to all of big family in Purwokerto for all their love and support. To Mas Iyo, Mba Tita, Ayoy, Dobreg, Nessa, Mayo for the patience to keep give me strength and support. To, Temaram’s girl, Mba Kanchee, Kak Sarah, Mita, Kak Nunuz, Kak Nengnong, Ziah, Okta and Heca for the emotional support. To all of my friends in Biologi46 and ZooCorner family for the spirit this far.
At last, I hope this research will be helpful for all the readers.
TABLE OF CONTENTS
LIST OF TABLES viii
LIST OF FIGURES viii
LIST OF APPENDIXES viii
INTRODUCTION 1
Background 1
MATERIALS AND METHODS 2
Time and Place 2
Sampling 2
Informed Consent 2
Determination 2
Menarcheal Age 2
Statistical Analysis 3
RESULTS 3
CONCLUSION 6
REFERENCES 6
APPENDIXES 9
CURRICULUM VITAE 13
LIST OF TABLES
1 Categories of food expenditures 3
2 Total subject who has or has not menstruate per age group 4 3 Correlation of menarcheal age and family food expenditure 5
4 Comparison of menarcheal age with other areas 5
LIST OF FIGURES
1 Estimation of menarcheal age 4
2 Breast development 4
LIST OF APPENDIXES
1 Example of informed consent 10
INTRODUCTION
Background
Puberty is a transition from childhood into adulthood. It occurs as a result of the hypothalamic pituitary gonadal axis activity. This activity stimulates the central inhibitory feedback and lifts the Gonadotropin Releasing Hormone (GnRH) pulse generator. For girls, the activation of GnRH increasingly stimulates the secretion of Follicle Stimulating Hormone (FSH) and Lutenizing Hormone (LH) from the pituitary gland. Both of these hormones stimulate the production of estrogen, which allows for menarche (first menstruation) and the development of secondary sexual characteristics (Rosen 2004). Menarche is the milestone that indicates the capacity to reproduce (Rees 1993; Burt and McCartney 2010). This event occurs mid to late puberty, after developmental events of secondary sexual characteristics have occurred (Mansfield and Stubbs 2004).
Development of secondary sexual characteristics includes the growth of pubic and axillary hairs, and development of breasts (Fox 2002). Breasts develop through accumulation of fat and other connective tissues. Breast development can be classified into five stages (Marshall and Tanner 1969). The first stage is called pre-adolescent or pre-pubertal stage. In this stage, elevation of bud is occurring only in the papilla. The second stage is called thelarche, where elevation occurs in breast and papilla as a small mound and the areola diameter becomes large. In this stage, puberty occurs. In the third stage, further enlargement of breast and areola occurs without separation of their contours. In the fourth stage, the areola and papilla are forming a secondary mound above the level of the breast. The last stage is the mature stage, in which projection only occurs in the papilla, due to recession of the areola to the general contour of the breast (Marshall and Tanner 1969). Fat accumulation relates to nutrition which fulfills needs of the body (Hoffman et al. 2006).
Nutrition and socioeconomic status are some of determinants in the menarcheal age (Karapanou and Papadimitriou 2010). Both of these determinants are correlated. In Nigeria, the menarcheal age of girls with better socioeconomic status were significantly earlier than those with the lesser socioeconomic status (Ikaraoha et al. 2005). Similar studies have been conducted in other cities in Indonesia which were Bogor, Pekalongan, and Jakarta, and other countries which were Canada, France, Iran, and Kuwait. The urban living environment is associated with better nutrition and living conditions, whereas a rural living environment is associated with malnutrition and less good living conditions (Kawulur et al. 2010).
MATERIALS AND METHODS
Time and Place
The research was held on February until June 2013. Sampling was done in Elementary Schools and Junior High Schools in Purwokerto. Data was analyzed in Biosystematics and Ecology of Animals, Department of Biology, Bogor, IPB.
Sampling
The subjects of this research are girls between 8-14 years old. The numbers of subjects used in this research are 99 individuals.
Informed Consent
Subjects were asked an informed consent. Before the tests begin, the researcher stated the purpose of the research and the form of agreement. The informed consent was administrated to the subject parents. When they agreed, the informed consent was signed and completed the questionnaires.
Determination
Breast development level was determined using anthroposcopy method by breast observation directly. The stages of breast development determined according to the Tanner classification (Marshall and Tanner 1969). I observed the breast on the right side and asked the subject to took off the breast cover for direct observation.
Nutrition and Socioeconomic Status
Table 1 Category of family food expenditure
Category Family Food Expenditure per Month (n, Rp)
1 n ≤ Rp500 000
2 Rp500 000≤ n ≤ Rp1 000 000
3 Rp1 000 000 ≤ n ≤ Rp1 500 000
4 n > Rp1 500 000
Statistical Analysis
The percentage of subject who has or has not menstruated was calculated for each classes of age. The statistical analysis was done using Probit-GLM method (Venables and Ripley 1999) implemented in R program version 3.0.1. This method was determined to discover the menarcheal age average and breast development stages.
RESULTS
I used 99 individual subjects, aged 8-14 years old, which contained 28 menarche subjects (Table 1). The average of menarcheal age in Purwokerto was 12.4 years old. Menarcheal age was categorized into early maturers which had probability below 11.6 years old (less than 25 percentile); average maturers which had probability between 11.6 to 13.1 years old (26-75 percentile); and late maturers which had probability more than 13.1 years old (76 percentile and over) (Figure 1).
Figure 1 Estimation of menarcheal age
Proba
bi
li
ty
Table 2 Total subject who has or has not menarche and stage of breast
In this 8-14 years old study, the breast measurement showed three stages of breast development. The youngest age of first recognizable enlargement of breasts (Tanner stage two) occurred at 9 years old with the average age was 10 years old. In the other hand, the youngest age of Tanner stage three was 10.8 years old with the average age was 12.5 years old (Table 2; Figure 2). Based on the result, menarche had correlation with the breast developmental stage three.
The family food expenditure was gotten from 24 subjects of 28 menarche subjects. These are the subjects that completed the family food expenditure question in the questionnaires (Table 2). If we use Rp1 000 000 as cut off, about half of them were lower and half other upper socioeconomic statuses. There were no correlation between these socioeconomic levels and menarcheal age.
Table 3 Correlation of menarcheal age and family food expenditure Food Expenditure per Month
Puberty is a transition from childhood into adulthood marked by changes in reproduction ability and development of secondary sexual characteristics. The average of menarcheal age in Purwokerto was 12.4 years old. It is similar with Bogin’s statement (1999) that menarcheal age occurred in the median age of 12.1– 13.5 years old. The comparison between present result with other areas showed that the oldest menarcheal age is in Nigeria (Ikaraoha et al. 2005). (Table 4).
Table 4 Comparison of menarcheal age with other areas
Author Years Area (Urban/ Rural) Average Age at Menarche Ikaraoha et al. 2005 Nigeria (rural) 13.2
Suhartini 2007 Bogor (urban) 12.4
Ulinnuha 2008 Pekalongan (rural) 13.3
Alchoiriah 2010 Jakarta (urban) 12.4
Al-Sahab et al. 2010 Canada (urban) 12.7
Gaudineau et al. 2010 France (urban) 12.8
Golchin et al. 2012 Iran (urban) 12.6
Al-Awadhi et al. 2013 Kuwait (urban) 12.4
Oktaviani Present study Purwokerto (urban) 12.4
Likewise the result on this study, menarche occurs in correlation to breast development stage three. Breast develops through accumulation of fat and other connective tissues (Hoffman et al. 2006) and brought about primarily by the influence of estrogens. Fat is deposited and functions as a matrix allowing epithelial glandular proliferation. It is proposed that fat mass is a facilitator for the timing of puberty in girls (Garcia-Mayor et al. 1997). Fat will be accumulated in breast during more or less 2.4 years before menarche. This result similar with previous study in Iran which is the duration is 2.4 years (Rabbani et al. 2010). This accumulation related to nutrition which fulfills the needs of body. If nutrition is excessive, fat will be more formed. On the other hand, if nutrition is lack, fat will be less formed.
Nutrition and socioeconomic status are some of determinants in menarcheal age (Karapanou and Papadimitriou 2010). Normal growth pattern can be obtained from healthy subject with a good nutrition and good family socioeconomic background. Nutrition and socioeconomic status can be seen from family food expenditure (Suhartini 2007). Based on Keputusan Gubernur Jawa Tengah no 561.4/58/2012, the minimum wage of Banyumas is Rp 877,500.00. About half of population spent food expenditure at less than minimum wage. It is shown that girls with low family food expenditure could grow normally and did not lack nutrition; however, present sample was too small to draw any conclusion.
The present study had similar result between Bogor (Suhartini 2007) and Jakarta (Alchoiriah 2010) but differ with Pekalongan (Ulinnuha 2008) (Table 4). This maybe because of the samples from Purwokerto, Bogor, and Jakarta came from urban areas whereas samples from Pekalongan came from rural area. This comparison also conducted between present study in Purwokerto with other countries, which were Nigeria (Ikaraoha et al. 2005), Canada (Al-Sahab et al. 2010), France (Gaudineau et al. 2010), Iran (Golchin 2012), and Kuwait (Al-Awadhi et al. 2013). The comparison showed that the youngest menarcheal ages are in Indonesia (Purwokerto) and Kuwait. Meanwhile, the oldest menarcheal age was in Nigeria (Table 4). These differences occurred because the studies in Indonesia, Kuwait, Iran, Canada, and French came from the urban environments (Etemadifar et al. 2006; Wilson et al. 2009; Gaudineau et al. 2010; Al-Awadhi et al. 2013) which had better socioeconomic status whereas samples from Nigeria came from poor country (Ifinedo 2006) which had lesser socioeconomic status. Girls who lived in urban area got menarche earlier than whom lived in rural area.
CONCLUSION
The average of menarcheal age in Purwokerto was 12.4 years. Thelarche and breast development stage three occurred at the average age of 10 and 12.5 years. Menarche occurred in the breast development stage three.
REFERENCES
Al-Awadhi N, Al-Kandari N, Al-Hasan T, AlMurjan D, Ali S, Taiar A. 2013. Age at menarche and its relationship to body mass index among adolescent girls in Kuwait. BMC Public Health. 13:29.
Al-Sahab B, Ardern CI, Hamadeh MJ, Tamim H. 2010. Age at menarche in Canada: National Longitudinal Survey. BMC Public Health 10:736. Bogin B. 1999. Pattern of Human Growth. 2nd Edition. Cambridge: Cambridge
Univ Pr.
[BPS] Badan Pusat Statistik. 2012. Data Agregat Kependudukan Per Kecamatan. Jawa Tengah (ID): BPS.
Burt SCM, McCartney CR. 2010. Obesity and the pubertal transition in girls and boys. Reproduction. 140(3): 399-410.
Etemadifar M, Janghorbani M, Shaygannejad V, Ashtari F. 2006. Prevalence of multiple sclerosis in Isfahan, Iran. Neuroepidemiology. 27: 39-44.
Fox SI. 2002. Human Physiology. Ed ke-7. New York: Mc Graw Hill.
Gaudineau A, Ehlinger V, Vayssiere C, Jouret B, Arnaud C, Godeau E. 2010. Factors associated with early menarche: results from the French Health Behaviour in School-aged Children (HBSC) study. BMC Public Health. 10:175.
Garcia‐Mayor RV, Andrade MA, Rios M, Lage M, Dieguez C, Casanueva FF. 1997. Serum leptin levels in normal children: relationship to age, gender, body mass index, pituitary‐gonadal hormones, and pubertal stage. J Clin Endocrinol Metab. 82(9): 2849-55.
Golchin NAH, Hamzehgardeshi Z, Fakhri M, Hamzehgardeshi L. 2012. The experience of puberty in Iranian adolescent girls: a qualitative content analysis. BMC Public Health. 12:698.
Gubernur Jawa Tengah. Keputusan Gubernur Jawa Tengah No. 561.4/58/2012 tentang Upah Minimum pada 35 Kabupaten/Kota di Provinsi Jawa Tengah Tahun 2013.
Hoffman WH, Barbeau P, Litaker MS, JOhnson MH, Howe CA, Gutin B. 2006. Tanner staging of secondary characteristic and body composition, blood pressure, and insulin in black girls. Obes Res. 13: 2195-2201.
Ifinedo P. 2006. Towards e-government in a Sub-Saharan African Country: impediments and initiatives in Nigeria. Journal of E-Government. 3(1). Ikaraoha CI, Mbadiwe IC, Igwe CU, Allagua DO, Mezie O, Iwo GTO, Ofori PI.
2005. Menarchial age of secondary school girls in urban and rural areas of Rivers State Nigeria. Online J Health Allied Scs. 2: 4.
Karapanou O, Papadimitriou A. 2010. Determinants of menarche. Reproductive Biology and Endocrinology. 8: 115.
Kawulur EIJJ, Suryobroto B, Budiarti S, Hartana A. 2010. Associations of sexual maturation and body size of Arfak children. Hayati. 19: 124-130.
Mansfield PK, Stubbs ML. 2004. Tracking the course of menstrual life: contributions from the society for menstrual cycle research. Women's Health Issues. 14:174-176.
Marshall WA, Tanner JM. 1969. Variations in patterns of pubertal change in girl. Arch Dis Child. 44: 291-303.
R Development Core Team. 2012. R: A Language and Environment for Statistical
Computing. R Fondation for Statistical Computing, Vienna, Austria. ISBN
Rabbani et al. 2010. Assessment of pubertal development in Iranian girls. Iran J Pediatr. 20: 160-166.
Rees M. 1993. Menarche when and why. ProQuest Biology Journals. 342: 8884
(1375).
Rosen DS. 2004. Physiologic growth and development during adolescence. Pediatrics
in Review. 25: 194.
Suhartini R. 2007. Tahap-Tahap Kematangan Seksual Perempuan di Wilayah Bogor [skripsi]. Bogor (ID): Institut Pertanian Bogor.
Ulinnuha DF. 2008. Usia Menarke dan Perkembangan Payudara Perempuan di Pedesaan Kabupaten Pekalongan [skripsi]. Bogor (ID): Institut Pertanian Bogor.
Venables WN, Ripley BD. Modern Applied Statistics with S-Plus. NewYork (US): Springer Inc.
Appendix 1 Informed Consent
INSTITUT PERTANIAN BOGOR
FAKULTAS MATEMATIKA DAN ILMU PENGETAHUAN ALAM
DEPARTEMEN BIOLOGI
Gedung Fapet Lt.2 Wing 5 Jl. Agatis Bogor 16680 Telp/ Fax (0251) 622833
Sehubungan akan diadakannya penelitian untuk penyusunan skripsi oleh: Nama : Arvina Oktaviani
NRP : G34090077
Institusi : Departemen Biologi, FMIPA IPB
Judul : Usia Pubertas Perempuan di Kota Purwokerto
Maka saya memohon izin untuk menjadikan putri Bapak/ Ibu sebagai probandus (orang yang diteliti). Tujuan penelitian ini adalah mengetahui waktu terjadinya pubertas atau maturasi seksual pada perempuan di Kota Purwokerto berdasarkan usia menarche dan perkembangan payudara, sehingga diperoleh pola pertumbuhan dan tahap-tahap kematangan seksual remaja perempuan khususnya di Kota Purwokerto. Aplikasi dari penelitian ini adalah untuk menentukan status gizi dan kesehatan anak perempuan. Prosedur penelitian ini meliputi pengambilan data pribadi, data orang tua, dan pengamatan langsung perkembangan payudara.
Data hasil penelitian dijamin kerahasiaannya, tidak seorangpun mengetahui kecuali peneliti dan tidak akan digunakan atau disebarluaskan selain untuk pendidikan dan ilmu pengetahuan. Selain itu, keseluruhan data akan disatukan untuk dianalisis sehingga data secara individu tidak jelas. Terima kasih atas kerjasamanya.
Pernyataan persetujuan :
Sehubungan membaca penjelasan surat penelitian diatas, maka kami orang tua/ wali murid dengan sadar dan sukarela tidak keberatan jika putri kami dijadikan probandus penelitian selama pelaksanaan tidak menyimpang dari maksud dan tujuan yang telah disampaikan.
Purwokerto, ………..2013
Appendix 2 Example of research questionnaire
KUISIONER PENELITIAN
USIA MENARKE DI KOTA PURWOKERTO DAN SEKITARNYA DATA PRIBADI
Menarche (menstruasi pertama) : sudah/ belum, jika sudah pada usia tahun
DATA ORANGTUA Ayah
Nama :
Tempat & Tanggal Lahir/ Usia :
Suku : Tempat lahir/ asal kakek dari ayah : Suku nenek dari ayah : Tempat lahir/ asal nenek dari ayah :
Ibu
Nama :
Tempat & Tanggal Lahir/ Usia :
Suku : Tempat lahir/ asal kakek dari ibu : Suku nenek dari ibu : Tempat lahir/ asal nenek dari ibu :
Pengeluaran keluarga per bulan untuk makan (pilih salah satu): 1. n ≤ Rp500 000
2. Rp500 000 ≤ n ≤ Rp1 000 000 3. Rp1 000 000 ≤ n≤ Rp1 500 000 4. n > Rp1 500 000
DATA HASIL PENGUKURAN
