Association between age of menarche and suicidality: A systematic review and meta-analysis

Abstract

Early menarche is associated with increased risks of mental distress, including depression, anxiety, and suicidal behaviors among adolescent girls. Studies suggest that hormonal fluctuations during puberty may contribute to it. The purpose of this review is to investigate a potential association between the age of menarche and suicidality among young females. A systematic literature search was conducted on March 17, 2025, using Cochrane, PubMed, ScienceDirect, and Scopus to assess the association between menarche and suicidality among women, as registered on PROSPERO (CRD420251235016). Among the 14 included studies were eight cross-sectional studies, three longitudinal cohort studies, two retrospective clinical studies, and one comparative study. The average age of early menarche was 11.2 years in this meta-analysis. The meta-analysis on suicidal ideation (two studies, n > 8,800) was not statistically significant under a random-effects model (odds ratio [OR] 1.41 [95% confidence interval [CI]: 0.98–2.02]), with substantial heterogeneity ( I ² =90.2%). The meta-analysis on self-harm (three studies, n > 12,000) found a significant association, with a pooled random-effects OR of 1.98 (95% CI: 1.25–3.14) and moderate heterogeneity ( I ² =53.6%). There is a notable correlation between early onset of menstruation and heightened psychological risks among females. Review findings indicate that those experiencing menstruation at a younger age are more susceptible to thoughts of self-harm and depressive symptoms during adolescence. Future research should focus on early intervention for females encountering early or irregular menstrual cycles.