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. Chapters 0:00 Introduction 1:57 Causes of early Menarche 2:23 What can delay Menarche 2:52 Signs of Menarche 3:45 Diagnosis of Menarche 4:17 Treatment of Menarche Menarche (/mɪˈnɑːrkiː/ mi-NAR-kee; Greek: μήν mēn "month" + ἀρχή arkhē "beginning") is the first menstrual cycle, or first menstrual bleeding, in female humans. From both social and medical perspectives, it is often considered the central event of female puberty, as it signals the possibility of fertility. Girls experience menarche at different ages. Having menarche occur between the ages of 9–16 is considered normal.[better source needed][1] The timing of menarche is influenced by female biology, as well as genetic and environmental factors, especially nutritional factors. The mean age of menarche has declined over the last century, but the magnitude of the decline and the factors responsible remain subjects of contention. The worldwide average age of menarche is very difficult to estimate accurately, and it varies significantly by geographical region, race, ethnicity and other characteristics. Various estimates have placed it at 13.[better source needed][2] There is a later age of onset in Asian populations compared to the West.[better source needed][3] The average age of menarche is about 12.7 years in Canada,[better source needed][4] and 12.9 in the United Kingdom.[5] A study of girls in Istanbul, Turkey, found the median age at menarche to be 12.7 years.[better source needed][6] In the United States, an analysis of 10,590 women aged 15-44 taken from the 2013-2017 round of the CDC’s National Survey of Family Growth found a median age of 11.9 years (down from 12.1 in 1995), with a mean of 12.5 years (down from 12.6).[