Age at menarche and depression: an updated systematic review and meta-analysis

Age at menarche may influence the onset of depression later in life. We aim to assess the association between early/late menarche and depressive outcomes in females by updating a systematic review and meta-analysis. The search of the original systematic review was updated for studies published in PubMed, Embase, and Cochrane Library from 2013 to 2023. The early/late and on-time menarche divisions were generally based on each study. Depression or depressive symptoms could be measured through various validated tools and diagnostic criteria. We assessed the quality of the evidence using the GRADE approach and performed a random-effect meta-analysis with age at menarche and the cases of depression as outcomes. We included eight cohort and three cross-sectional studies (138,819 participants). Females with early menarche were more likely to have depression later in life compared with those who had on-time menarche (early vs. on-time menarche: odds ratio (OR) = 1.11; 95% confidence interval (CI): 1.03, 1.20; I2 = 44.5%). We found a null association between late menarche and depression for females (late vs. on-time menarche: odds ratio (OR) = 1.00; 95% confidence interval (CI): 0.87, 1.15; I2 = 73.2%). Sensitivity analyses showed that the results were robust. The quality of the available evidence was rated as very low. Existing evidence suggests that early menarche may be associated with an increased risk of depression in females. But it remains unclear about late menarche. More high-quality studies are warranted. • Being updated based on an original systematic review and meta-analysis. • Females with early menarche were more likely to have depression later in life, whether assessed at different ages (age<25y and age ≥25y), compared with those who had on-time menarche. • Results raise concerns on the mental health of females with early menarche.