Ten years of age tends to be the lower limit for menarche, and the mean age in North America is 12.5 years. Most children develop secondary breast changes 2 years prior to the onset of menarche. At the time of ovarian stimulation, a white or yellow vaginal discharge, which is both nonodorous and nonirritating, may appear. Early cycles are anovulatory and irregular, but unlike adult anovulatory cycles, bleeding is generally not excessive. The hypothalamic pituitary axis takes 1 to 5 years to reach full maturity, and the average time to establish ovulatory cycles is 2 years after menarche.
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