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‘What triggers puberty?’ was among the ‘125 Big Questions’ posed in Science magazine's 125th anniversary edition in July 2005. Since then, researchers have made great progress in understanding the genetic, epigenetic and other biological mechanisms that regulate puberty timing, through studies of patients with rare disorders, in large-scale genetic array studies in normal populations and by well-designed animal models.1 As well as being a topic of scientific fascination, this question is highly pertinent to families affected by rare disorders of puberty and to the larger number of families who present with concerns arising from the wide extremes of its normal age distribution, its secular trends and population patterns.
The paper by Kelly et al2 describes substantial patterning by socioeconomic and ethnic background in the prevalence of early age at menarche (the first menstrual period, a late milestone of puberty in girls). They analysed freely available data from the Millennium Cohort Study, a very large prospective UK birth cohort, enriched for socially disadvantaged groups. The main outcome, mother-reported daughter's menarche at the 11 year study interview (mean 11.2 years), was reported by nearly 10%. This age coincides roughly with the earliest ∼5% …