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Practice Bulletin Number 128, July 2012

(Reaffirmed 2016)

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Committee Opinion Number 651, December 2015

(Replaces Committee Opinion 349, November 2006, Reaffirmed 2019)

ABSTRACT: Despite variations worldwide and within the U.S. population, median age at menarche has remained relatively stable—between 12 years and 13 years—across well-nourished populations in developed countries. Environmental factors, including socioeconomic conditions, nutrition, and access to preventive health care, may influence the timing and progression of puberty. A number of medical conditions can cause abnormal uterine bleeding, characterized by unpredictable timing and variable amount of flow. Clinicians should educate girls and their caretakers (eg, parents or guardians) about what...


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