Menstrual Manipulation for Patients With Disabilities

Adolescence can be a period of turbulence and transition for both teens and their parents or caregivers. Teens with disabilities—physical, intellectual, or both—also encounter the challenges of adolescence, particularly when it comes to pubertal development, menstruation and sexuality.

Families may be worried about how menstruation will impact their daughter and seek information prior to the first period. Fortunately, studies have shown that most teens with disabilities and their families manage menstruation without any interventions.

Most teens with disabilities will undergo normal puberty. As puberty progresses – it is important to discuss body changes, menstruation, sexuality, safety and consent. Using medication to stop the first period from coming is not recommended because it is difficult to predict how an individual will react to menses (most do well!) and pubertal hormones are necessary for adolescents to reach their full height. 

However, once the patient has started her period, there are several reasons why a family may request menstrual suppression. Some patients may need treatment of heavy periods or painful periods. Some may have hygiene concerns. Others may have behavioral changes or distress related to menstrual blood. In addition, some families request contraception. A clear discussion of treatment goals ensures that the patient, family/caregiver and provider are working together to achieve best outcomes.

If, after an evaluation, the adolescent, her family and the provider have decided that menstrual intervention is warranted, the provider will review the patient’s medical history and determine which methods are okay to use. The advantages and disadvantages of hormonal methods should be reviewed and individualized to each patient’s specific needs. 

Complete amenorrhea (no bleeding at all) may be difficult to achieve, and realistic expectations should be discussed for each patient. 

Some families may request a hysterectomy for their daughter. However, it is not recommended unless other less-invasive options have been exhausted. A hysterectomy is irreversible and is major surgery. It will not protect the patient from sexual abuse or sexually transmitted infections. Disabled adolescents have the same rights as any women, and the benefits of surgical intervention must outweigh the risks.
 
Optimal gynecologic health care for adolescents with disabilities is comprehensive. It should:

• Maintain confidentiality
• Be an act of dignity and respect toward the patient
• Maximize the patient’s autonomy
• Avoid harm
• Assess and address the patient’s knowledge of puberty, menstruation, sexuality, safety and consent.

For more information about Nationwide Children's Hospital's Pediatric and Adolescent Gynecology services, click here.