Management of Menses in Adolescents with Disabilities or Complex Medical Conditions

  • February 17, 2020
  • Paediatric/Adolescent Gynaecology

Dr Brooke O’Brien’s recent article is focussed on educating GPs and other women’s health professionals on the management of menses in young women who suffer from complex physical or mental health conditions. For more information, contact Northside Gynaecology.

In adolescents with physical and/or intellectual disability, many parents or paediatricians will consider menstrual suppression to be an appropriate decision. In adolescents with various disabilities, ranging from mild to severe, the onset of menstruation can cause significant suffering in terms of exacerbation of behaviour or mood or sleep, issues with managing hygiene, and cause additional burdens for parents and carers. In adolescents with significant or several other medical issues, having menses can make life significantly more difficult and also impacts their needs and care. In children with epilepsy, menarche can often exacerbate or lead to a deterioration of seizure control.

In adolescents with disabilities or complex medical conditions it is important that all options be considered, taking into account each girl’s individual needs including contraceptive requirements in the longer term, type of disability, medical history and comorbidities, and personal and carer preferences. Often oral hormonal contraceptives, such as the OCP, are contraindicated due to medical comorbidities or are not as effective due to other medications taken by the patient, such as behavioural or anti-seizure medications, and a more individualised approach is required.

Where the aim of therapy is for menstrual suppression, the goal of treatment is that no menses will occur and amenorrhoea will be achieved. In some cases, it may be the preference to allow  menstruation to occur, however with menstrual regulation, where medications can be used to make menses more manageable for the adolescent.

Medical modalities are highly effective in achieving menstrual suppression and it is nearly always unnecessary for adolescents with even the most severe disabilities to undergo a hysterectomy. A range of options for menstrual regulation or suppression will be discussed, including hormonal therapy which can be given orally, as injection form  and an intrauterine device, which have been demonstrated to have a high safety and efficacy in adolescents with disabilities requiring menstrual suppression and contraception. 

Menstrual suppression in adolescents with disabilities is an important aspect of care in these girls, given the anxiety around the management of this aspect of their lives that is often present for these patients and their carer.  Menstrual suppression in adolescents may be required to manage the complexities of menstrual hygiene, pain and other discomfort associated with menses.

It may be beneficial to consult Dr Brooke about a plan for menstrual suppression prior to the first period, or when early signs of puberty occur, so a plan can be made in advance to reduce anxiety and commence therapy as soon as menarche occurs.

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