Menstruation and Mental Disability: Advice for Parents of Adolescent Girls

Grace's Note:  The Canadians say it like it is.  Menstruation and sexuality for a disabled daughter can be a messy difficult time.  Research, talk with your health care provider and come up with a plan. Each and every child and family situation is different.
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A page from: www.aboutkidshealth.ca 

Adolescence is a time of change

Adolescence is the time when a child starts to become an adult. A child goes through many changes in adolescence when puberty begins. Her body changes. Her feelings and moods change as well.

Children with mental disabilities go through the same changes during puberty. But these children also have extra challenges that other children may not have.

You can help your mentally or physically disabled daughter to cope with menstruation.  
On average, girls usually get their first menstrual period when they are about 12 or 13 years old.

Some parents worry how their disabled daughter will cope with menstruation. They worry about how she will keep clean, or how she will deal with the bleeding. They worry that she may be in pain or have mood changes.

Sometimes, parents are concerned about sexuality and consider suppressing menstrual periods to protect against pregnancy.

How well a mentally disabled girl copes with menstruation depends on many things. Depending on her level of disability, some girls are able to cope with menstruation and some are not. Give your daughter as much information as she can understand. Some caregivers do not find menstruation as much as an issue as they thought it might be. If it does become difficult for your daughter, there are some things that can be done to help.

Suggestions for helping your daughter

On a calendar, write down when your daughter's periods begin and end. Also write down how heavy they are. Many girls have heavy blood flow. Many girls have irregular periods for the first five years of menstruation. That is, the periods do not come every month, or at the same time every month. Sometimes, irregular periods make daily life hard. If this is the case, ask your child's doctor about medicine that can help. Some girls have painful cramps, backaches, headaches, or other problems. Medicines can help. Exercise and physical activity also help. Pads are cheaper than diapers. If your daughter wears a diaper, put a pad inside the diaper. Change the pad when it is soiled so you do not have to change the diaper as often. Shaving pubic hair is not necessary for hygiene reasons. Some parents have their daughter's pubic hair shaved for religious or cultural reasons. This is fine, but it is just as clean to leave the area unshaved.
  Some girls can learn how to care for themselves during their periods. Your daughter might need you to teach her. She might also need time to learn. Be patient.

Medicines for painful periods

Pain medicine can help with period cramps. Medicines called non-steroidal anti-inflammatories (NSAIDS) work very well. NSAIDS work best if you use them regularly during the times of pain, rather than only when the pain gets very bad. Ibuprofen (Advil) is the cheapest NSAID that is available over the counter (without a prescription). You can buy it in any drugstore.

Sometimes it is hard to know when to give pain medicine, especially if your daughter has trouble communicating. If your daughter is not acting like herself, or behaving strangely, it may be because of pain.

Sometimes your daughter might need stronger medicine. If NSAIDS do not help enough, talk to your child’s doctor. To get stronger medicine, you need a prescription. Examples of stronger medicines are Anaprox DS or Naprosyn.

Birth control pills or other hormone pills can also help decrease painful periods. They are especially helpful if the pain medicine is not enough on its own. Talk to your child’s doctor about these pills.

Menstruation can be suppressed or stopped all together
.  Sometimes, parents ask doctors if it is possible to suppress menstruation. That is, to stop menstruation or make it happen less often.

It is possible to suppress menstruation, but there are risks.

Wait until your daughter's first period

Wait until your daughter gets her first period before you make a decision. Sometimes, girls do not have the problems their parents think they will have.

Hormonal therapy is an option

Contraceptives are medicines that are used for birth control. They can also decrease menstrual flow, reduce menstrual pain, and increase the time between periods. Contraceptives can be birth control pills, patches, needles, or implants.

These forms of birth control do not protect against sexually transmitted diseases (STDs).

There are different benefits and side effects with each form of contraceptive.

The birth control pills or patch

The birth control pill is taken once per day. The birth control patch is changed once per week. The pill or the patch can be used in one of two ways:

In a cycle, starting and stopping each month (cyclically). Once a month, a girl stops taking the medicine for a few days and has a period. All the time (continuously). Every two to four months, a girl might stop taking the medicine for a few days and have a period. After a while, she might take the medicine all the time, without breaks. When this happens, she stops having periods.

These are the benefits of the pill or patch:

o   Periods are lighter, shorter, less painful, and more regular

o   Skin is healthier, with fewer pimples.
Less mood changes or a more even mood.
A girl has less chance of getting cancer of the uterus or ovaries.

Often, the pill and patch do not have side effects. Or they can have mild side effects, such as these ones:

o   Headache
 mood changes
 sore breasts or leg cramps
stomach upset or bloating
small amounts of vaginal bleeding from time to time girls with some medical conditions cannot use the pill or patch. For example, the pill might not work if your daughter uses a feeding tube. If this is how she is fed, the patch will probably work better for her.

Talk to your daughter’s doctor before you give your daughter any kind of medicine.

Depo-provera injection

Depo-provera is a hormone injection (needle). It is given every three months.

These are the benefits of Depo-provera:

Periods are lighter, shorter, and less painful. Periods might stop completely after a year.

Often, Depo-provera does not have side effects. Or it can have mild side effects, such as these ones:

o   Headache

o   Mood changes
weight gain
small amounts of vaginal bleeding from time to time

Sometimes, Depo-provera can lead to osteoporosis with long-term use. Osteoporosis is a condition where the bones become weaker and less dense. Doctors will test your daughter's bone density before she starts hormone therapy. They will test it again while she is on hormone therapy. This way they can make sure the medicine is not harming her bones. They might also give her vitamins to help protect her from osteoporosis.

Mirena IUD with progesterone

An intra-uterine system or device (IUD) is a small device that is placed inside the uterus. The IUD contains a hormone called progesterone. From the IUD, a small amount of progesterone slowly enters the body every day.

The IUD is put in place by a doctor. Your daughter will be asleep during the procedure, or she will be given a medicine called a sedative to make her very relaxed. Once the IUD is in place, it may stay in the uterus for five years.

The benefit of an IUD is that periods are lighter and less painful.

The side effects of an IUD can include these ones:

o   Headache mood changes weight gain

o   Small amounts of vaginal bleeding from time to time

There is a small chance that hormonal therapy can cause problems after a long time.  
Many women have used hormones for birth control for a long time, and they have been fine. But we do not know everything about what might happen to a woman who takes hormones all her life.

We think that a woman who takes hormones for a long time has a higher chance of having some health problems. This does not happen often, but you need to know about it. These problems can include weak bones, blood clots, heart disease, and breast cancer.

Making the right decisions for your daughter
 all mentally challenged girls are different. How you decide to handle your daughter's menstrual periods depends on many things, including:

o   Your family's situation
your daughter's educational and social situation

o   The level of your daughter's disability
if your daughter takes other medications your own abilities
what will be best for your daughter's health and quality of life

The last point is the most important one. What will give your daughter the best possible quality of life?

Key points

Most girls get their first menstrual period when they are about 12 or 13 years old. This includes girls with mental disabilities.
  Some mentally disabled girls find it hard to cope with their periods.
  Some parents decide to give their daughter medicine to help her cope.
  These medicines include hormonal therapy, or birth control.
  Wait until your daughter has her first period before you decide to give her medicine.  Medicines can make a girl's periods lighter and more regular, or make them stop.
  These medicines can also have some side effects.