Menstrual disorders in females with developmental disability

The same disorders of menstruation are seen in females with developmental disability as in the general population. See advice on managing heavy menstrual bleeding, dysmenorrhoea and premenstrual syndrome, including investigations and indications for referral. For strategies to support people with developmental disability who find examinations difficult, see Physical examination and investigations.

For advice on delayed puberty in a person with developmental disability, see Pubertal disorders.

In females taking antipsychotic drugs, hyperprolactinaemia can cause amenorrhoea. Hypogonadism secondary to hyperprolactinaemia may also cause loss of bone mineral density and increase the risk of osteoporosis. For advice on the management of hyperprolactinaemia secondary to antipsychotic drugs, see Antipsychotic adverse effects: hyperprolactinaemia. Referral to an endocrinologist is recommended. The combined oral contraceptive may offer some protection against loss of bone mineral density.

Premenstrual syndrome (PMS) or dysmenorrhoea may lead to disturbed behaviour (eg self-injury), nausea, anorexia and weight loss. In females who experience significant PMS, chart behaviour for 3 cycles (eg marking the days on which the female was menstruating, and which days the female displayed disturbed behaviours). For more advice, see Initial assessment and support for challenging behaviour in a person with developmental disability and Pain assessment tools.

In some females with epilepsy, seizures increase or occur exclusively around menstruation (catamenial epilepsy). This is related to changes in estrogen and progesterone levels. Hormonal manipulation with a monophasic combined hormonal contraceptive is generally unsuccessful—seek specialist advice.