Considerations for menstrual suppression

There are many circumstances in which menstrual suppression may be appropriate in females with developmental disability to reduce or avoid menses, including:

• when it is an informed decision or requested by the female
• the presence of menstrual disorders (eg menorrhagia, dysmenorrhoea, endometriosis, premenstrual syndrome [PMS])
• when a female is likely to injure herself or others, most commonly due to menstrual pain or distress
• when it will enable participation in education and activities (eg allowing swimming, avoiding absence from school if assistance is required for managing pads).

Females with developmental disability may have difficulty understanding the implications and risks associated with a specific form of menstrual suppression. Accessible information and support from a parent or carer may be necessary to enable understanding and informed consent.

Although menstrual suppression may be thought to be in a female’s best interests, it should only be considered when all less restrictive options (eg education, support, menstrual flow reduction, regulation of periods) have been trialled and failed. If the female exhibits behavioural difficulties in relation to her menstrual cycle, it is important to exclude pain as a cause before considering menstrual suppression.

If menstrual suppression is appropriate, document the clinical indication for the intervention in the person’s medical record, and regularly review with the female (and parents or carers when appropriate) for efficacy and adverse effects.