title: Menstrual management in developmentally delayed adolescent females.
abstract: BACKGROUND
  Requests for assistance in menstrual management and menstrual suppression are a common, emotive and sometimes controversial aspect of adolescent disability care.
  
  
  OBJECTIVE
  To review the uptake and outcomes of menstrual suppression among adolescent patients with developmental delay.
  
  
  METHODS
  A retrospective review of the medical records of adolescent females with intellectual disability referred for menstrual management to the Paediatric and Adolescent Gynaecology Clinic, Children's Hospital at Westmead, Sydney, for the three-year period between January 1, 2010 and January 1, 2013.
  
  
  RESULTS
  Eighty adolescent patients with developmental delay were identified. A third (n = 28) of the patients were pre-menarcheal at first review with parent/caregivers seeking anticipatory advice. Of the post-menarcheal patients, the median age of menarche was 12 years (range 10-15 years). First and second line interventions were documented as were reasons for change where applicable. The combined oral contraceptive pill (COCP) was the most frequently used therapy (67%), and 19 patients in total had a levonorgestrel releasing intrauterine system (LNG-IUS) inserted (31%). Our study population differs from similar previously published groups in the marked absence of the use of depot medroxyprogesterone acetate or the subdermal etonogestrel releasing device.
  
  
  CONCLUSIONS
  As a paediatrician, it is important to address menstrual management issues and allay caregiver concerns with appropriate advice. Our study supports the use of the COCP as sound first line management in achieving menstrual suppression. The LNG-IUS appears to be a favourable second line option. Further investigation into longer-term outcomes and potential complications of device insertion is recommended.
authors.affiliation: Department of General Medicine, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Sydney, New South Wales, Australia.
authors.forename: Irene
authors.initials: I
authors.lastname: Chuah
authors.affiliation: Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Sydney, New South Wales, Australia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: McRae
authors.affiliation: Department of Adolescent Medicine, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Sydney, New South Wales, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Matthews
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Sydney, New South Wales, Australia.|Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Maguire
authors.affiliation: Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Sydney, New South Wales, Australia.|Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Katharine
authors.initials: K
authors.lastname: Steinbeck
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D017028:Caregivers / Q000523:psychology; D002648:Child; D002652:Child Behavior; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use*; D002658:Developmental Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D008572:Menarche; D008598:Menstruation / Q000187:drug effects / Q000523:psychology*; D008796:Metrorrhagia / Q000188:drug therapy; D010290:Parents / Q000523:psychology; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D003277:Contraceptives, Oral, Combined; D016912:Levonorgestrel
keywords: adolescent; contraceptive agents; developmental disabilities; menarche; menstruation