Opinions in pediatric and adolescent gynecologyThe Conservative Management of Abnormal Bleeding in Teenagers with Developmental Disabilities
Introduction
The start of menarche and the menstrual cycles in women with mental disabilities often pose significant problems in the lives of the patients and families caring for them. Often already faced with multiple issues, including physical and mental handicaps, menstrual cycles and the whole topic of sexuality are one more major thing to worry about and to deal with. Not surprisingly, therefore, health care providers often get the request to help with or “fix” the periods. Sometimes the consultation is already obtained prior to the onset of menarche, because of the fear it creates for the family. If the mother or caregiver herself has multiple gynecological issues the requests become even stronger. So how to deal with these requests, which often hint to a surgical solution? Several issues are important in this discussion and need to be explored: normal bleeding patterns in teenagers, the data available on bleeding patterns in teenagers with mental disabilities, and the options in management of abnormal bleeding.
Section snippets
Normal Bleeding Patterns in Teenagers
Menstrual irregularities are a common gynecological problem in adolescents. Most patients have dysfunctional uterine bleeding, defined as excessive, prolonged, or unpatterned bleeding from the endometrium, without an organic cause. The etiological factors of anovulatory uterine bleeding are slow maturation of the hypothalamic-pituitary-ovarian axis especially for the first 18 to 24 months after menarche. Although menarche occurs at the average of 12.8 yr in the United States, up to five years
Menarche and Bleeding Patterns in Women with Mental Disabilities
There are not many specific studies done on the bleeding patterns of developmentally disabled teenagers. A recent study measured FSH and LH responses to GnRH stimulation in teenagers with and without developmental disabilities and found an impaired response of the FSH-secreting pituitary cells in initial pubertal stages. This difference disappeared during further sexual development.4 There is some evidence that the ovarian sensitivity to FSH is blunted in patients with Down syndrome, possibly
The Management of Abnormal Uterine Bleeding in the Teenager with Developmental Disabilities
The request for the management of abnormal bleeding in a teenager with developmental disabilities usually comes from the parents or caregivers. It is very important to understand the reasons why treatment is requested. These can include issues regarding the heaviness, irregularity, or discomfort of the cycle; menstrual hygiene issues; fear of pregnancy; problems with management of behavior at the time of menstrual cycles;12 or a feeling from the parent that either she or the patient should not
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