Menstrual problems are common in adolescence. Management can be very problematic in girls with disability or medical disorders, as their condition and other medications may mean they are less likely to achieve satisfactory control with standard medical treatments. Those with disability tend to tolerate menses poorly. We report experience with the levonorgestrel intrauterine system (LNG IUS) for treatment of menstrual problems in adolescents with a range of medical problems or with severe learning disability. It provided of significant therapeutic benefit for 12 of 14 participants, with the majority opting to continue for the 5-year duration of the device. The rates of expulsion, bleeding and amenorrhoea appear similar to those reported in older women, where contraception is the primary indication.