For some female adolescents who have developmental, intellectual or physical disabilities, menstruation (monthly bleeding, periods) can be challenging for a variety of reasons. Some may have difficulties physically managing their own personal care or tasks related to their period. Others may not fully understand the menstrual process and may not have the skills needed to manage their periods. In these cases, menstrual suppression, which reduces or prevents periods, may be a viable solution.
As the only pediatric and adolescent gynecology program in Arizona, Phoenix Children’s staffs a highly specialized team that has extensive experience working with families and young women on a variety of menstrual suppression options, while keeping overall and gynecologic health in mind.
There are different hormonal treatment options proven to suppress or decrease menstrual cycles — most of which come in the form of birth control medication, however, there are some hormonal options that are not birth control. It is important that our care team fully evaluate a young woman’s unique needs, medical conditions, and current medications before prescribing any of the following hormonal treatment options.
Oral Birth Control
Birth control pills, oral contraceptives, are a popular choice for many of our patients. There are a wide variety of birth control pills, each addressing different needs. These pills may be taken to cause a regular light, predictable periods, or the pills can be taken continuously to prevent periods. However, it is very important that birth control pills be taken consistently, as prescribed, to maximize effectiveness. Missing or skipping pills may result in irregular bleeding and can significantly increase the chances of pregnancy for young women who are sexually active.
Injectable Birth Control
Medroxyprogesterone acetate (DMPA) is an injectable form of birth control often used to suppress periods. Since this method is only administered every three months, this option is convenient for patients and families alike. Many of our patients stop having periods completely when given the DMPA injections. Occasionally, some patients may experience spotting or irregular bleeding during the first few doses. Some side effects of DMPA can include weight gain and a reversible decrease in bone density.
Wearable Birth Control
There are a variety of ways to control hormones using wearable devices. A transdermal contraceptive patch (birth control patch) is an effective option for families of young women with disabilities. There are currently two patches that are FDA-approved. Both must be applied weekly, and similarly to birth control pills, can be used to cause regular, light, predictable periods or used continuously to prevent bleeding.
The contraceptive vaginal ring is a small, flexible plastic device that is inserted into the vagina. The vaginal ring stays in position for approximately 3 – 4 weeks and continuously releases hormones, which are absorbed into the bloodstream. If girls are comfortable placing a tampon, this can be a good option.
More popular long term birth control methods for managing hormones in young women who have disabilities include intrauterine devices (IUDs) and arm implants. Overall, these types of devices have been well studied. Each device contains and releases progestin, a type of hormone often used to prevent periods.
While IUD placement is an in-office procedure for adult women, many of our younger patients have an IUD inserted under sedation to make them as comfortable as possible during the procedure. IUDs can remain in place for up to seven years. After the first three months, many of our patients experience an 80% decrease in bleeding and by six months greater than 90% decrease in period bleeding. Many patients stop having periods completely. IUDs do have an indication for heavy menstrual bleeding and are recommended by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology for teens.
Placing an arm implant is typically an office procedure. About 20% of women stop having periods with the progestin arm implant. Irregular and unpredictable periods can occur with the arm implant. This device is effective for 3 years.
Phoenix Children’s is Here to Help
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Together, we can discuss which of the above options would work best for your daughter and your family.