Menstrual Concerns in an Adolescents with Disabilities.

A collection of Curbside Consultation published in AFP is available at http://www.aafp.org/afp/ curbside. Case Scenario A mother brought her 12-year-old daughter to my clinic for gynecologic concerns. The daughter has a congenitally acquired intellectual disability. Recently, the girl began to menstruate, which appeared to cause her distress. While at school, she repeatedly removed her sanitary pad. The mother asked about a procedure to stop her daughter’s menstrual periods. She was unable to say which procedure she meant, only that a friend had arranged one for her daughter. We discussed long-acting contraception and recommendations to wait and see whether her daughter might become accustomed to her menses. Is it ethical to initiate a long-acting contraceptive in this adolescent to suppress menses? If the mother was requesting something more permanent than implantable or intrauterine long-acting contraception, what is the best way to proceed?