Australian and New Zealand Journal of Obstetrics and Gynaecology 2003; 43: 109–110 109 Blackwell Publishing Ltd. Consensus Statement Management in intellectual disabled women Consensus statement: Menstrual and contraceptive management in women with an intellectual disability Eleanor ATKINSON, Michael J BENNETT (Chairman), Jan DUDLEY, Sonia GROVER, Kim MATTHEWS, Paddy MOORE, Julie QUINLIVAN and Tamara WALTERS The Australian Society of Paediatric and Adolescent Gynaecology (TASPAG) Working Party Chairman’s foreword A National Consensus meeting was held on 28 October 2001 to discuss the evidence-based management of men- strual problems in women with intellectual disabilities. Participants were all active members of The Australian Society of Paediatric and Adolescent Gynaecology. Prior to the meeting, an extensive literature review was undertaken to review best clinical practice. In addition, members consulted with State based Guardianship Boards or Family Courts to obtain information relevant to individual states. The out- comes listed in the present document were achieved by complete consensus of participants. Consensus statement • Most girls who have an intellectual disability pass through menarche at the usual time and go on to men- struate with the same regularity as their non-disabled peers • Women with intellectual disabilities have the same right to the full range of management options as other women, tailored to their specific needs • Treatment options recommended should be the least restrictive and always in the woman’s best interest. The management of menstrual problems in young girls (minors) rarely requires destructive surgery such as hyster- ectomy or endometrial ablation. Issues for consideration and assessment in women with intellectual disability • Level of functioning: dressing, self-care, toileting, com- munication skills • Behavioural issues particularly around the time of menses: including catamenial epilepsy, head-butting, smearing of menstrual blood • Mobility: wheelchair, dexterity; hand skills for menstrual/tampon change, capacity and practicalities of menstrual care • Complicating medical factors: risk for osteoporosis, cardiac problems, anticoagulants, epilepsy/anticonvulsants. Careful documentation should be made of the history with information from other doctors, psychologists, etc. included. Initial assessment • Cognitive skills • Extent of physical disability • Care arrangements: who is responsible for blood products • Respite care for family relief • Consider assistance for care in day facilities and schools. Management of blood products by carers should not be different to concerns regarding urinary and faecal toilet management (see menstrual manage- ment and contraceptive options following) • Ask about other factors contributing to osteoporosis: diet (calcium), exercise (weight bearing), oestrogen, vitamin D/sunlight exposure. Investigations • May be influenced by disabilities • Principles of investigation should be the same as for other women • Consider testing vitamin D levels. Menstrual management and contraceptive options • Amenorrhoea can generally be achieved by reversible, less invasive methods than hysterectomy • Hysterectomy will not solve perimenstrual behavioural or other cyclic problems Correspondence: Professor Michael J. Bennett, School of Women’s and Children’s Health, The University of New South Wales, C/o Royal Hospital For Women, Barker Street, Randwick New South Wales 2031, Australia. Email: mj.Bennett@unsw.edu.au Received 3 September 2002; accepted 7 January 2003.