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Options for Menstrual Management
Resources and Information for Staff and Carers of Women with an Intellectual Disability
Women with an intellectual disability have the same rights as other women in the community to access relevant resources to help them manage their menstruation. This booklet is designed as a resource for those working with women who have an intellectual disability. It does not provide specific or complete programs. Rather, it is intended to assist workers and carers to develop their own individualised menstrual management strategies and programs for the women with whom they work.
Many of the points will be of interest to parents, too.
Menstruation is a normal, healthy process for women. Women with an intellectual disability are able to manage their menstruation either by themselves or with varying degrees of assistance
What is menstrual management?
Menstrual management refers to a range of strategies that a woman might use during her menstrual cycle.
The aim of menstrual management for a woman with intellectual disability is :
- for her to experience her normal
- menstrual cycle.
- for her to be comfortable with her menstrual fluid.
- for her to manage her menstruation hygienically, with dignity and privacy.
- to meet the individual needs of each woman.
A woman with an intellectual disability will have the same menstrual hygiene needs as all other women.
Is menstruation any different in women with disability?
- Most girls who have an intellectual disability begin menstruating at the usual time and go on to menstruate with the
- same regularity as their non-disabled peers.
- Women with intellectual disabilities have the same right to the full range of menstrual management options as any other women.
- Regardless of disability, the management of any menstrual problem is the same for all women.
- Treatment options recommended should be the least restrictive and always in the woman's best interest
When considering menstrual management options for a woman with an intellectual disability, all facets of a woman's life which may relate to her menstruation must be taken into account.
These include :
Age
Most women experience variations in their menstruation during different stages of their life.
The first few years of a young woman's menstruation often bear little resemblance to what will become her long-term pattern.
The older woman may be approaching menopause, when the possibility of heavy or irregular periods increases.
Level of Ability/Functional Capacity:
This will impact on a woman's ability to understand her menstrual cycle and how to manage it. Menstrual education programs must be tailored individually so as to be accessible to each woman.
Associated Disability:
Some women will have other disabilities such as visual impairment or cerebral palsy which may make menstrual management more difficult. Individual programs will need to be adjusted to suit each woman's needs.
Personal Hygeine Skills:
The extent to which a woman can manage her toileting will probably reflect her ability to manage her menstrual period.
- If a woman is toileting independently then it would be reasonable to assume that, given appropriate education and time, she could manage her menses.
- If a woman needs assistance with toileting then menstrual pads/tampons can be checked and changed at that time.
- If a woman is being taken to the toilet at specific times (toilet timing) menstrual pads/tampons can be checked and changed at those times.
- If a woman has difficulty handling soiled pads or if she spreads menstrual blood, she might find it preferable to learn to use tampons. Many women choose tampons as a matter of personal preference.
- Alternative hygiene products (appendix 2) may be necessary if a woman is incontinent of urine and in particular faeces, or is unable to tolerate disposable pads.
- The usual effective infection control procedures must be observed to prevent infections such as Hepatitis B, Hepatitis C and HIV/AIDS, although transmission through menstrual fluid has never been documented.
Where to start?
Most women with intellectual disabilities should be able to manage their menstruation either by themselves or with some assistance from staff or a carer.
If a woman has high support needs and requires assistance to manage her menstruation, it is important to remember:
- Staff and carers play a significant role in the success of menstrual management programs. Positive attitudes towards menstrual care will usually generate positive outcomes.
- When implementing individual programs and strategies, the staff member involved should be someone with whom the woman feels comfortable and who is able to assist her consistently with her routine.
If staff and carers require further information, the woman's medical practitioner or agencies such as the University-based Developmental Disability Units, Centre for Social Health and Family Planning Victoria may be able to provide additional assistance (appendix 1).
What makes a successful program?
1. Simplicity
- Programs should be as simple as possible and appropriate to the individual's needs.
- Do not reinvent the wheel. Use existing programs and resources and adapt them for individual needs.
- Above all, use common sense.
2. Choice of Carer
- The availability of a carer who is acceptable to the woman is important if she requires assistance with management of her menses.
- Whenever possible this carer should be: female and should be chosen by the woman.
3. Consistency
Any program decided upon should be followed consistently by everyone involved i.e.
- wherever possible the same support person should be involved.
- the same language, phrases and actions should be used by all support persons.
- the same educational aids should be used by all support persons.
4. Dignity:
- Use the rule of thumb of "what if it was me/or my daughter?" and afford that same degree of respect and dignity to the woman concerned.
5. Environment:
- The aim for every woman wherever she resides is to be given every opportunity to develop her personal hygiene skills to the full.
- Privacy, access to personal hygiene aids and adequate facilities for disposal are all important for the proper management of menstruation by the woman herself.
- Infection control guidelines should be followed.
6. Comfort/Protection:
- Specialised products and hygiene aids (appendix 2) should be made available if necessary, so that women with an intellectual disability can maintain maximum independence in the management of their menstruation.
Most women will experiment with different pads and tampons to find the ones of their preferred choice. Therefore, it is important for women with disabilities to have the same opportunities to choose what is most comfortable and appropriate for themselves.
7. Skill Development:
Use existing skills and develop on those. For example, if a woman can change her underpants herself, fit adhesive pads into them beforehand and then she only has to change her underpants (which she can already do) when the pad becomes soiled. Later in the program she may learn to fit pads into her underpants independently.
If after an adequate trial a particular program is found to have been unsuccessful, a new approach should be considered.
8. Personal Beliefs and Attitudes:
In assisting a woman with her menstruation, individual people will approach the task with their own values, myths and misunderstandings weighing upon them.
- Do not view menstruation as some mystical rite, as in our society this only adds to the confusion and awkwardness which shrouds this normal physiological function.
- Recognise the ethnic and cultural context within which a woman views her menstrual cycle.
Do not impose your own feelings about menstruation on the woman being assisted.
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