MENSTRUAL MANAGEMENT: THE MOTHER'S PERSPECTIVE

Assessing the menstrual cycle and related problems in adolescents with a Genetic Syndrome associated with Intellectual Disability

STUDY OBJECTIVE

This study aimed to assess the experience and quality of life related to menstruation in adolescents with a genetic syndrome accompanying intellectual disability (ID).

METHODS

This prospective cross-sectional study was conducted on 49 adolescents with a genetic syndrome accompanied by ID, which was defined by the Wescher Intelligence scale for children-Revised and 50 unaffected controls. In a survey created by the authors, demographic information, menstrual history, and information regarding menstrual difficulties, school abstinence, dysmenorrhea, and premenstrual changes were collected. The Childhood health assessment questionnaire was utilized to evaluate physical impairment, whereas the QoL scale was utilized to evaluate QoL in general and during menstruation. Data was collected from caregivers and additionally from the participants with mild ID, whereas in the control group, data was collected from the participants.

RESULTS

Menstrual history were similar between the two groups. Menstruation related school absenteeism was higher among the ID group (8%vs.40.5%, p<0.001). Mothers reported that 73% of their daughters need help with menstruation care. Social, school, psychosocial functioning, and total QoL scores during menstruation were significantly lower in the ID group when compared with the controls. A significant decrease in physical, emotional, social, psychosocial functioning and total QoL score occurred during menstruation in the ID group. None of the mothers requested menstrual suppression.

CONCLUSION

Although menstrual patterns in two groups were similar, QoL decreased significantly while menstruating in the ID group. Despite a decrease in QoL, an increase in school absenteeism and a high percentage of needing assistance while menstruating none of the mothers requested menstrual suppression.

Supporting Minimally Verbal Autistic Girls with Intellectual Disabilities Through Puberty: Perspectives of Parents and Educators

Limited research has examined puberty in autistic girls, yet alone those who are minimally verbal and with additional intellectual disabilities. In this study, ten parents and ten educators were interviewed about their views and experiences of supporting these girls through puberty. Results demonstrated that many parents had concerns prior to the onset of puberty in these girls. Yet, for most girls, experiences of puberty were felt to be positive, with the girls coping well with changes that they were experiencing (e.g. menstruation, breast development and developing body hair). Thematic analysis of interview data highlighted three main themes: a range of individual experiences and needs; the importance of promoting dignity and respect; and identifying ways to support these girls through puberty.

Hysterectomy for the Management of Menstrual Hygiene in Women With Intellectual Disability. A Systematic Review Focusing on Standards and Ethical Considerations for Developing Countries

Background: Menstruation poses particular challenges for women with intellectual disability (ID). In low-and middle-income countries, where these women do not have access to facilities and resources for adequate menstrual care, hysterectomy could be considered as an ethically acceptable procedure. We conducted the first systematic review to identify what constitutes best practice for menstrual hygiene in women with ID and explored the perspectives of actors involved in the hysterectomy decision.

Methods: Theory-informed mixed-method thematic systematic review with theory development.

Results: Eleven ethical guidelines and 17 studies were included. Respect for autonomy and the patient's best interest were the criteria to determine what constitutes best practice. The actors' values and attitudes expressed some dimensions of existing inequities. In low-and middle-income countries, the main concern of parents was the difficulty to train their daughters about menstrual hygiene. Parents (mothers in particular) also expressed the feeling of being excessively burdened, and complained about the limitations of their support networks. Doctors perceived hysterectomy as a safe procedure and a solution for women with ID, whose menstrual hygiene is problematic. In general, the more severe or profound the level of ID, the more likely the interested parties advocated for a hysterectomy. The women with ID perceived their menstruation as a negative experience. Hence, the three parties supported hysterectomy for menstrual hygiene. Parents and doctors considered informed consent or assent (from the women with ID) as necessary and achievable.

Conclusion: The international ethical guidelines suggest that non-therapeutic hysterectomy in women with ID should not and ought not to be recommended as routine and appropriate method to cope with menstrual hygiene even if it is technically safe. Although hysterectomy to cope with menstrual hygiene is still a live issue in high-, middle-, and low-income countries, in high income countries it is performed with authorization from the Court; whilst in low-and middle-income countries there is not an active involvement of the State, or financial or training support for women with ID and their carers. Hence, in low-and middle-income countries there is an urgent need to develop and enact policies and statutes in this area of public health and clinical practice.

Management of Menstrual Disorder in Adolescent Girls with Intellectual Disabilities: A Blessing or a Curse?

Objective

This study aims to describe the menstrual pattern and menstrual care of girls with intellectual disabilities and to evaluate the impact of menstruation and awareness of parents/guardians on girls with intellectual disabilities.

Methodology

Parents/guardians of girls aged 9–17 years with known intellectual disabilities who attended a scheduled public forum and Paediatrics and Adolescent Gynaecology Clinic (PAC) were recruited in a questionnaire-based study.

Results

A total of 123 parents/guardians with a mean age of 41.83 ± 5.45 years completed the questionnaire. The mean age of girls with intellectual disabilities was 12.28 ± 2.78 years, and the mean menarcheal age was 11.12 ± 1.76 years. Only 53 (43.1%) parents/guardians were aware of availability of menstrual suppression. Parents/guardians with lower family income (OR = 0.00; 95% CI = 0.00–0.20), unable to manage menses (OR = 0.03; 95% CI = 0.00–0.61), and moderate severity of menses (OR = 0.01; 95% CI = 0.00–1.21), were associated with seeking medical help on menstrual suppression. The factors associated with parents/guardians requesting for sterilization were lower family income (OR = 0.02; 95% CI = 0.00–0.36) and concern about sexual abuse (OR = 0.25; 95% CI = 0.06–0.39).

Conclusion

Menstrual pattern in girls with intellectual disabilities is similar to those without disabilities. Parents/guardians' knowledge and awareness on menstrual suppression were still lacking.

Teaching menstrual care skills to intellectually disabled female students

AIMS AND OBJECTIVES

The aim of this study was to teach pad replacement skills to intellectually disabled adolescent female students during their menstruation periods by demonstrating on a dummy.

BACKGROUND

It may be difficult to make intellectually disabled adolescents achieve self-care during menstruation. In addition, there are difficulties experienced in explaining menstruation, such as physical changes and the practice of cleaning during this period.

DESIGN

The study used a 'One group pretest and post-test model'.

METHOD

The study was performed in a special educational institution. The population consisted of 77 female students in the high school section. Calculation of a sample size was not attempted, and 54 students with no attendance issues agreed to take part in the study and were included.

RESULTS

In this work, we found that pad replacement training significantly changed the scores of mentally disabled adolescents before and after training. Our training yielded positive results, and the population improved their skills at all stages of skill building.

CONCLUSION

Training adolescents with mental disabilities helped them gain hygiene habits. Performance of these trainings occurs at the beginning of menstrual hygiene education.

RELEVANCE TO CLINICAL PRACTICE

To achieve improved success in life, it is important that adolescents assume the responsibility of self-care and manage sustained care activity on their own.

Caring for a daughter with intellectual disabilities in managing menstruation: a mother's perspective

BACKGROUND

The concerns of mothers and their experiences while providing help to their daughters with intellectual disability (ID) and considerable support needs during menstruation have rarely been addressed. This qualitative study explored mothers' experiences and perceptions of managing their daughters' menstruation.

METHOD

Twelve Taiwanese mothers of 13 daughters with ID (1 mother had twins) were interviewed to explore their experiences of providing help to their daughters with high support needs during menstruation.

RESULTS

Support networks were limited and mothers developed their own strategies for managing their daughter's menstruation. Surgical hysterectomy or use of medication to cease or postpone menstrual bleeding was never considered by the mothers. The financial cost of menstrual pads and nappies was significant.

CONCLUSIONS

Both an appropriate allowance for families involved in the menstrual care of women with ID and access to appropriate support are needed. More information and educational programs need to be provided to relevant professionals and carers.

Deciding about sterilisation: perspectives from women with an intellectual disability and their families in Taiwan

BACKGROUND

This qualitative study explores decision-making regarding sterilisation for women with intellectual disabilities (ID) living with their families, including how such decisions are made and who is involved in the decision-making.

METHODS

Eleven families including sterilised women with ID participated in the study. Semi-structured interviews were conducted with family members and four of the women with ID; the interviews took place at the family homes during March 2009. The interview schedule sought information regarding decision-making on sterilisation including the reasons for the sterilisation, the identities of those involved in the decision-making, attitudes towards the sexuality of women with ID and the role of women with ID in decision-making about their own sterilisation. Additionally, women with ID were asked about their experiences of sterilisation.

RESULTS

The data showed that most of the women who underwent tubal ligation were married and had mild ID; the decision to perform tubal ligation was mostly made by the husband or parents-in-law, and was made after the women had given birth. The reasons given by the families of these women for deciding on sterilisation included: the woman was unable to care for the children, the family could not afford to raise many children, the concern that the ID might be hereditary, or a perceived risk of pregnancy from rape. The two women who underwent hysterectomy were unmarried and had more severe ID than the married women with ID who received tubal ligation. In these two cases, the decisions were primarily made by the mothers of the women based on concerns about managing their menstruation. Almost none of the women with ID were involved in the decision-making process, and some were not even informed of the nature of the surgery. Health professionals and service workers contacted by the families were also influential in the decision-making. The autonomy of the women to engage in decision-making regarding sterilisation thus was constrained by their families and professionals, without considering either sterilisation or hysterectomy a violation of the essential human rights of the women involved.

CONCLUSION

The results suggest that with respect to sexuality and body images among women with ID, concern should exist among society in general and among professionals in particular, regarding human rights; furthermore, more information and better educational programmes must be provided to relevant professionals, as well as to women with ID and their families.

Prevalence and severity of menstrual symptoms among institutionalised women with an intellectual disability

BACKGROUND

Perimenstrual syndrome (PMS) among women with an intellectual disability (ID) has not been investigated in Taiwan. This study explores the prevalence/severity of PMS experienced by women with ID who are institutionalised.

METHOD

Ninety two female residents aged 15 to 54 at six public institutions completed a structured interview between June and November 2006, together with the Moos Menstrual Distress Questionnaire (MMDQ).

RESULTS

Strong significant differences were detected between the participants' physical, emotional, behavioural, and psychological changes during the perimenstrual and remainder phases in all domains other than Arousal. Cramps, hot flushes, affection, orderliness, excitement, and bursts of energy/activity were most prevalent during the perimenstruum (>50%). The participants' unique characteristics and cultural context were associated with the various domains of the PMS.

CONCLUSIONS

Special attention should be paid in future to ascertain whether these experiences and perceptions of PMS are common among all women with ID.