Ask the Expert 

Q:  My daughter is 10 years old and is starting to show signs of puberty.  I am concerned about how we will handle her menses.  Can you help?

A:  It is important to address issues of menstrual and sexual function in adolescents with Down syndrome. Major concerns include management and control of menses, hygiene, vulnerability and sexual function. Women with chronic disorders and disabilities may get pregnant. There is no difference with respect to irregular menses, premenstrual syndrome, or dysmenorrhea (menstrual cramps), although it has been reported that women with Down syndrome may go through menopause at an earlier age, as in their 30’s.  The use of female hormones (as contraceptive pills or patches) is a safe and effective way to regulate menses in very young females. 

Use of female hormones (as contraceptive pills or patches) is a safe and effective way to regulate menses in very young females.  Use of intramuscular injections may be an option; however, they are not recommended before menarche (first menses). 

Menarche is one of the major and latest developmental events of female puberty.  In the United States menarche occurs at 12 years and 4 months, and varies normally from 9 to 16 years of age.  The age of menarche depends on many factors (nutrition, socioeconomic status, weight, heredity, race, etc.).  During the last century, the age at menarche has gradually decreased.  Menarche always occurs after the growth spurt, pubic hair and breast growth have occurred. 

There are other methods available to regulate fertility and menses in older adolescents and young women which include surgical interventions (e.g. endometrial ablation). 

We encourage parents to discuss medical and hygiene issues related to menses, earlier probably during the time when the girl is starting to show the first signs of puberty.  Parents should discuss these issues with their pediatrician or adolescent medicine specialist. 

 Professor, Margaret Blythe, M.D.

Fellow, Tatiana Pavlova-Greenfield, M.D., Ph.D.

Section of Adolescent Medicine