Most girls start their periods between the ages of 11-14 years old but anywhere from 9-16 years is normal. Signs that puberty is starting are that breasts start to develop, and girls will start to grow pubic hair. It is usually around 2 years after this that periods will start.
For girls with autism or learning difficulties there can be many challenges associated with starting periods, and these will be different for each girl. They may need longer to understand and adjust to these changes; they may have difficulties dealing with associated symptoms or emotions and/or there may be associated sensory difficulties.
There are different ways periods can be managed depending on the specific difficulties experienced. Below are some ideas which may help your child.
Supporting Understanding
Early discussion – it can give your child longer to understand and adapt to these changes. It is important that girls understand what periods are to help them prepare and so that when it does start they are not scared that something is wrong with them. Using pictures or diagrams may help. Try to give both biological AND practical information, having these discussions regularly will help to reinforce the information.
Social stories – these use stories to explain social situations to children with autism or learning difficulties and help them to learn socially appropriate responses and behaviours. Social stories could be used to explain what happens when you start your periods, symptoms your child might experience and/or what to do when it happens.
Visual schedules – can help to explain what to do when she starts her period and how to use sanitary products. They could also be used to give some predictability by using a calendar to show when a period is due (this may not work for all girls as periods can be irregular especially when they first start).
https://able2learn.com/products/i-have-my-period-visual-schedule-1-pages.html
Period products
Starting to introduce sanitary products early and practising using them and wearing them can help her to get used to them.
As well as traditional sanitary products such as pads and tampons, there are now a wide variety of reusable sanitary options. Brands such as ‘Cheeky Wipes’ and ‘Modi Bodi’ are examples of these, although there are many other brands available. They use absorbent fabrics either as a pad or within the gusset of specially made underwear, meaning they feel more like wearing normal pants and may be easier to change.
Medical Options
If necessary there are medications which can reduce bleeding or possibly stop it altogether.
Tranexamic acid – can be given during the period to reduce the flow and make a period lighter. This is two tablets taken four times a day but only during menstruation.
Oral contraceptive pill – this medication has a combination of hormones (oestrogen and progesterone) and can be taken continuously to reduce the frequency of bleeding or possibly even stop the bleeding altogether. If breakthrough bleeding is experienced then this can be combined with tranexamic acid to further reduce the flow. It is a small tablet taken every day and could be hidden in soft food if taking tablets is a problem for your child.
Mirena coil (or other progesterone containing device) – this is a more invasive option and would most likely need to be done under general anaesthesia. This option uses locally acting hormone (progesterone) and will usually stop periods altogether. This option would be used to stop periods for 3-5 years.
In some circumstances it is possible to use treatment to delay puberty. This is not a long-term option as going through puberty is important for long-term health and well-being, and in particular there are risks to long-term bone health.
You should feel free to discuss any of these options with your GP or with your Paediatrician at your next appointment.
Useful Information
The Autism Friendly Guide to Periods by Robyn Steward – the author of this book is autistic and has written it with information gathered from young people, medical professionals and research done by herself. Much of the information in this book is written in a way that children with autism and learning difficulties can read it themselves.
This Australian parenting website has more information about preparing for periods and some examples of social stories you can use:
https://raisingchildren.net.au/autism/development/physical-development/periods-and-autism
Places you can find period underwear
Modi Bodi –
https://www.modibodi.co.uk/collections/underpants
THINX (children’s sizes) –
Cheeky wipes pants and cloth sanitary towels –