Obstet Gynecol. 2016 Aug;128(2):418-419. doi: 10.1097/AOG.0000000000001581.
For an adolescent with physical disabilities, intellectual disabilities, or both, and for her caregivers, menstruation can present significant challenges. If, after an evaluation, the adolescent, her family, and the obstetrician-gynecologist have decided that menstrual intervention is warranted, advantages and disadvantages of hormonal methods should be reviewed and individualized to each patient's specific needs. Complete amenorrhea may be difficult to achieve, and realistic expectations should be addressed with the patient and her caregivers. The goal in menstrual manipulation should be optimal suppression, which means a reduction in the amount and total days of menstrual flow. Menstrual suppression before menarche and endometrial ablation are not recommended as treatments. Optimal gynecologic health care for adolescents with disabilities is comprehensive; maintains confidentiality; is an act of dignity and respect toward the patient; maximizes the patient's autonomy; avoids harm; and assesses and addresses the patient's knowledge of puberty, menstruation, sexuality, safety, and consent.
对于有身体残疾、智力残疾或两者兼有的青少年及其照顾者来说，月经可能会带来重大挑战。如果经过评估，青少年、她的家人和妇产科医生认为需要进行月经干预，那么应该审查激素方法的优缺点，并根据每个患者的具体需求进行个体化处理。完全闭经可能难以实现，应向患者及其照顾者说明现实的预期。月经干预的目标应该是最佳抑制，这意味着减少月经流量的数量和总天数。不建议在初潮前进行月经抑制和子宫内膜消融作为治疗方法。为残疾青少年提供最佳的妇科保健应包括全面的服务；保持保密性；是对患者的尊严和尊重的体现；最大限度地提高患者的自主权；避免伤害；并评估和解决患者对青春期、月经、性、安全和同意的认知。
