Supporting Menstrual Health and Birth-Control Choices for People with ID/DD
Key principles (what good support looks like)
Respect autonomy and consent. People with ID/DD have the right to information and to make decisions about their bodies to the extent they can give informed consent; always prioritize the person’s voice and choices. (See ACOG guidance on person-centered counseling and consent considerations.) (ACOG)
Use accessible education. Plain language, visuals, social stories, task analysis, and practice with real materials improve learning and self-management. Educational programs tailored to ID/DD show improved pad-replacement and hygiene skills. (PubMed)
Start with reversible, low-risk options. For menstrual suppression or contraception, begin with the least invasive, reversible choices and individualize care according to medical history, medication interactions, and preferences. (ACOG)
Avoid making assumptions about sexuality or capacity. People with ID/DD may be sexual, may need contraception, and are at higher risk of sexual abuse — so open, proactive sexual-health conversations matter. (ACOG)
What options exist for managing periods and for birth control?
Menstrual-management choices
Period education + supports (first-line). Teaching pad replacement, toileting sequences, and pain-management using task analysis and repetition often enables independence. Visual checklists, mats, and step-by-step practice are effective. (PubMed)
Non-surgical medical management (NSAIDs, tranexamic acid). For heavy bleeding or pain, non-hormonal medications (NSAIDs, tranexamic acid) can reduce flow or dysmenorrhea and may be appropriate depending on medical history. (Royal Children's Hospital)
Hormonal options (combined or progestin-only methods). Combined oral contraceptive pills, progestin-only pills, the implant, the shot (Depo-Provera), and hormonal IUDs can reduce or eliminate periods (medical menstrual suppression) and also provide contraception. ACOG recommends individualized selection and monitoring for people with cognitive or physical disabilities. (ACOG)
Long-acting reversible contraception (LARC). Implants and intrauterine devices provide highly effective, low-maintenance contraception and often reduce bleeding over time; hormonal IUDs in particular commonly reduce menstrual flow. Discuss benefits, potential side effects, and consent carefully. (ACOG)
Surgical options (rare, considered last). Hysterectomy or endometrial ablation may stop menses but are irreversible and carry major ethical and consent implications, especially for people with ID/DD; these should be reserved for clear medical indications and only after careful, multidisciplinary review. (Clinical reviews show surgical approaches are infrequently required and should be a last resort.) (PubMed)
Birth-control framed around menstrual goals. Some people choose contraception primarily for pregnancy prevention; others choose methods because they reduce painful or heavy menses. Both goals are valid. ACOG guidance encourages clinicians to discuss both contraception and menstrual suppression options together, tailored to the person’s priorities and medical profile. (ACOG)
Alternatives to pads, tampons, and cups — and which may suit people who have difficulty using them
Not everyone can or wants to use disposable pads, tampons, or menstrual cups (due to dexterity, sensory issues, difficulties with insertion/removal, or privacy and hygiene constraints). Below are alternatives — practical pros/cons and accessibility notes.
1) Period underwear (absorbent “period panties”)
What: Underwear with built-in absorbent layers (brands include Thinx, Modibodi, etc.). Reusable, washable, and worn like normal underwear. (WIRED)
Why it helps people with ID/DD: No insertion needed; easy to change like regular underwear; less fine motor skill required than pads/tampons. Visual signals and a straightforward wash routine can support independence. (Royal Children's Hospital)
2) Reusable cloth pads
What: Washable fabric pads that fasten to underwear with snaps or wings. UNICEF and other agencies distribute reusable pads globally. (UNICEF)
Why it helps: No vaginal insertion; fastening may be easier than single-use pads for some people with dexterity challenges; they’re cost-effective and better for the environment.
3) Disposable absorbent briefs / “adult diapers” designed for menstruation
What: High-absorbency disposable briefs (often used for incontinence) can be used during heavy flow or for people who cannot reliably change pads.
Why it helps: Very low manual dexterity required; easy to change by caregivers; good for night use or when frequent changes are hard to manage.
4) Menstrual discs or cups — with caution
What: Internal products that collect (cups) or sit higher in the vaginal fornix (discs). They reduce external leakage and can be worn up to ~12 hours. (AP News)
Why they may be considered: Longer wear time, less frequent changing, lower waste. For some people who can manage insertion/removal reliably, they can increase independence.
5) Adaptive tools & simple aids
Examples:
Long-handled applicators or tampax-style applicators adapted for easier grip.
Special disposal bags and labelled storage to avoid confusion.
Visual cue cards attached in bathrooms showing step-by-step change instructions.
Why it helps: These small modifications reduce dexterity and memory demands and build routine. Clinical guidance on menstrual management for disabled adolescents highlights the importance of task analysis and motor-skill supports. (PubMed)
Talking about birth control: consent, communication, and monitoring
Use plain language and repeat information. Present pros/cons visually and simply. Allow time for questions and use teach-back (“Can you tell me how you’d take this pill?”). (PubMed)
Discuss medication interactions. Some medications can reduce hormonal contraceptive effectiveness; clinicians should review all meds before recommending a method. (ACOG)
Monitor side effects and benefits. For any hormonal method, schedule follow-up to check for bleeding changes, mood effects, or medical concerns and adapt the plan. (ACOG)
Final thoughts
Supporting people with ID/DD around periods and birth control means combining respect, education, and pragmatic options. Start with accessible education and try different menstrual products; when pads/tampons/cups aren’t workable, period underwear, reusable cloth pads, or absorbent briefs are realistic alternatives. If bleeding, pain, or hygiene concerns become barriers to health or participation, medical options exist to reduce or stop menses — but these must be chosen carefully, with consent and individualized counseling.