How do I prepare a girl with autism for menstruation?

Getting your period is a tough topic for every parent/child to cope with, but introducing the topic of menstruation to girls on the autism spectrum can be a daunting task. Mothers worry about how their daughters will react to the event. Will there be sensory issues around blood flow and the use of sanitary pads? How will they feel about this change in their body? Will it be painful? How do you teach hygiene around menstruation? Will menstruation be understood and accepted?

Introduce the topic of menstruation early

There are ways to ease the transition into menstruation. Introduce the topic of menstruation early – one to two years before you think it may occur- to get used to what it is about and how natural a process it is. Allow time to become familiar with the vocabulary around menstruation and practice routines. Have the child wear a pad from time to time to get used to the feeling of it. Teach how to put on a pad and proper disposal of pads (not in the toilet, wrapping up a used one, putting it in the wastebasket). Visual supports can help with the process of breaking down the routine into steps. A great book that addresses this topic with the use of visual supports and social stories is Mary Wrobel’s book Taking Care of Myself.

Create a rite of passage

I have always liked the idea of cultures that have a rite of passage around menstruation. This makes a natural change something to look forward to and not be feared. Children on the spectrum will understand the concept of a celebration or event to look forward to. We told our daughter for some years before the time we thought she might get her period,  that menstruation was a sign of growing up, moving towards independence, and making more of your own choices. Parents can create their own rites of passage. Maybe this means going to bed 15 minutes later, a little more computer time, going out for a special treat, or moving into one’s own room. The choice is yours and parents will know what will be most meaningful.

Use positive language

Use positive language around menstruation. How often have we heard negative connotations like “the curse”? Our own attitudes around menstruation can influence how our girls feel about it too. Children with ASD often fear change and unpredictability so it is important to make menstruation part of our dialogue with our children. Preparation and demystification of the process is key to easing anxiety.

Use visual aids to create predictability

Introduce the 28-day cycle calendar once menstruation has started to build in awareness and predictability of when menstruation will happen. People with ASD like predictability and no surprises. It may take a few cycles in order to become regular, but the calendar will provide a place to start. Colour days 1 – 5 in red to represent the menstrual bleeding. If the girl is aware of ovulation (my daughter is), you may also want to mark in ovulation on Day 14 since there is a change in discharge at that time.

Talk about social rules

Don’t forget to talk about social protocol. It’s fine to talk about menstruation, but there is a time and place. Teach those boundaries early. It is something you don’t announce each month to everyone! Establish what is appropriate social etiquette. If the child will need assistance with pads at school, make sure staff is informed. Will a particular aide be assigned to help the child at school? Talk with school about support that will be needed.

Some great resources

Great books for parents and children to read together that introduce menstruation, facts of life and hygiene for girls are The Body Book for Girls and The Growing Up Guide for Girls. Both books offer great illustrations and simple, accessible language. Don’t worry about introducing the male aspects right away because there is enough information to process that just pertains to girls.

I also recommend Girls Growing Up on the Autism Spectrum for parents to read. It is very in-depth but covers a wide range of topics such as menstruation, personal safety, self-esteem, and healthy sexuality.