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Drs Albanese and Hopper review the therapeutic options available to suppress menstruation in adolescents with severe learning disabilities. Gary Butler and Elaine Beadle comment on this paper and the American girl Ashley X. For reasons related to menstrual hygiene, pregnancy and vulnerability to sexual abuse, Drs Albanese and Hopper suggest that suppression of menstruation may be worthwhile. They discuss both medical and surgical options. This review is part of the debate in dealing with growth and sexual maturity in children with severe developmental disabilities. In October 2006, in a widely discussed, debated and quoted article in Archives of Pediatric and Adolescent Medicine, two physicians describe how Ashley X, a 6
-year-old girl with static encephalopathy, was treated in order to attenuate both growth and sexual development.1 High-dose oestrogen and surgery, and pretreatment hysterectomy, were used. Few medical articles in the past year have stirred such debate in the US.
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