The recent review by Albanese and Hopper1 of suppression of menstruation in adolescents with severe learning difficulties is the first review of its type published in the UK. We have recently looked at the issues surrounding puberty and the management of menstruation in a group of young women with severe learning difficulties and epilepsy, who are living at a residential school in Cheshire.

The cohort consisted of 21 young women whose ages ranged from 12 to 20 years. Their age equivalent functional level on Vineland Adaptive and Behavioural Scales was 1–2 years, …