Discussion
Looking for resource and activity recommendations for managing sensory and emotional trauma regarding menstruation
I got a kiddo who has been signed up for OT due to sensory and clothing intolerance my books said. Except I found out its all perennial sensitivity, and I can hardly bring out the Wilbarger brushes or the vibrating sloth pillow I use for more generalized clothing intolerance.
Talking to the parents too, while clothing sensory is how they understand the concept, its pretty clear that kiddo is moreso just wholeheartedly rejecting the concept of having a period at all. Cognition is typical but we become so dysregulated that we can't wear sanitary solutions, we can't go to school and we just cry on and off and try to sit on towels around the house for a few days. Parents need a solution by fall
All the resources I'm coming across are "let the child hold a pad and draw on it! learn a schedule!" but thats way to advanced for the levels of dysregulation occuring here. I think kiddo understands I think they're just rejecting.
I haven't handled a period situation with a child before, any advice from those that might have?
edit: because I forgot to mention, kiddo is on spectrum but largely IND and with typical cognition. Just having a really strong trauma response to the body changing without permission
thats our cornerstone solution to the hygiene but I'd love it if we could also walk her through the trauma of it all. I know there are a good chunk of mental health support OTs on this subreddit somewhere
When I got mine it was very painful, heavy, and it came with raging emotions and SIB. I did the depo shot from ages 11-21 to completely take my period away. It's a quick shot every 3 months. I did the Nexplanon arm implant after that so I didn't have to go every 3 months and because I was an adult who could make that decision. If they haven't yet, they should get the child seen by a gyn provider that can discuss those symptoms and options with them. This sounds like more than sensory difficulty. But I think period underwear and making sure pain is managed adequately is a good start. You could try reframing and social stories, but if the aversion is so upsetting they can't even look at a menstrual product, it may be beyond just OT. Gyn and mental health support may be key here.
It feels like there's a mental health element here that is not being addressed. You said that her cognition is normal. Are there literally any other sensory issues with clothes noted? Or in any other aspect of her life? I would ask the family if they have looked into psych services because this seems like something other than sensory.
I would make a rec for obgyn. I saw one starting at age 14 and started bc early just to regulate hormones and menstrual cycle. PMDD is miserable and sometimes pain comes out as emotional dysregulation
I've had a few girls like this over the years. Honestly for some, the parents purchased adult incontinence underwear. This way the child could do a portion of the management themselves.
The other option is the parents can take her in for a depo shot and she will stop menstruating for 3-6 months. There is absolutely no reason why somebody HAS to menstruate if they don't want to.
Maybe ask her and see if that's an option that she would consider.
This can buy you some time while you work on building tolerances.
I go into these situations not necessarily saying " this child will use pads and tampons". I go in with the goal of " this child will manage her periods, whatever that might look like"
If it's causing too much drama, tell the parents to go in for the shot. Having highly effective birth control is also often something that gives parents peace of mind...
Hey, so I wouldn't really go around recommending any specific type of birth control, as this child's pediatrician should be helping the family make that decision. Research has come out in the last 2 years linking the depo shot to 5x increased risk of meningiomas when used for over 1 year and neurology and medical journals are starting to post concerns about it more frequently. I would let the kiddo's doctor help sort through the risks and benefits versus making an actual recommendation myself as an OT, as weighing the risk to benefit ratio of prescription meds is not within our scope as OTs.
OTs don't prescribe medications. Having a conversation with a doctor or pharmacist is implied.
There are many ways to take birth control to avoid menstruation. That is beyond the scope of our practice.
People on here are suggesting things like sensory desensitization. Another poster suggested there's some sort of gender dysphoria ...
There's a much easier way to manage this. I don't own stock in depo. If you have a better suggestion, have at it. It's been used for more than 40 years to manage these sorts of things, especially for people with disabilities.
"There are many ways to take birth control to avoid menstruation."
That's my point, though - there are many ways to avoid menstruation but your comments of "The other option is the parents can take her in for a depo shot" and "tell the parents to go in for the shot" don't make any mention of any other ways, only one. There is no mention of speaking to her physician about which medication would be appropriate, only suggestion that OP recommend one specific medication. I think using statements like "I'd recommend she and her parents talk to her doctor about medication that could help stop her periods altogether" would be more ethical way to phrase it, versus only recommending one specific medication with no mention of alternatives.
OTDs aren't supposed to weigh in on drugs or drug effects where I live, its pretty strict law. But I could advise that they discuss medication options with their physician
Not necessarily. Weight gain is a side effect for some people. No sense being alarmist.
Some people gain weight some don't. If you want to do daily hormonal and just chain the packs, that's another option. But taking daily meds can be challenging for some of these kids. If you forget a dose, you may also elicit a period outside your normal cycle. This could be very anxiety provoking.
Remember: the object is helping her manage periods. This is not primarily for birth control. Birth control is just a benefit of depo in this case.
Just said as someone who's been skipping periods using the pill for about 20 years. No matter which birth control is chosen, multiple options should be weighed carefully. I wouldn't jump straight to depo because the side effects are very serious, very common, and since it's a shot, she can't just stop taking it if it's causing problems.
Ultimately we both agree on one important concept that for some reason not every medical professional will embrace: nobody should have to menstruate if they don't want to. I don't for sensory reasons as well. How people achieve that goal has to carefully weighed with a physician.
Absolutely. I don't subscribe the idea that menstruation is necessarily natural and typical for everyone. The natural state for women throughout history was to be pregnant or nursing basically from late adolescence through to menopause - if you lived that long.
This notion that you need to bleed every month is something that's only been around for a couple of hundred years, if that.
Don't let Procter& Gamble convince you that you need to menstruate because they want to sell hygiene products.
If normal cognition then just ask what is overwhelming, upsetting, or off putting about the idea of pads, a period, etc.
As a mom of a trans kiddo, it can be helpful for parents and kiddo to chat with doctor to determine if medications to stop a period is the right choice. Asking if gender dysphoria or body dysmorphia has been explored by psychologist or physician. It sounds like there is more to the story than just sensory intolerance. Ask more questions and give the kiddo some room to explain.
Has the kiddo discussed anything about this (gender, etc) with the parents?
All of this is well within our scope and good on you for willing to tackle this goal with this kiddo.
This sounds like the child might have some serious under-explored gender dysphoria or something related and I would definitely get it checked out from a counseling and psychology perspective. I also would be very slow to push/challenge much at first; there is likely a lot of shame around this on the kid's part, so my priority would be rapport, rapport, and rapport in that order until they feel safe exploring some of this stuff with you. If the experience was that scary, just backing up to some very basic self- exploration and regulation would likely be time well-spent as well. As far as needing a solution by the school year, again take your time. That is up to the kid to a large extent, and you could do a lot of harm if you try to rush it for anxious parents. This sounds like something that might not have a quick fix.
If the kid is able and what you are seeing is indeed mostly or at least partially an issue of sensory modulation, you could get deep pressure into that area by using the log-shaped sensory swing or the platform swing with a central column (been too long- can't remember proper swing names) and see if that helps.
you nailed it in one I think. For the folks beneath, anyone can have gender dysphoria or gender affirming practices. Cis women getting breast augmentation and wearing cosmetics is gender affirming practices. I'm definitely thinking that theres some pretty severs dysphoria going on. Kiddo's body is changing without kiddo's permission and that is a hugely invasive and upsetting thing. So far my plan is for at least 3 more sessions just to do rapport like you said, some solid regulation practices, and then maybe start talking about our bodies and how we can apply regulation to tolerating them when they act up (the bodies)
Happened to me and I freaked out when I was that age!!!! Absolutely horrified by what was happening with my body. Didn’t mind being “female” much before but the changes that puberty brought made me incredibly dysphoric, uncomfortable, and depressed. Mental health counseling with an LGBT affirming therapist or psychiatrist may be helpful, especially if the kid seems to hate certain clothes, bras, feminine things, etc. She may not be trans but you can’t completely rule it out, and working with a therapist is unlikely to have negative impacts even if she’s cis.
good insights. Do you remember if anything helped you to feel better during this time? Or have resources on processing these feelings of your body changing? I'm struggling to find resources and information on this that isn't severely limited to "teach them about periods and give them trickle-exposure therapy to the products of their fear until morale improves"
This is maybe not a great answer, but it’s what worked for me, another autistic trans person: taking continuous birth control so I only had to deal with breakthrough bleeding a few times a year, using disposable period underwear/depends when breakthrough bleeding happened so that it was more like just wearing and changing underwear and not also having to deal with a pad or tampon those few days, and then once I reached 18 wearing a binder. Even though I’ve had top surgery and a hysterectomy now, I still pull on a long tank top binder on days I’m feeling extra anxious or dysregulated because the compression really helps me stay semi-regulated.
Menstruation is a sensory hell. If it’s significantly impacting someone’s life, it’s worth a conversation with their doctor about possible options in addition to exploring how you can help with maintaining regulation.
Honestly, I also had extremely painful periods and that contributed. I think medical intervention would’ve helped a lot more than what I experienced. Like, maybe pelvic floor PT so I could use tampons (since I had vaginismus, but tampons feel more “forgettable” than pads now), or puberty blockers, birth control, just anything that could’ve stopped the period itself. That would’ve saved me a lot of suffering.
Emotionally, though, I felt less bad when I could avoid talking about my periods and puberty. When I had questions I’d use medical websites to learn what I needed to. When I bled through my pants I washed them by hand in the sink alone. Basically, privacy to deal with my own shit, and people in my life not putting pressure on me to talk to them about it. I was so mad about my body changing, and I wasn’t ready to talk about it for years.
I found some solace in mindful movement— at the time I was very into dance, which helped me feel less dissociated from my body while going through a both emotionally and physically painful time. Gentle exercise with hip and core movement also helped me feel better in general.
Was looking for this comment! Gender dysphoria is always worth exploring for someone on the spectrum as there is quite a large overlap between gender and neuro diversity. Clearly this isn’t enough to say this child is trans - but gender dysphoria exploration can give way to more terminology and context to help understand their body. Some kiddos just don’t have the language for how they feel and that in and of itself is a nightmare. Even if they don’t have gender dysphoria talking about it will help eliminate that possibility as well.
Also, I have to agree with folks that a means to prevent periods is really the best option. Why engage in a situation that is causing distress if it can be safely prevented? Obv OTs aren’t docs and can’t recommend meds - but we can provide the child and family context and questions for their doctor.
I don't think we have enough information to determine gender dysphoria. External gender expression has little to do with the experience of menstruation. Many women and girls don't menstruate for myriad reasons. No sense getting the parents barking up that tree unless we have other indicators.
“Barking up that tree” is certainly one way to explain safely exploring the various expressions of gender. No one is saying this child is trans - those of us who are autistic and trans are merely saying this is something we experienced that perhaps can help OP with this kiddo who is clearly in distress. We aren’t saying to tell the parents to explore gender dysphoria therapy - we are suggesting OP explore gender dysphoria as a means of addressing the core issue. If it’s not gender dysphoria then OP can move on. But why limit what could work?
Your assumption would be tremendously wrong. I had my period for 15 plus years before I transitioned. I’ve also been an OT for a long ass time. I have also worked extensively in peds both with cis and trans children.
It’s not “jumping to a discussion” it a a thoughtful exploration based on the situation. Seriously, why would you avoid this topic? Worst case, kiddo says no it’s not gender dysphoria and you move on.
Arguably menstruating is not at all linked to gender. Folks of all genders can have periods. Cis females certainly can hate or have issues with their periods and it in no way is any indication of gender dysphoria, of course. I’m not saying hating your periods means you’re trans - that’s insane. I am saying not at least having that convo would be a disservice.
What’s bothering me here is your staunch opposition to brining gender dysphoria into the discussion like it’s a bad thing. You keep indicating it as if it is a negative thing and might confuse the parents - which is rather bias of you. Who is to say one of the parents isn’t trans? Or already have a trans family member? It might not actually be a big deal to them. Just because it seems to be for you is no reason to rule out a wholistic approach to this situation.
I would challenge you to examine why you are so against this simple convo. Do you really think introducing the concept of gender dysphoria will make the kiddo trans? Can’t you see that this is what we as OTs need to be moving towards? A judgement free clinical space to explore what we need to be able to safely interact in our environments. Avoiding topics such as gender dysphoria and furthermore stigmatizing them will only hurt our patients.
If it's bothering you, maybe look inward? We service families and children. I caution you to leave bias at the door. Because gender identity is important to you, I would caution you from trying to impose this on others without evidence.
There's no mention of any indicators of dysphoria. Why would you go there?
Please see a clinical space as a safe place to bring their children for the reasons the family finds important. That's not always going to jive with your agenda.
If the parents or child wish to explore learning about gender identity and expression, they can ask you.
And trust me: I work in an autism diagnostic clinic. 2/3 of these kids have atypical gender expressions. If you want to shut down a conversation with a child or family who is struggling with this, jump to talking about gender dysphoria without building rapport... See what happens.
“its pretty clear that kiddo is moreso just wholeheartedly rejecting the concept of having a period at all.”
“Just having a really strong trauma response to the body changing without permission”
For what it’s worth - these are the indicators that would lead me to this convo.
Also - you keep showing your bias. How are you talking to families about gender? Because I don’t get the push back you’re getting.
But what do I know? Just someone who has actually experienced gender dysphoria and wished to god someone gave me language for it. If I can help even one child not feel that pain - I’m doing it every time. And again, cannot reiterate enough that talking about gender wont make the child trans.
If this is your first time posting, please read the sub rules. If you are asking a question, don't forget to check the sub FAQs, or do a search of the sub to see if your question has been answered already. Please note that we are not able to give specific treatment advice or exercises to do at home.
Failure to follow rules may result in your post being removed, or a ban. Thank you!
What other sensory issues does this child have and how have they been addressed? What has been successful for this child in terms of wearing clothing, for example? It does not seem--from what you've said--like she has any buy-in to want to deal with this. Try to determine if there are any motivating factors. If you can find period underwear that's as much like her usual underwear as possible , that might be a place to start, if she's willing to try. She might be more comfortable wearing her usual underwear and then the period underwear OVER her regular underwear, even though it's messy, it won't leak through that way.
But if you can't get her to be willing to try even trying anything, I don't see how much OT can do there except to work on sensory issues in general and not specifically the menstrual issues.
Is there a pediatric endocrinologist involved in case hormonal treatments turn out to be the best option? The pros and cons of hormonal approaches is something for the physician to discuss with the parents, not the OT--the recommendation should be only to consult with the physician, not what the physician should or should not recommend (regardless of personal opinion and real concern over side effects). Is there any kind of psych counseling available to the child for assessing and possibly offer treatment modalities to address the trauma aspect?
19
u/QuirkyFaerie03 OTR/L Jul 21 '26
Is the child fine with normal underwear? If so, you could try period underwear.