1. Puberty and Hormones Notes taken by Iris Lau from the 2014 Australian & NZ Dravet Syndrome Family Conference

2. Puberty and Hormones  Adolescence is a developmental stage involving Cognitive Pubertal Separation Independence Peer group Risk taking

3. Puberty Blues – the challenge's of managing periods  Menstrual management – for women with intellectual and/or severe physical disability  AIMS  Optimise quality of life  Ensure no pain, no negative health consequences

4. Puberty Blues- understanding hormones

5. Puberty blues – the challenges  Menstrual management – for women with intellectual and/or severe physical disability  Options simple measure – reduce pain, reduce heaviness of periods  “the pill” – continuously – “skipping periods”  Depo Provera – need to watch bones  Mirena IUS iris Note: the speaker explained that “skipping periods” –  Like grandmothers – have ten kids, normally only 55 periods in their life  Like pregnancy – no period, then go to breast feeding with no period.  So no period for few years is not unhealthy, just the way to control the hormones

6. Continuous Pill  “skipping periods on the pill”  Concern by some regarding “ not natural”  Well….How many periods in a life time is natural?

7. Continuous Pill continued  Tricks to make it work  …need higher dose with most anticonvulsants  Need continuous dose ( not changing dose pill)  Care with lamotrigine – as may reduce the effectiveness of this

8. Non Contraceptive benefits of the pill  50-80% reduction in ovarian cancer  50% reduction in endometrial cancer  Reduction in bowel cancer  Less endometriosis  Less Anaemia  Less ovarian cysts

9. Rules for skipping  Period at the end of the first packet  Can go continuous after that  Go as long as possible…until spotting starts, put up with this for 2 or 3 days  If persists, have a 4 days off the pill and restart  If cyclic 4 week bleed or pain despite continuous pill not suppressed. Need to increase pill dose  Can’t always achieve no periods at all – accepts 4-6 month interval

10. Mirena IUS  95% less bleeding by 6 months  97% less bleeding by 12 months  Lasts 5+ years  95% satisfaction reported by families of young women with disabilities at RCH

11. Implanon  Lasts 3 years  Almost 100% effective in preventing pregnancy  Causes irregular bleeding – resulting in removal in 25-30% of young women  Not helpful if aiming for constant hormones