Menarche is usually only slightly delayed in girls with Down's syndrome. Menstruation usually settles into a regular pattern and, although many cycles will be anovulatory, fertility should be presumed. It is hard to justify involuntary menstrual suppression or sterilization unless there are major medical indications. 

Women with Down syndrome need annual pelvic exams, Pap smears, and breast exams beginning at age 18 years, even if they are not sexually active. Mammograms are recommended periodically after age 35, depending on age and personal risk of breast cancer. Mammograms and breast exams are crucial in women who are not functionally able to do this themselves. There is a slightly higher risk of breast cancer in

women who have never had children.Women with DS may have menstrual irregularities, painful menstruation, or bloating, weight gain, and mood changes associated with pre-menstrual syndrome. Other women may have difficulty with menstrual hygiene, depending on their level of function.

Medications may be helpful for symptom management. Diuretics are used to rid the body of excess fluid and analgesics may relieve cramping. Oral contraceptives and long-term contraceptives such as Depo-Provera injections may be used to control bleeding irregularities and for contraception, if needed

Transition into adulthood :

Individuals with Down syndrome range in their abilities to live independently from requiring ongoing, consistent supervision to minimal guidance with complex tasks. 

Recreational activities such as bowling, swimming, and dancing are encouraged because these activities promote social relationships and physical fitness.

Vocational choices are directed by the individual's cognitive abilities, social skills, and adaptive abilities. Many will be able to seek competitive employment in custodial work, offices, housekeeping, restaurants, landscaping, or other occupations where the required skills are not too difficult, fairly repetitive, and there is ongoing supervision. Skills necessary to survive in the work force such as basic money management, telling time, or using public transportation need to be mastered before seeking such positions.

Generally most individuals' overall health is good, although premature aging occurs as early as age 20 with dental changes. Dermatologic, thyroid, cardiac, and sensory problems are the most troublesome and worsen with aging. Perhaps of greatest concern is Alzheimer's disease, which may occur as early as age 20.

When an adult with Down's syndrome is diagnosed with Alzheimer's disease, focus on Safety, Stability (of the environment), Social (emotional) issues, and Symptoms. As the adult with Down's syndrome experiences greater decline, family will often have difficulty maintaining a safe environment. Falling because of gait apraxia, wandering from home, and touching or using objects in the home that can be harmful if used inappropriately (e.g., the stove) can all be problems that the family cannot prevent. In addition, when the adults become bed-bound, frequent turning or changing the position to prevent bedsores is necessary and may be more than the family can provide. Safety is frequently the concern that requires a change in living arrangements and, if no specialty care programs are available, may require admission to a nursing facility

References :

1. Primary care of the child with a chronic condition: Patricia Ludder Jackson, Judith A. Vessey.
2. Biomedical concerns in persons with Down syndrome: Siegfried M. Pueschel and Jeanette K. Pueschel.
3. The mongoloid child: Recognition and care: Christof Wunderlich, M.D.
4. Down syndrome: An introduction for parents: Cliff Cunningham.
5. Medical and surgical care for children with down syndrome: A guide for parents: D.C. Van Dyke, M.D., Philip Mattheis, M.D., Susan Schoon Eberly, M.A., and Janet Williams, R.N., Ph.D.
6. Health Care Guidelines for People with DS -- 1999 DSMIG Edition
7. Down Syndrome: Health Issues, from Dr. Len Leshin

For further details see Down's syndrome:-prenatal diagnosis
                          see Clinical features of Down's syndrome in neonates

Last created on 23-02-2001
Last updated on 30-04-2007