Puberty, Periods and Sexual Health in Girls with additional needs

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Overview of puberty

What is puberty?

Puberty is a normal stage of growing up when a child’s body and mind start to develop into those of an adult. For girls, puberty usually begins between 8 and 13 years and is guided by hormonal changes (chemical changes in the body). These changes can affect the body, emotions and social relationships.

It can help to start discussing puberty and periods early so your young person feels prepared.

For girls with learning disabilities or neurodivergence, puberty can bring extra challenges. Families often find it helpful to know what to expect and when to seek support.

This guide is for parents and carers. It explains what happens during puberty, how to manage periods and how to support a young person to understand their body, boundaries and sexual health in a clear, sensitive and supportive way.

What physical changes should I expect during puberty?

Girls usually go through puberty in a broadly predictable order, although the exact age can vary.

  • Breast development (thelarche): Often the first sign. This begins with small breast buds (a small mound of breast tissue) and enlargement of the areola (the darker area around the nipple). This can start at any time from 8 to 13 years.
  • Pubic and underarm hair (pubarche): This usually follows breast development. Hair will grow around the vulva, underarms and other parts of the body.
  • Adrenal gland activity increases (adrenarche): The adrenal glands produce hormones. Changes in these hormones can cause body odour, acne (spots) and increased sweating.
  • Growth spurt: A rapid increase in height usually occurs around 10 to 14 years. You may notice widening of the hips and further physical development.
  • Periods (menarche): Periods happen when blood passes out of the vagina because the womb (uterus) sheds its lining. Most girls start periods around age 12, but periods can start as early as 8. The first period usually happens around 2 years after breast buds begin to develop. In the lead-up to, and during, a period your child may have tummy or back discomfort and changes in mood.

Overview of periods

What should I expect during a period?

  • Most girls start periods between 12 and 13 years, but they can start from as young as 8.
  • If periods start before 8, or have not started by 15 (or by 13 if there are no other signs of puberty), seek medical advice from your GP or paediatrician.
  • When periods first start, cycles are often irregular. A cycle may range from 21 to 45 days. This usually settles within a couple of years.
  • Once settled, periods usually occur every 23 to 35 days and last 2 to 7 days.
  • Mild to moderate period pain is common and usually improves with the right support. Discomfort is often in the tummy or lower back.

Simple ways to ease period pain

  • Heat: A heat pad or hot-water bottle on the lower tummy or back, or a warm bath or shower.
  • Movement: Gentle walking, stretching, yoga, or pelvic tilts can help relax cramping muscles.
  • Over-the-counter pain relief: Simple pain relief such as ibuprofen or paracetamol can help.

Managing period pain
Managing period pain

What types of period products are available?

Different products can be used to manage periods. The right choice depends on comfort, ability and personal preference. Families may need to try a few options before finding what works best.

  • Sanitary pads (sanitary towels): Absorbent pads placed in underwear. They are easy to use and change and widely available, but some people find them bulky.
  • Period pants: Absorbent, reusable underwear. They can be comfortable and may help if your young person has sensory sensitivities. They come in different absorbency levels and can be washed and reused.
  • Tampons: Absorbent products inserted into the vagina and changed during the day. Some young people may not feel ready for these because they require confidence with insertion and removal.
  • Menstrual cups: Cups inserted into the vagina to collect blood. They require confidence to use and need to be emptied and cleaned regularly.

Tips for families

  • Start with the simplest option and involve your young person in choices where possible. Many young people find pads or period pants easiest to begin with.
  • Let your young person feel and explore products before their first period.
  • Young people with learning disabilities may not understand why they are bleeding, which can feel distressing. Start talking about periods and products early. Short, regular conversations often work better than one long discussion. Everyday opportunities can help, such as seeing products in the supermarket or adverts on TV.
  • Check what support is available at school and ensure staff know how to support your young person.

Period products
Period products

How can we prepare for the first period?

  • Talk about puberty and periods early. Periods can start from age 8, so early preparation matters.
  • Breast buds are often the first sign that puberty has started. This can be a useful time to start introducing the topic, then revisit it over time as understanding develops.
  • Introduce the topic gradually using everyday opportunities (for example, while shopping for toiletries).

Putting together a period pack

Having a small pack ready can help your young person feel more confident, especially at school or when out. A simple starter pack might include:

  • a spare pair of knickers (dark colours can feel more reassuring)
  • a sanitary product (pad or period pants)
  • a small zip-up bag or pouch to carry items discreetly
  • a resealable plastic bag or wet bag for used knickers if an accident happens
  • tissues for freshening up
  • a dose of simple pain relief such as paracetamol (if appropriate)

Some families keep one kit in a school bag and another at home. Schools are usually supportive if a child needs time or space to manage their period.

Troublesome periods

How can I tell if periods are abnormal?

Most periods can be managed with simple measures and over-the-counter pain relief. In the first few years after periods start, they can be heavier and more irregular. Over time, as the systems that regulate periods mature, periods often become lighter and more regular.

If periods cause very distressing symptoms or significantly affect daily life, for example making it hard to attend school or usual activities, it is sensible to seek medical advice.

Signs of troublesome periods

  • Very heavy bleeding (soaking through pads every 1 to 2 hours).
  • Severe pain that does not improve with simple measures.
  • Periods that have a significant impact on daily life, for example:
    • recurrent missed school days
    • marked changes in behaviour or mood around periods
    • distress that is difficult to manage at home or school

If periods are affecting your young person’s ability to take part in normal daily life, seek advice from your GP or paediatrician. There are medical options that can help manage heavy or troublesome periods.

When should I seek support from a doctor?

  • Needing to change pads or tampons every 1 to 2 hours.
  • Needing to use tampons and pads at the same time because of heavy bleeding.
  • Regular “flooding” or “leaking”, including bleeding through clothes or bedding.
  • Feeling faint, very tired, or unwell during periods.
  • Periods lasting longer than 7 days.
  • Periods stopping your young person from attending school or taking part in usual activities.

Please speak to your GP or paediatrician if your young person has any of these symptoms, if periods cause significant distress, or if they are missing school because of periods.

Medical options for troublesome periods

Medical treatments may reduce the flow of a period, reduce how often periods happen, or stop them for a time.

Note: Any medication should be discussed with your GP or paediatrician to check it is suitable for your young person and to make sure there are no contraindications.

Non-hormonal treatments

  • Tranexamic acid (TXA): Tranexamic acid is taken when bleeding is heaviest. It helps blood clot and can reduce bleeding. People with a history of blood clots may not be able to take this medication.
  • Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen is a common NSAID. Doctors may also prescribe mefenamic acid. These medicines can reduce period blood flow and help with discomfort. They may work best when started 24 to 48 hours before a period begins.

Important: Some clinicians recommend using tranexamic acid and mefenamic acid together during a period because they can help with both flow and pain. Always follow your prescriber’s advice on whether to use these together, when to start them and how often to take them.

Hormonal treatments

Hormonal treatments may not completely stop bleeding. Some young people experience irregular, small amounts of bleeding (spotting), which can settle over time.

Hormone tablets (oral contraceptives)

These medicines can reduce bleeding or temporarily stop periods. They can also help reduce cramping. Possible side effects include bloating, nausea, appetite changes and mood changes.

Options your clinician may discuss:

  • Progesterone-only pill (POP): A small daily pill containing progesterone only.
  • Combined oral contraceptive pill (COCP): Contains oestrogen and progesterone. It can help regulate bleeding patterns, particularly when bleeding is irregular.
  • Intrauterine system (IUS), sometimes called a coil: A small device placed in the womb that can reduce or stop periods. For some young people with learning disabilities, fitting may need a general anaesthetic. These are usually changed every 5 to 8 years.
  • Contraceptive implant: A small rod inserted under the skin of the arm, lasting up to 3 years. It releases progesterone, which can reduce or stop periods.
  • Contraceptive injection (Depo-Provera): An injection that can reduce or stop periods. It lasts for 3 months and needs repeating.

For more information, you can read the British Society for Paediatric and Adolescent Gynaecology leaflet on heavy menstrual bleeding:

Social and emotional changes during puberty

Puberty is not only about physical changes. It can also bring new feelings and social experiences. These shifts happen for most young people, but they may look different for those with learning disabilities or neurodivergence. Support can be tailored to each young person’s needs.

Typical changes

  • greater self-awareness about appearance
  • mood swings or stronger emotions
  • a desire for more independence from parents and carers
  • greater interest in friendships and later romantic relationships
  • increased influence of peers

For girls with learning disabilities

  • Social rules may be harder to understand, which can lead to anxiety or isolation.
  • Support may be needed with understanding privacy, appropriate touch and consent.
  • Friendships can become more complicated and gentle guidance is often helpful.

For girls with neurodivergence (for example autism, ADHD)

  • Friendships can become more complex in the teenage years. Unspoken rules, sarcasm, or shifting friendship groups can be confusing.
  • Emotional changes can feel more intense. Hormonal shifts may heighten anxiety, mood swings, or sensitivity to stress.
  • Feeling different may become more noticeable as girls compare themselves with peers.

What helps

  • Providing safe, structured spaces (clubs, groups or activities linked to interests) where friendships can grow naturally.
  • Celebrating strengths and individuality so young people feel proud of who they are.
  • Making sure there are trusted adults at home and at school to talk to if they feel upset or confused.

Understanding public and private

Explaining public and private places and activities

For girls with neurodivergence or learning disabilities, it can help to explain the difference between public and private by linking the idea of place with the types of activities that happen there. Keeping language concrete and consistent makes it easier to understand.

Understanding public and private supports socially appropriate behaviour. These ideas can be hard to grasp, so your young person may need clear guidance. Public and private relates to how we act, what we show and where certain behaviours are appropriate. You can support your young person by giving consistent rules, setting clear boundaries and modelling appropriate behaviour and language in everyday situations.

How to explain public and private

  • Start with places
    • Public places are where other people are around, for example school, the park, shops, buses, or the living room when others are present.
    • Private places are where your child is on their own, such as the bathroom, or their bedroom with the door closed.
  • Link activities to places
    • In public places, only public activities happen, such as talking, eating, playing, or shopping.
    • In private places, it is okay to do private activities, such as using the toilet, changing clothes, washing, or touching their own body.
  • Be clear about rules
    • Private activities should only happen in private places.
    • Nobody should touch your young person’s private parts unless it is for care or medical reasons and your young person agrees.
    • Support your young person to learn which body parts should only be touched in private and which activities belong in private spaces (for example touching themselves, masturbating, using the toilet, washing).

Tips for carers

  • Use simple language and repeat messages regularly.
  • Visual supports (for example pictures of public and private places) can help.
  • Reinforce learning in the moment, for example, “This is the bathroom. It’s a private place. It’s the right place to change clothes.”
  • Give positive feedback when your young person follows the rules so boundaries feel safe and encouraging.

As girls grow up, it is important to help them understand what makes a healthy relationship and how consent works. For girls with neurodivergence or learning disabilities, clear, simple explanations and regular reminders can help these ideas feel safe and easier to follow.

How to explain healthy relationships

  • A healthy relationship means people are kind, respectful and caring towards each other.
  • You should feel safe with friends, family, carers and partners.
  • It is not okay for someone to hurt you, make fun of you, or pressure you to do something you do not want to do.
  • Tell a trusted adult if you do not feel safe, or if someone is hurting or upsetting you.
  • Tell a trusted adult about any secret that makes you feel worried or upset.

How to explain consent

  • Consent means saying “yes” because you want to, not because you feel pressured or scared.
  • It is always okay to say “no” if something makes you uncomfortable, even with people you know well.
  • Your body belongs to you. Nobody should touch your private parts unless it is for care or medical reasons and only if you agree.
  • You can change your mind at any time. You can say “no” even if you said “yes” earlier.

Tips for carers

  • Use everyday examples to teach consent, for example “Would you like a hug?” and show that “no” is respected.
  • Reinforce choice by helping your young person practise making decisions in safe, small ways (for example choosing clothes or food).
  • Use role play, social stories, or visual aids to model safe and unsafe situations.
  • Repeat messages often. Simple, consistent language supports understanding over time.

Puberty in girls with learning disabilities

Puberty can feel like a big step for any young person. For girls with learning disabilities it may bring extra challenges. With the right preparation and support, most families find this stage can be managed smoothly.

Understanding changes

Puberty changes can be confusing if they are not explained clearly. Simple language, pictures and social stories can help. Talking little and often usually works best.

Managing personal care

Periods and body changes can bring practical challenges. Your young person may need extra help with hygiene routines such as showering, using deodorant, or changing pads. Consistency and reminders can be reassuring.

Behavioural responses

New sensations such as period pain or breast tenderness can cause distress. Preparing your young person and offering reassurance can help them feel supported.

Growing independence

Many girls learn self-care skills with gentle, step-by-step teaching. Celebrate small achievements. Every step towards independence matters.

Sexual feelings and masturbation

Some young people touch their private parts because it feels good. This is called masturbation and it is normal. Explain that it is a private behaviour and should only happen in private places, such as a bedroom or bathroom with the door closed.

Setting rules and boundaries

Clear, simple rules can help create safety.

  • Knock before entering bedrooms.
  • Encourage wearing clothes in shared spaces.
  • Remind your young person that private behaviours only happen in private places.
  • Support predictable hygiene routines.

Practical tips

  • Use clear, correct words (for example “vagina”, “breasts”).
  • Repeat information often.
  • Use pictures, calendars, or visual stories.
  • Track periods together.
  • Support hygiene and emotional wellbeing.

Sexual health and safety

Girls with learning disabilities may be more vulnerable to unsafe situations. Reinforce that private parts are private and encourage your young person to talk to a trusted adult if anything feels wrong. If behaviour seems worrying or unsafe, seek advice from a healthcare professional.

Useful resources

Puberty in girls with neurodivergence

For girls with autism, ADHD, or other forms of neurodivergence, puberty can feel like a particularly big adjustment. With the right support, many cope very well.

Hormonal shifts can make it harder to manage emotions and behaviour, which can affect how they feel at home, at school and socially. Young people often rely on trusted adults to help them make sense of what is happening. Talking openly at a level that suits your young person can help them understand their body, feelings and what to expect. Planning ahead and offering clear, calm support can help puberty feel more predictable and reassuring.

How can you support your young person?

Communication

  • Use short, simple explanations and books or visual aids.
  • Use clear, correct words (for example “vagina”, “period”, “breasts”). Slang can be confusing. If school uses specific terms, it can help to use the same words at home.
  • Start conversations early so your young person feels prepared.
  • Break information into small steps. Pictures and symbols can help.
  • Social stories may support understanding.

Managing personal care

  • Sensory sensitivities may make some products uncomfortable. You may want to try period pants or softer pads.
  • Let your young person look at and explore products so they understand how they work and what might suit them.
  • Create routines and rules around personal hygiene early. Consistent routines and visual reminders can reduce anxiety.

Behavioural and emotional responses

  • Hormonal changes can heighten mood swings or anxiety. Calm spaces, predictable routines and reassurance from trusted adults can help.

Growing independence

  • Give clear guidance, consistent routines and opportunities to practise skills at your young person’s pace.
  • Break tasks into manageable steps, use checklists if helpful and give plenty of praise as confidence builds.
  • Teach personal safety skills explicitly, including how to recognise safe and unsafe situations, who to ask for help and how to communicate needs.

Sexual feelings and masturbation

  • Talking about sexual feelings and masturbation can help your young person understand this is a normal part of growing up and understanding their body.
  • New feelings can cause anxiety. Clear information, hygiene advice and reassurance can help your young person feel calmer.

Setting rules and boundaries

  • Knock before entering bedrooms.
  • Encourage wearing clothes in shared spaces.
  • Private behaviours stay in private places.
  • Keep hygiene routines predictable.

Practical tips for families and carers

  • Use clear, concrete words (for example “period”, “vagina”).
  • Break information into small steps.
  • Use visual schedules, trackers, or social stories.
  • Track periods together to reduce anxiety.
  • Support emotions as well as hygiene.

Sexual health and safety

Girls with neurodivergence may be more vulnerable to peer pressure or unsafe situations. Reinforce safe and unsafe touch and make sure they know who they can talk to. Seek medical advice if behaviours are concerning.

Useful resources

Precocious puberty (early puberty)

Sometimes puberty starts earlier than expected. In girls, this means before 8 years of age. It can feel worrying to see these changes so soon, but help is available.

What might you notice?

  • Early breast development (small “buds” behind the nipples).
  • A rapid growth spurt (growing in height sooner than peers).
  • Pubic or underarm hair appearing at a young age.
  • New body odour or acne.

Why does early timing matter?

  • Children who start puberty very early may stop growing sooner, which can affect final adult height.
  • Changes can feel confusing or upsetting for a child who is not ready to understand them.
  • Sometimes (not often) early puberty is linked to a medical cause affecting hormones and needs assessment and, occasionally, treatment.

What should I do if I’m concerned?

  • Make a note of what you are noticing (when breast changes began, hair growth, growth spurts, mood changes).
  • Speak to your GP or paediatrician if signs appear before age 8, or if you are unsure.
  • Use simple, reassuring language with your child, for example “Your body is growing a bit earlier. We are going to talk to the doctor to help.”

What might happen at the appointment?

  • The doctor will ask about growth and development and may examine your child.
  • They might arrange growth measurements, a bone age X-ray, blood tests, or an ultrasound.
  • Sometimes treatment is recommended to pause or slow puberty, giving your child more time to grow and develop at a pace that suits them.