Adolescent girls with learning difficulties are more likely than average to have menstrual problems. This relates in part to the use of neuroleptic and antiepileptic drugs. Obesity and thyroid dysfunction may also be relevant. A case series from Cheltenham suggests that the levonorgestrel intrauterine system (LNG IUS) is a useful option for those patients and for those with medical disorders or physical disability. Over a ten-year period 14 young women aged 11-21 years with medical, physical or learning disabilities were referred by their GP or a consultant. All had menstrual problems that had resisted standard therapies: antifibrinolytics, NSAIDs, and where appropriate the combined oral contraceptive pill or contraceptive patch. The disabilities included previous CVA, diabetes, epilepsy, various congenital causes of learning difficulty and behavioural problems. 'The LNG IUS is now a first-line therapy for menorrhagia and should be considered in all women before proceeding to hysterectomy. Its use in teenagers with menstrual problems or indeed those requiring contraception is less common. This is, however, an example of usual practice not having kept up with medical progress. The IUS can be fitted in nulliparous women and it provides excellent long-term contraception as well as being remarkably effective in the treatment of menorrhagia. '