A 14 year old female with autism and severe developmental delay presents with her parents to discuss her menstrual patterns. The mother states that she is able to go to school with other delayed children. However, since she began her menses her parents state that she is unruly on the days of her menses. They state that she is very irritable and is acting out in school. They also note that she is quite moody on the week before her menses and during her menses.  The patient is unable to communicate.