Assessment and education in self‐care, ‘activities of daily living’ (ADL) have provided a traditional focus among occupational therapists. Available literature supports the teaching of self‐care skills to clients who have severe and profound intellectual disability. Although some programmes have been developed to deal with menstrual management for women with mild and moderate intellectual disability, studies addressing the needs of women with more severe disabilities (high support needs) are sparse, and generally involve only small numbers of women. A menstrual management project based at the University of Queensland developed a model of intervention to assist with menstrual management for women with high support needs. Case studies illustrate three key areas of intervention: (1) assessment of the women's actual or potential menstrual management skills; (2) increasing awareness of attitudes towards menstruation for women who have intellectual disability, among people assisting them; and (3) provision of a range of information, processes and resources to assist educators, families and others providing personal assistance, with informed menstrual management for these women. Positive gains made by four women with high support needs are presented. Relevant issues and difficulties are discussed.