Menstrual suppression effective, well-liked by transgender, gender-diverse adolescents

Key takeaways:

• Nearly all transgender adolescents receiving menstrual suppression reported satisfaction and effectiveness.
• Of those not currently receiving menstrual suppression, 87.5% had a strong interest in treatment.

Transgender and gender-diverse adolescents reported high menstrual suppression effectiveness and satisfaction, according to a cross-sectional study published in Obstetrics & Gynecology.

“In the general population, menstrual suppression is typically used for dysmenorrhea and heavy menstrual bleeding. Although menstrual suppression can be used in transgender and gender-diverse adolescents for these same reasons, it is commonly used with the aim of reducing the gender dysphoria associated with having periods,” Dehlia Moussaoui, MD, from the department of pediatrics, gynecology and obstetrics at Geneva University Hospitals, and colleagues wrote. “Consistent with this, current international clinical guidelines recommend considering menstrual suppression in transgender and gender-diverse adolescents who are experiencing gender dysphoria whose menstruation is not already suppressed.”

Moussaoui and colleagues evaluated 530 transgender and gender-diverse adolescents who were assigned female at birth and attended their first appointment at a specialist pediatric gender service from February 2017 to December 2021. Researchers obtained demographic and mental health data through a questionnaire conducted during the first visit and obtained information on menstrual suppression from medical records.

Overall, 92.8% of adolescents reported distress related to menstruation and 24.7% were on menstrual suppression at their first visit. The most common agent used was combined oral contraceptive pills (46.6%) followed by norethindrone (29.8%) and intramuscular medroxyprogesterone (14.5%).

Researchers observed high rates of effectiveness (93.8%) and patient satisfaction (86.4%) with menstrual suppression. Of the 399 adolescents who were not on menstrual suppression, 87.5% had a strong interest in starting the treatment. The most common reasons for interest in beginning menstrual suppression were to improve gender dysphoria (61.4%) followed by improving mood changes linked to menstruation (16.2%), improving dysmenorrhea (15.2%) and improving bleeding (6.9%).

Researchers noted no differences in the risks for gender dysphoria, depression or anxiety between adolescents receiving menstrual suppression and those who were not.

“Our study did not show any association between the use of menstrual suppression and gender dysphoria, depression or anxiety symptoms, but prospective longitudinal studies to better understand the effects of menstrual suppression on mental health are needed to properly address this question,” the researchers wrote. “In the meantime, we recommend that primary care clinicians routinely explore and manage menstrual health as part of their care and support for transgender and gender-diverse adolescents.”