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. 2023 Apr 1;141(4):748-755.
doi: 10.1097/AOG.0000000000005123. Epub 2023 Mar 9.

Outcomes of Menstrual Management Use in Transgender and Gender-Diverse Adolescents

Beth I Schwartz  1 , Benjamin Bear, Vanessa L Short, Anne E Kazak
Affiliations

Outcomes of Menstrual Management Use in Transgender and Gender-Diverse Adolescents

Beth I Schwartz et al. Obstet Gynecol. .

Abstract

Objective: To describe and compare the outcomes of various menstrual-management methods, including method choice, continuation, bleeding patterns, amenorrhea rates, effect on moods and dysphoria, and side effects, in transgender and gender-diverse adolescents.

Methods: This was a retrospective chart review of all patients seen in a multidisciplinary pediatric gender program from March 2015 to December 2020 who were assigned female at birth, had achieved menarche, and used a menstrual-management method during the study period. Data were abstracted on patient demographics and menstrual-management method continuation, bleeding patterns, side effects, and satisfaction at 3 months (T1) and 1 year (T2). Outcomes were compared between method subgroups.

Results: Among the 101 included patients, 90% chose either oral norethindrone acetate or a 52-mg levonorgestrel (LNG) intrauterine device (IUD). There were no differences in continuation rates for these methods at either follow-up time. Almost all patients had improved bleeding at T2 (96% for norethindrone acetate and 100% for IUD users), with no difference between subgroups. Amenorrhea rates were 84% for norethindrone acetate and 67% for IUD at T1 and 97% and 89%, respectively, at T2, with no differences at either point. The majority of patients had improved pain, menstrually related moods, and menstrually related dysphoria at both follow-up points. There were no differences in side effects between subgroups. There were no differences in method satisfaction between the groups at T2.

Conclusion: Most patients chose norethindrone acetate or an LNG IUD for menstrual management. Continuation, amenorrhea, and improved bleeding, pain, and menstrually related moods and dysphoria were high for all patients, indicating that menstrual management is a viable intervention for gender-diverse patients who experience increased dysphoria related to menses.

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Conflict of interest statement

Financial Disclosure Beth I. Schwartz disclosed that this article discusses off-label use of norethindrone acetate for menstrual suppression. The authors did not report any potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.. Flowchart of the study population.
Fig. 2.
Fig. 2.. Menstrual-management method use during the study period.
See this image and copyright information in PMC

References

    1. Schwartz BI, Effron A, Bear B, Short VL, Eisenberg J, Felleman S, et al. . Experiences with menses in transgender and gender non-binary adolescents. J Pediatr Adolesc Gynecol 2022;35:450–6. doi: 10.1016/j.jpag.2022.01.015 - DOI - PubMed
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    1. Schwartz BI, Alexander M, Breech LL. Intrauterine device use in adolescents with disabilities. Pediatrics 2020;146:e20200016. doi: 10.1542/peds.2020-0016 - DOI - PubMed
    1. Carswell JM, Roberts SA. Induction and maintenance of amenorrhea in transmasculine and nonbinary adolescents. Transgend Health 2017;2:195–201. doi: 10.1089/trgh.2017.0021 - DOI - PMC - PubMed
    1. Kanj RV, Conard LAE, Corathers SD, Trotman GE. Hormonal contraceptive choices in a clinic-based series of transgender adolescents and young adults. Int J Transgend 2019;20:413–20. doi: 10.1080/15532739.2019.1631929 - DOI - PMC - PubMed

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