Menstrual Suppression in Gender-Diverse Youth: What's Most Important to Patients?

To explore reasons for menstrual suppression method choice among transgender and gender-diverse (TGD) youth at the time of method initiation DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis of baseline data from a prospective cohort study of menstruating TGD youth (N = 55), aged 12-17 years, initiating a hormonal method for menstrual suppression in a gender health specialty clinic at a single site, quaternary hospital in the Midwest INTERVENTIONS AND MAIN OUTCOME MEASURES: Participants completed a baseline survey that included identifying the most important reason, as well as other important reasons, for menstrual suppression method selection.

The mean age was 14.9 (SD 1.5) years, and most participants identified as White (81.8%) and male or transgender male (90.9%). For menstrual suppression, participants chose progestin-only pills (43.6%), followed by depot medroxyprogesterone acetate injections (29.1%), levonorgestrel intrauterine devices (21.8%), and continuous combined oral contraceptive pills (5.5%). The 3 most reported reasons important to method choice were "seemed like the best choice for me," "ease of use," and "I don't want anything with estrogen in it." "Uncomfortable with a device in my body" and "not wanting a pelvic exam" were also frequently indicated as important factors influencing method choice.

Consistent with a patient-centered approach, comfort level with estrogen, implantable devices, and pelvic exam should be assessed early when discussing menstrual suppression options with TGD youth.