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

Study objective: To explore reasons for menstrual suppression method choice among transgender and gender diverse (TGD) youth at time of method initiation.

Design, setting, and participants: A cross-sectional analyses of baseline data from a prospective cohort study of menstruating TGD youth (N=55), age 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 which included identifying the most important reason, as well as other important reasons in menstrual suppression method selection.

Results: 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 three most reported reasons important in 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.

Conclusion: 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.