Abstract
Study Objective
To study the presentation of dysmenorrhea and endometriosis in transmasculine adolescents
and review their treatment outcomes.
Design
A retrospective review.
Setting
Boston Children's Hospital.
Participants
Transmasculine persons younger than 26 years old who were diagnosed with dysmenorrhea
and treated between January 1, 2000 and March 1, 2020.
Interventions
Not applicable.
Main Outcome Measures
An electronic medical record review of the clinical characteristics, transition-related
care, and treatment outcomes.
Results
Dysmenorrhea was diagnosed in 35 transmasculine persons. Mean age was 14.9 years ± 1.9 years.
Twenty-nine (82.9%) were diagnosed after social transition. Twenty-three of 35 (65.7%)
were first treated with combined oral contraceptives, but 14/23 (61%) discontinued
or transitioned to alternative therapy. Twelve patients with dysmenorrhea alone initiated
testosterone treatment, and 4/12 (33.3%) experienced persistent symptoms. Seven of
35 patients with dysmenorrhea (20.0%) were laparoscopically evaluated for endometriosis,
and it was confirmed in all seven. Six had stage I disease, and one had stage II.
Three of the 7 (42.9%) were diagnosed after social transition, with one diagnosed
20 months after initiating testosterone treatment. Their endometriosis was treated
with combined oral contraceptives, danazol, or progestins; four experienced suboptimal
response during treatment with these therapies alone. Two of those with suboptimal
response subsequently resolved their dysmenorrhea when using testosterone. Five patients
with endometriosis initiated testosterone treatment, and of the 5 (40%) experienced
persistent symptomatology with combined testosterone and progestin therapies.
Conclusion
To our knowledge, this is the first study to characterize endometriosis in transmasculine
persons. Evaluation for endometriosis was underutilized in transmasculine persons
with dysmenorrhea, despite those who underwent laparoscopic evaluation and had disease
confirmation. Although testosterone treatment can resolve symptoms in some, others
might require additional suppression. Endometriosis should be considered in transmasculine
persons with symptoms even when they are using testosterone.
Key Words
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Article info
Publication history
Published online: June 10, 2020
Footnotes
Dr Marc Laufer is the Director of the Boston Center for Endometriosis, which receives funding from the J. Willard and Alice S. Marriott Foundation. He is also on the International Advisory Board of AbbVie Pharmaceuticals, an advisor for NextJane Gen, and an author for UpToDate. Drs Frances Grimstad and Jessica Shim have no conflicts of interest to disclose.
Identification
Copyright
© 2020 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
