Evaluation of the factors affecting the selection of methods used for menstrual suppression in adolescents experiencing menstrual dysphoria

Gender diversity is having a gender identity that differs from the social and cultural expectations ascribed to one's gender assigned at birth. The distress or discomfort caused by this difference is defined as gender dysphoria. The distress or discomfort associated with menstruation is defined as menstrual dysphoria. Studies show that depression, self-harm, and suicidal ideation increase in individuals with gender diversity during menstruation. Menstruation suppression is the reversible use of hormonal methods to reduce or stop menstrual bleeding, and studies show that it may alleviate menstrual dysphoria. The aim of this study was to evaluate the menstruation experience of gender diverse individuals and to determine the factors affecting the choice of menstruation suppression method. The study population consisted of gender diverse youth aged between 12-24, experiencing menstruation-related anxiety, who applied to Hacettepe University between December 2021 and September 2023. Two surveys were developed by the researchers: The first survey aimed to evaluate the gender characteristics and menstruation experiences of the participants. After counseling the participants about menstruation suppression, the reasons for choosing and not choosing each method were evaluated with the second survey. All of the participants (n=21) felt very/extremely uncomfortable with menstruation. Among menstruation-related conditions, "menstruation not being compatible with gender identity" was defined as very/extremely disturbing by 95.2% of the participants. "Carrying and changing hygienic products" was the menstrual condition most frequently associated with extreme discomfort (95.2%). "Buying hygienic products" was found very/extremely disturbing by 90.5% of the participants. The most commonly chosen menstrual suppression method was the combined oral contraceptive (COC) (63.1%). Etonogestrel implant (10.2%), depot medroxyporgesterone acetate injection (10.2%) and the progesterone-containing pill (5.2%) were chosen less frequently, whereas the Levonogestrel-releasing intrauterine device was not chosen at all. Many factors such as estrogen content, method and frequency of application, need for gynecological examination, need to apply to a different medical department, and frequency of follow-up were effective in choosing the method. In our study, it was found that the most preferred method was combined oral contraceptive. Although all participants were given the same counseling, the methods chosen and reasons for choosing this method varied. Therefore, generalizations about the choices of youth with gender dysphoria should not guide our counseling. Our study highlights the importance of individual counseling in menstrual dysphoria.