Stopping periods is not a minor detail in trans adolescence: for many trans and non-binary young people menstruation is a direct source of distress and dysphoria, and managing it sits squarely inside medical care. A Canadian team has just published, in the Journal of Obstetrics and Gynaecology Canada, the most detailed picture to date of what is prescribed and how often in a paediatric gender diversity clinic.
112 charts, more than five years of follow-up
The authors retrospectively reviewed the records of 112 young people assigned female at birth, aged 11 to 18, first seen at a paediatric gender diversity clinic between 1 November 2016 and 31 May 2021 and followed until 1 June 2022. Median age at first consultation was 15.2 years. Most identified as binary transgender (91 participants, 81%) and the rest as non-binary or questioning (21, 19%). Gender identity, medical gender-affirming treatments and outcome measures were extracted from the charts, with menstrual suppression as the central focus.
What is prescribed in practice
- Almost half of the cohort (44.6%) received gonadotropin-releasing hormone agonists alone at least once during follow-up, with high rates of menstrual suppression. These drugs — the so-called puberty blockers — shut down the hormonal axis that drives the cycle.
- Hormonal contraceptive monotherapy was prescribed to 40.2% of the whole cohort, at similar proportions among binary transgender (38.5%) and non-binary or questioning participants (47.6%).
- The study also describes the different combinations of menstrual suppression and contraception used over follow-up, without the authors finding marked differences between the two identity groups.
The key point is one of framing: managing the cycle is not an exception or a late add-on, but a routine part of care for these adolescents, alongside the assessment of any gender-affirming treatment. Puberty blockade and hormone therapies do not only act on puberty — they also interrupt or alter menstruation, and that demands explicit follow-up.
Why periods hurt and why they are treated
Menstruation is one of the most insistent bodily reminders of an assigned sex that does not match a person’s felt identity, and it can rekindle dysphoria at a particularly delicate point in development. When the goal is to stop it, the usual pharmacological route combines hormonal contraceptives — often taken continuously, without a break — with GnRH agonists when deeper suppression is sought or when the person is at a different stage of transition.
Each option has nuances: hormonal contraceptives are usually accessible and reversible, while GnRH agonists allow pubertal suppression and are the backbone of treatment in the earliest stages, with the cost and monitoring they entail. The choice depends on age, developmental stage, the young person’s own goals and the side effects to watch, especially in bone.
What the study does not answer
This is a descriptive, retrospective, single-centre study with no comparison group: it portrays one specific clinical practice in a specialised paediatric clinic and does not allow comparison of the effectiveness of one regimen against another, nor extrapolation of its figures to other countries or health systems. It does not analyse the individual reasons behind each choice either, nor patient satisfaction. Its authors present it as a basis for knowing what is actually being done — a first step towards designing studies that measure outcomes.
For families and for the teams supporting these decisions, the message is twofold: suppressing the cycle is a legitimate and frequent part of gender-affirming care, and it deserves the same seriousness, information and follow-up as any other hormonal treatment.
Source: Menstrual Suppression and Contraception in a Cohort of Gender Diverse Adolescents Assigned Female at Birth. Michaud P, Jodoin A, Kelley J, et al. Journal of Obstetrics and Gynaecology Canada 2026;103520. DOI: 10.1016/j.jogc.2026.103520.
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