(34) Correlates of Endometriosis Diagnosis from Diagnostic Laparoscopy for Pelvic Pain in Transgender-Non Binary Patients

Background: Endometriosis is estimated to affect 49-75% of adolescents with chronic pain who undergo laparoscopy. The prevalence of endometriosis in transgender-nonbinary (TGNB) adolescent and young adults (AYA) is estimated at 25% but data is limited. Interaction between gender dysphoria and pelvic pain have been poorly characterized. We aimed to describe the characteristics and rate of endometriosis in TGNB AYA patients who underwent diagnostic laparoscopy for pelvic pain at a single institution.

Methods: We performed a retrospective chart review of TGNB patients who underwent diagnostic laparoscopy for dysmenorrhea and/or chronic pelvic pain at an academic children’s hospital with a pediatric and adolescent gynecologist from July 1, 2019 to June 15, 2023. IRB approval was obtained. Data on demographics, medical history, gynecologic history, social history, operative and pathology reports were collected. Descriptive statistics are reported.

Results: Of 11 TGNB patients 4 (36.4%) were diagnosed with endometriosis. The mean age of chronic pain onset was 13.5 years and average age at surgery was 16.4 years. Ten (90.9%) had dysmenorrhea and 8 (72.7%) had chronic pelvic pain. In sexually active patients 16.7% reported dyspareunia. Eight (72.7%) reported a family history of endometriosis. Gender identities included transgender male 54.5%, nonbinary 18.2%, gender fluid 9.1% and gender dysphoria not specified 18.2%. Four (36.4%) were receiving testosterone for a mean treatment length of 8.5 months, with no difference in rate of endometriosis from those not using testosterone (50% and 28.6% respectively, p=0.58). Mean number of different non-testosterone hormonal therapies ever used pre-operatively was 1.8, and 5 patients had a levonorgestrel intrauterine device (IUD). The most common concomitant procedure was IUD insertion (7, 63.6%). Peritoneal biopsies were performed in 8 (72.7%) patients with a mean number of 2.38. Endometriosis diagnosis did not affect improvement in pain at 6 months (p =0.52) and 12 months (p=1) (Figure 1). One patient without endometriosis went on to have a hysterectomy due to continued pelvic pain and gender dysphoria, with a second patient planned for the same.

Conclusions: In this small study, the rate of endometriosis diagnosis in TGNB patients undergoing diagnostic laparoscopy was lower than previously reported for adolescents. Time from symptom onset to surgery was shorter than generally reported for endometriosis diagnosis. Rate of endometriosis was not different between testosterone users and non users. Further study is needed involving a comparison group of cis gendered AYA patients.