Recently, a remarkable study was published that found that the prevalence of endometriosis among transgender and gender-diverse people is 3 percent, a lower rate than previous research has shown.
The aim of the study was to determine the surgically confirmed prevalence of endometriosis among transgender and gender-diverse individuals who were diagnosed as female at birth. The study was a retrospective, multicentre cohort study involving 325 individuals who underwent laparoscopic pelvic surgery between 2021 and 2024 at three university clinics in the Netherlands and the UK. The average age of participants was 27.2 years.
The study diagnosed surgically confirmed endometriosis in 10 participants, or about 3.1 percent of the sample. The vast majority - 95.4 per cent - had been on testosterone therapy prior to surgery, and more than a third (38.5%) had been taking the hormone for at least five years at the time of surgery.
Painful menstruation, or dysmenorrhoea, occurred in only 6% of the total population. Of those found to have endometriosis, 30 per cent reported this symptom. This means that pain alone was not a reliable predictor of the presence of endometriosis in this group. This is in stark contrast to the data for cisgender women, where endometriosis is commonly found at a prevalence of 6-10 per cent and is detected in up to half of symptomatic women.
The authors of the study emphasise that understanding the prevalence of endometriosis among transgender and gender-diverse people is key to improving gynaecological and gender-affirming care. The findings highlight that these patients may have different symptoms and patterns of occurrence, and therefore require a personalised diagnostic approach. The research also suggests that sex-affirming hormone therapy, particularly early testosterone therapy, may have an impact on the development and detectability of endometriosis.
One limitation of the study is that it is retrospective, so there may be data communication gaps, the ethnic background of participants was not always documented, and differences between electronic health record systems and different surgical techniques may have influenced the results. A further limitation was the small number of cases (n=10), which makes subgroup analysis and generalisability of results difficult.
The fact that the prevalence was only 3 per cent - much lower than the rate among cisgender women - raises important questions about how sex-affirming hormone treatments, early menstrual suppression and different care pathways affect the onset and recognition of the disease.
Of particular note is that dysmenorrhoea, although present, has not been shown to be a reliable diagnostic sign in this population. This reminds clinicians that traditional diagnostic patterns and symptoms may not be uniformly applicable to all patients with gender identity. Although the study is limited in number of cases and retrospective in nature, it represents a fundamental step towards future prospective studies.
So the key message is that endometriosis is less common in transgender and gender-diverse people than previously thought, but when it is present, it requires the same thoughtful, empathetic and individualised care as cisgender women.
The authors stressed that the transgender and gender-diverse population is biologically, psychologically and socially specific, and therefore endometriosis research in this population requires a separate approach. Further studies are needed to explore the extent to which symptomatic or clinically significant endometriosis occurs in this group, how gender-affirming treatments affect the development and detection of the disease, and which diagnostic and therapeutic methods are most effective in taking into account the bio-psycho-social context.
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