Fertility preservation knowledge among transgender women: preliminary findings from the gear study

Abstract

MATERIALS AND METHODS: Transgender and gender diverse individuals assigned female at birth age 18 and older that currently have an IUD participated in an online survey about reproductive history, rationale for IUD choice, unwanted side effects, and satisfaction.RESULTS: 85 surveys were completed. The mean age was 25.8 (SD 4.7). 14 (16%) identified as transgender, 70 (82%) as genderqueer or non-binary, and 1 (1%) as agender. The majority (71 (85%) was white and had minimum of a college education (47, 55%). 72 (85%) were sexually active, and 63 (88%) were at risk for pregnancy. 62 (73%) chose a 52mg-Levonorgestrel (LNG) IUD (MirenaÒ/ LilettaÒ), 5 (6%) the lower dose IUDs (KyleenaÒ/ SkylaÒ), and 17 (20%) the copper IUD (ParagardÒ).Menstrual manipulation was the main reason for choosing a 52mg-LNG IUD (35, 56%). Other influential factors included how long the IUD lasted (39, 63%), provider recommendation (28, 45%), and to avoid side effects experienced from other methods of contraception (28, 45%). 24 (39%) experienced unwanted side effects including worsening cramping (8, 33%,), pelvic pain (7, 29%), bloating (7, 29%) and weight gain (7, 29%). 6 (25%) reported these side effects within the first 0-6 months. 6 (25%) desired removal. Of those that desired removal, 2 (33%) would opt for another IUD.The main reasons for choosing the lower dose IUDs were the size of IUD (2, 40%), and lower hormone dose (2, 40%). Other influential factors included insurance coverage (4, 80%), how long the IUD lasted (4, 80%), and menstrual manipulation (3, 60%). 2 (40%) experienced unwanted side effects including heavy bleeding (2, 100%), worsening cramping (2, 100%), and pelvic pain (2, 100%). 1 (50%) reported these side effects within the first 3-6 months. Neither (2, 100%) desired removal.The majority of participants selecting the copper IUD did so to avoid hormones (12, 71%). Other influential factors included how long the IUD lasted (12, 80%), to avoid side effects experienced by other methods of contraception (9, 60%), and provider recommendation (6, 40%). 10 (67%) stated they were experiencing unwanted side effects including irregular bleeding (7, 70%) and worsening cramping (5, 50%). 4 (40%) reported these side effects in the first 0-6 months. However, only 2 (20%) desired removal, and both would opt for another type of IUD.CONCLUSIONS: Of the IUD options available, the majority of transgender and gender diverse individuals surveyed opted for a 52mg-LNG IUD and chose this specific IUD type for menstrual manipulation. Although side effects were experienced with all options, many occurred within the first 6 months, and few desired removal. As a result, providers should counsel this population about the benefits of an IUD as well as expected side effects including those that should resolve over time.