How to talk to your gender-diverse or transgender child about their period

For any parent, talking about puberty and periods can be a little nerve-wracking. If your child is gender-diverse or transgender, the conversation can feel even more difficult. Luckily, it might not be as difficult as you think.

Fíona (Fí) D. Fonseca, M.B., B.Ch., B.A.O. (they/them), a psychiatry specialist at Mayo Clinic in Rochester, says, “My general approach to talking about periods with transgender and gender-diverse children would be quite similar to the one for cisgender children.”

Rather than having one big, formal, sit-down talk about periods, Dr. Fonseca recommends a continuous process starting early in childhood with fact-based, straightforward and age-appropriate information.

 “Caregivers and parents can find organic opportunities to talk about it, such as when kids ask about growing up, older siblings’ bodies changing, where babies come from or if they are around while the adult is buying menstrual products,” Dr. Fonseca says. “All children need to know about what can happen to their bodies during puberty before they actually reach puberty. It’s particularly important for trans kids who may benefit from considering interventions such as puberty blockers.”

Questions your gender-diverse or transgender child might have about periods

Children with the potential for menstruation — regardless of gender identity — will likely have many questions and concerns about periods. Parents should be ready to answer questions, such as: Do periods hurt? When will I get my period? How do menstrual products work?

Trans and gender-diverse kids also might ask about whether transgender people have periods. So, be prepared to talk about how menstruation works in bodies of all kinds.

Do transgender and gender-diverse individuals have periods?

Anyone with a uterus, vagina and ovaries may have periods. People who do not have these organs cannot menstruate.

To stop getting periods, menstruating individuals may use hormone treatments, such as birth control pills and IUDs. Additionally, hormone therapies such as testosterone supplementation designed to develop traditionally masculine traits can eliminate or reduce periods. However, when hormone treatments and therapies end, periods will restart. To eliminate periods permanently, some individuals may choose procedures such as hysterectomies (removing the uterus). However, surgical interentions are typically not performed until adulthood.

How does gender dysphoria impact a child getting their period?

Gender dysphoria — a serious condition that can happen when an individual’s biological sex and gender identity differ — can cause significant distress. For some gender-diverse or trans masculine kids, a period can be a (literally) painful reminder of a gender they don’t identify with. Halting menstruation may be especially helpful for kids who experience premenstrual dysphoria, which are mood changes such as sadness, irritability and anxiety around the time a period starts.

“Some individuals with periods struggle with painful or heavy menses and these experiences may further impact gender dysphoria. It is important to let children know that there are ways to halt menstruation that can be used as treatments for these conditions, but also if the experience of menstruation is distressing to them in general. If the premenstrual dysphoria gets to the point where there is a significant impact on well-being or day-to-day functioning, children may also benefit from additional mental health supports such as medication for mood, psychotherapy or both,” Dr. Fonseca says.

What to do if a child wants to stop their period

“If a child wants to stop their period, parents and caregivers can schedule an appointment with the child’s physician or advanced care provider in pediatrics, primary care or gynecology,” says Dr. Fonseca. “They will be able to discuss options for menstrual suppression with the patient and the parent(s) or caregiver(s), so a fully informed and collaborative decision can be made.”

The World Professional Association for Transgender Health (WPATH) Standards of Care, 8th Edition, recommends that “providers consider prescribing menstrual suppression agents for adolescents experiencing gender incongruence who may not desire testosterone therapy, who desire but have not yet begun testosterone therapy or in conjunction with testosterone therapy for breakthrough bleeding.”

Dr. Fonseca adds, “It is also important to note that if the child is on testosterone therapy, some options, for instance, oral contraceptive pills containing drospirenone which is anti-androgenic, might be less favorable. For some individuals, the use of puberty blockers or testosterone can suppress menstruation.”

How parents can prepare for transgender kids getting their periods

When it comes to preparing your kid for getting their period, Dr. Fonseca has some advice.

“Three main things stand out as concerns to me: accessibility to restrooms, [menstrual] supplies, gender dysphoria and sense of safety,” Dr. Fonseca says. “Once again, it is critical that we talk about this with children as part of an ongoing process rather than a one-off conversation.”

“Parents and caregivers are in a position to advocate for their children. For instance, children need access to restrooms that are safe, and adults can help advocate for such access. In some states, the situation is more dire and not all parents and children have that privilege. It is so, so unfortunate,” Dr. Fonseca says.

As a result, Dr. Fonseca recommends parents and caregivers also may have to talk with their children about safety measures.

“For instance, ask children to use a buddy system to help with safety concerns, but honestly, no child should have to go through this. We need to keep advocating for safety for all and access to basic needs.”

New research on gender dysphoria and periods is on its way

There’s currently not much research on how menstrual suppression interacts with gender dysphoria in adolescents. However, Dr. Fonseca says, “We recently received a small grant at Mayo and are in the beginning stages of research into exploring the transgender and gender-diverse experience of menstruation. Stay tuned for further updates!”

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