Ethics and the Medicalization of Menarche and Menstruation in Pediatric Endocrinology

Pediatric endocrinologists routinely manage menstruation for female children with limited evidence-based attention to the social and corporeal experiences of menstruation. This raises concern for harm from current care practices, given negative beliefs and stigma surrounding menstruation, as well as assumptions based on hetero-normative and cis-normative biases that influence clinical care practices. For instance, pediatric endocrinologists suppress menarche in early variant puberty and in gender questioning individuals to alleviate distress presumed to accompany menarche and menstruation. On the other hand, in female children with hypogonadism, menstruation is routinely induced to mimic the bodies of “normal females.” To what extent do clinical practices reinforce stigma associated with menstruation and/or reify narrow understandings of what it means to be female? What are the harms? Considering that menstruation is highly value-laden and tied to sense of self, and that harm results from unfavorable views and experiences of menstruation, arriving at ethical care requires interrogating not just safety and efficacy of pharmaceutical interventions, but also how best to respond to individual and social values that respectively shape experiences and provision of care. Given increasing rates of early pubertal development and numbers of gender questioning individuals, as well as the high frequency of individuals with menstrual irregularities, there is an urgent imperative to understand how best to promote patient well-being in menstrual management, especially in pediatric contexts where caregiver values shape decision-making. We propose a framework for advancing menstrual-related care that prioritizes experiences, values, and preferences of individuals capable of menstruating to define goals of care.

Anne Lyerly – Social Medicine – University of North Carolina at Chapel Hill