Rapid systematic literature review of endometriosis in transgender, gender diverse and non-binary individuals: Barriers, treatment, and lived experiences.

Abstract

Introduction: It is anticipated that endometriosis, a chronic inflammatory condition affecting around 10% of people assigned female at birth (AFAB), is significantly underreported within transgender, gender diverse, and non-binary (TGDN) people due to specific barriers this population experiences in gaining access to supportive, gender-affirming healthcare. This rapid systematic literature review (RSLR) aims to explore existing research on the management, treatment, and lived experiences of endometriosis and associated pelvic pain among TGDN individuals AFAB, to ultimately inform enhanced future healthcare.

Methods: Conducted in accordance with World Health Organization guidelines, multiple databases were searched with a search strategy developed using Boolean operators. Studies were assessed against predetermined inclusion/exclusion criteria, with included studies published in English, with no date/geographical limitations applied and relevant to the research question. Drawing upon Braun and Clarke, collected data were analyzed using a thematic analysis approach.

Results: Twelve studies were identified, with findings highlighting significant healthcare barriers for TGDN people AFAB with endometriosis, including delayed diagnosis, limited provider knowledge, and gender dysphoria linked to gynecological care. Studies highlighted a lack of awareness among healthcare providers, contributing to inadequate support.

Conclusions: This RSLR provides timely insights into current treatment approaches, barriers to care, and potential strategies to improve gender-affirming and holistic healthcare for TGDN people AFAB experiencing endometriosis and related pelvic pain. Addressing systemic barriers through further research and future interventions may inform improved diagnosis, treatment, and access to care, creating a more supportive and gender-affirming healthcare environment for this underserved population.