‘Every boy should know about it’
Periods can be a difficult time for trans boys and men. But, as finds, for Awatea Rotherham, it is made far worse by the pain of endometriosis.
Each month when Awatea Rotherham gets his period, he is often crippled with pain from cramping and the discomfort of nausea. He has to take days off school, which can add up to almost amonth of missed classroom time in a year.
Rotherham is a trans teenage man, in his last year of high school in Wellington.
Menstruation can be a complicated time for trans boys and men, and for those who are nonbinary – people who are not exclusively masculine or feminine. It is a tangible reminder of the unease – and even hate – they might feel for a body and its functions that don’t line up with their gender.
In Rotherham’s case, that time of the month comes with a one-two punch. That’s because he has endometriosis, a painful disorder caused when tissue that lines the inside of the uterus grows elsewhere in the pelvic area, often producing cysts and scar tissue.
‘‘When you have something happening in your life that you don’t want to happen anyway, then for it to be a struggle, it’s not great,’’ said Rotherham.
It is estimated that one in 10 women have endometriosis. And that’s one of the issues for trans men or non-binary people – one in 10 women.
The area of endometriosis care is an example of a gendered space, like the exclusionary marketing of tampons and pads as ‘‘feminine products’’, where language and mindset tend to cater only to women. However, experts say that statistic is true for trans men and those who are non-binary, but labelled female at birth.
Endometriosis treatment can be tough and liberating for these two groups of people. Different treatments, like the contraceptive pill, can exaggerate feminine aspects of a body, causing trauma for some.
On the flip side, transition-related medical care, such as testosterone that often results in a lower voice and coarse facial hair, can also help endometriosis symptoms.
For all those who have endometriosis, treatment is often achieved through trial and error, with no guarantee of success.
‘‘You have to treat these patients with a multidisciplinary team and whether that involves individual surgeons, endocrinologists, sexual health physicians, and then also pain specialists, pain physiotherapists and pain psychologists,’’ said Dr Michael Wynn-williams, an Auckland gynaecologist and endometriosis specialist who has worked with trans and non-binary patients.
‘‘Any person, whether they are cis [a person whose gender aligns with their birth sex] or transgender, you need to treat them holistically.’’
As an ‘‘early bloomer’’, Rotherham started his period around 11. His hips started to widen and breasts started to grow. It was awakeup call that he wasn’t quite comfortable with his body.
His periods didn’t become debilitating with the telltale signs of endometriosis until he was in year nine.
‘‘It is a really isolating time of hormonal stress,’’ said Rotherham.
‘‘I was very uncomfortable that my body could just do this. I had no control over it.’’
Rotherham moved to Wellington in 2016 from Palmerston North at the beginning of year 10. Within an LGBTQI+ support group, he began trying out different pronouns like they/them/ theirs or ze/hir/hir. In the end, it was he/him/his that felt right.
At this time, he sought medical help for his period pain that just couldn’t be normal. A doctor told him he likely had endometriosis and put him on contraceptive pills, a common management strategy that can stop someone’s periods and the accompanying pain.
‘‘It was not effective for me,’’ said Rotherham. ‘‘I didn’t stop bleeding.’’
The daily pill he took for several months also came with a hormone imbalance, swelling, bloating, and general aches and pains. The cure