Review article| Volume 85, ISSUE 6, P527-537, June 2012

Contraception for individuals with sickle cell disease: a systematic review of the literature



      Women with sickle cell disease have an increased risk of pregnancy-related complications and need safe, effective contraceptive methods to prevent unintended pregnancy.

      Study Design

      We conducted a systematic review to examine the safety of hormonal and intrauterine contraceptive use among women with sickle cell disease.


      Eight articles met the inclusion criteria. The evidence was of fair to poor quality and suggested that progestin-only and combined hormonal contraception had no effect on frequency of sickle crises or other adverse events and no effect on hematologic parameters associated with sickle crises. No studies examined the risk of thromboembolism in combined hormonal contraceptive users with sickle cell disease. There was insufficient evidence to comment on the safety of intrauterine contraception.


      While data are limited, there is no evidence to suggest that hormonal contraceptive use among women with sickle cell disease is associated with an increased risk of clinical complications.


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        • Hassell K.L.
        Population estimates of sickle cell disease in the U.S.
        Am J Prev Med. 2010; 38: S512-S521
        • Rees D.C.
        • Williams T.N.
        • Gladwin M.T.
        Sickle-cell disease.
        Lancet. 2010; 376: 2018-2031
        • Booth C.
        • Inusa B.
        • Obaro S.K.
        Infection in sickle cell disease: a review.
        Int J Infect Dis. 2010; 14: e2-e12
        • Smith J.A.
        • Espeland M.
        • Bellevue R.
        • Bonds D.
        • Brown A.K.
        • Koshy M.
        Pregnancy in sickle cell disease: experience of the Cooperative Study of Sickle Cell Disease.
        Obstet Gynecol. 1996; 87: 199-204
        • Larrabee K.D.
        • Monga M.
        Women with sickle cell trait are at increased risk for preeclampsia.
        Am J Obstet Gynecol. 1997; 177: 425-428
        • Powars D.R.
        • Sandhu M.
        • Niland-Weiss J.
        • Johnson C.
        • Bruce S.
        • Manning P.R.
        Pregnancy in sickle cell disease.
        Obstet Gynecol. 1986; 67: 217-228
        • Charache S.
        • Niebyl J.R.
        Pregnancy in sickle cell disease.
        Clin Haematol. 1985; 14: 729-746
        • Sun P.M.
        • Wilburn W.
        • Raynor B.D.
        • Jamieson D.
        Sickle cell disease in pregnancy: twenty years of experience at Grady Memorial Hospital, Atlanta, Georgia.
        Am J Obstet Gynecol. 2001; 184: 1127-1130
        • Reid R.L.
        • Westhoff C.
        • Mansour D.
        • et al.
        Oral contraceptives and venous thromboembolism consensus opinion from an international workshop held in Berlin, Germany in December 2009.
        J Fam Plann Reprod Health Care. 2010; 36: 117-122
        • Francis R.B.
        Large-vessel occlusion in sickle cell disease: pathogenesis, clinical consequences, and therapeutic implications.
        Med Hypotheses. 1991; 35: 88-95
        • Francis Jr, R.B.
        Platelets, coagulation, and fibrinolysis in sickle cell disease: their possible role in vascular occlusion.
        Blood Coagul Fibrinolysis. 1991; 2: 341-353
        • Ataga K.I.
        Hypercoagulability and thrombotic complications in hemolytic anemias.
        Haematologica. 2009; 94: 1481-1484
      1. Stein PD, Beemath A, Meyers FA, Skaf E, Olson RE. Deep venous thrombosis and pulmonary embolism in hospitalized patients with sickle cell disease. Am J Med 2006;119:897 e897-811.

        • Austin H.
        • Key N.S.
        • Benson J.M.
        • et al.
        Sickle cell trait and the risk of venous thromboembolism among blacks.
        Blood. 2007; 110: 908-912
        • DeVenuto F.
        Interaction of progesterone and aldosterone with red blood cells of the rat.
        Proc Soc Exp Biol Med. 1967; 124: 478-483
        • Norris L.A.
        • Bonnar J.
        The effect of oestrogen dose and progestogen type on haemostatic changes in women taking low dose oral contraceptives.
        Br J Obstet Gynaeco. 1996; 103: 261-267
        • Mehta P.
        • Mehta J.
        Circulating platelet aggregates in sickle cell disease patients with and without vaso-occlusion.
        Stroke. 1979; 10: 464-466
        • Papadimitriou C.A.
        • Travlou A.
        • Kalos A.
        • Douratsos D.
        • Lali P.
        Study of platelet function in patients with sickle cell anemia during steady state and vaso-occlusive crisis.
        Acta Haematol. 1993; 89: 180-183
        • Ballas S.K.
        • Smith E.D.
        Red blood cell changes during the evolution of the sickle cell painful crisis.
        Blood. 1992; 79: 2154-2163
        • Oski F.A.
        • Lubin B.
        • Buchert E.D.
        Reduced red cell filterability with oral contraceptive agents.
        Ann Intern Med. 1972; 77: 417-419
        • Durocher J.R.
        • Weir M.S.
        • Lundblad E.G.
        • Patow W.E.
        • Conrad M.E.
        Effect of oral contraceptives and pregnancy on erythrocyte deformability and surface charge.
        Proc Soc Exp Biol Med. 1975; 150: 368-370
        • Yoong W.C.
        • Tuck S.M.
        • Yardumian A.
        The effect of ovarian steroids on sickle cell deformability.
        Clin Lab Haematol. 1998; 20: 151-154
      2. Isaacs WA. The effect of certain lipid substances on sickling. Acta Haematol;45:259-65.

        • Isaacs W.A.
        • Effiong C.E.
        • Ayeni O.
        Steroid treatment in the prevention of painful episodes in sickle-cell disease.
        Lancet. 1972; 1: 570-571
        • Isaacs W.A.
        • Hayhoe F.G.
        Steroid hormones in sickle-cell disease.
        Nature. 1967; 215: 1139-1142
        • Legardy J.K.
        • Curtis K.M.
        Progestogen-only contraceptive use among women with sickle cell anemia: a systematic review.
        Contraception. 2006; 73: 195-204
        • Manchikanti A.
        • Grimes D.A.
        • Lopez L.M.
        • Schulz K.F.
        Steroid hormones for contraception in women with sickle cell disease.
        Cochrane Database Syst Rev. 2007; : CD006261
        • Mohllajee A.P.
        • Curtis K.M.
        • Flanagan R.G.
        • Rinehart W.
        • Gaffield M.L.
        • Peterson H.B.
        Keeping up with evidence a new system for WHO's evidence-based family planning guidance.
        Am J Prev Med. 2005; 28: 483-490
        • Harris R.P.
        • Helfand M.
        • Woolf S.H.
        • et al.
        Current methods of the US Preventive Services Task Force: a review of the process.
        Am J Prev Med. 2001; 20: S21-S35
        • O'Brien S.H.
        • Klima J.
        • Reed S.
        • Chisolm D.
        • Schwarz E.B.
        • Kelleher K.J.
        Hormonal contraception use and pregnancy in adolescents with sickle cell disease: analysis of Michigan Medicaid claims.
        Contraception. 2011; 83: 134-137
        • De Ceulaer K.
        • Gruber C.
        • Hayes R.
        • Serjeant G.R.
        Medroxyprogesterone acetate and homozygous sickle-cell disease.
        Lancet. 1982; 2: 229-231
        • Howard R.J.
        • Lillis C.
        • Tuck S.M.
        Contraceptives, counselling, and pregnancy in women with sickle cell disease.
        BMJ. 1993; 306: 1735-1737
        • Ladipo O.A.
        • Falusi A.G.
        • Feldblum P.J.
        • Osotimehin B.O.
        • Otolorin E.O.
        • Ojengbede O.
        Norplant use by women with sickle cell disease.
        Internl J Gynecol Obstet. 1993; 41: 85-87
        • de Abood M.
        • de Castillo Z.
        • Guerrero F.
        • Espino M.
        • Austin K.L.
        Effect of Depo-Provera or Microgynon on the painful crises of sickle cell anemia patients.
        Contraception. 1997; 56: 313-316
        • Nascimento Mde L.
        • Ladipo O.A.
        • Coutinho E.M.
        Nomegestrol acetate contraceptive implant use by women with sickle cell disease.
        Clin Pharmacol Ther. 1998; 64: 433-438
        • Yoong W.C.
        • Tuck S.M.
        • Pasi K.J.
        • Owens D.
        • Perry D.J.
        Markers of platelet activation, thrombin generation and fibrinolysis in women with sickle cell disease: effects of differing forms of hormonal contraception.
        Eur J Haematol. 2003; 70: 310-314
        • Yoong W.C.
        • Tuck S.M.
        • Yardumian A.
        Red cell deformability in oral contraceptive pill users with sickle cell anaemia.
        Br J Haematol. 1999; 104: 868-870
        • Barbosa I.C.
        • Ladipo O.A.
        • Nascimento M.L.
        • et al.
        Carbohydrate metabolism in sickle cell patients using a subdermal implant containing nomegestrol acetate (Uniplant).
        Contraception. 2001; 63: 263-265
        • Howard R.J.
        • Tuck S.M.
        Contraception and sickle cell disease.
        IPPF Med Bull. 1994; 28: 3-4
      3. Austin H, Lally C, Benson JM, Whitsett C, Hooper WC, Key NS. Hormonal contraception, sickle cell trait, and risk for venous thromboembolism among African American women. Am J Obstet Gynecol 2009;200:620 e621-623.

        • Centers for Disease Control and Prevention
        U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. Adapted from the World Health Organization Criteria for Contraceptive Use, 4th edition.
        MMWR Early Release. 2010; 59 (ed2010)