Contraception

Background
In women with SCD, regular use of contraception can decrease the health risks associated with an unintended pregnancy. Hormonal contraceptives may also decrease menstrual blood flow, leading to higher hemoglobin levels. Use of progestin-only hormonal contraceptives lowers the risk of thromboembolism compared to use of estrogen-containing contraceptives and has been shown to be safe for women with SCD.

Intrauterine devices (IUDs) and intrauterine implants carry modest risks associated with the insertion procedure, while sterilization carries risks associated with the surgical procedure. There is no evidence that IUDs pose an increased risk for women with SCD.

Summary of the Evidence
Published data about contraception and SCD were reviewed by the WHO prior to their latest publication of “Medical Eligibility Criteria for Contraceptive Use. Eight studies were reviewed. With the exception of one survey,”4 the studies were small and compared differences in hematologic parameters or numbers of crises in women before and after starting a particular contraceptive, or between women who were or were not using a particular contraceptive. Progestin-only contraceptives were not associated with an increased risk of thrombosis and may have noncontraceptive benefits in terms of fewer crises and improved hematologic parameters. Data were insufficient on combined hormonal contraceptives.

Women with SCD may have additional considerations that need to be taken into account when assessing the safety of contraceptive methods. For example, a history of stroke is a contraindication to combined hormonal contraception, and by age 20, approximately 11 percent of untreated women with SCD have had a clinically apparent stroke; this statistic increases to 24 percent by age 45.
The CDC adapted the WHO’s “Medical Eligibility Criteria for Contraceptive Use” for women with SCD, and those criteria are the basis for the panel’s recommendations.

Recommendations

Evidence reviews on this topic were not performed by the methodology team. Therefore, the expert panel based its recommendations on those developed by the WHO and the CDC.
1. Progestin-only contraceptives (pills, injections, and implants), levonorgestrel IUDs, and barrier methods have no restrictions or concerns for use in women with SCD.
(Consensus—Adapted}
2. If the benefits are considered to outweigh the risks, combined hormonal contraceptives (pills, patches, and rings) may be used in women with SCD.
(Consensus—Adapted}