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Evidenced Based Management: A Journey for Physicians

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  1. Historical Perspective, Epidemiology, and Methodology
  2. Overview of the SCD guidelines and chapters
  3. Process and methodology
  4. Consensus Statements
  5. Clinical Practice Guidelines and the institute of Medicine
  6. Prevention of invasive infection
  7. Screening for Renal Disease
  8. Electrocardiogram Screening
  9. Screening for hypertension
  10. Screening for Retinopathy
  11. Screening for risk of stroke using neuroimaging
  12. Screening for Pulmonary disease
  13. Reproductive counseling
  14. Contraception
  15. Clinical Preventive services
  16. Immunizations
  17. Vaso-Occlusive Crisis
  18. Fever
  19. Acute Renal Failure
  20. Priapism
  21. Hepatobiliary Complications
  22. Acute Anemia
  23. Splenic Sequestration
  24. Acute Chest Syndrome
  25. Acute Stroke
  26. Multisystem Organ Failure
  27. Acute Ocular Conditions
  28. Chronic pain
  29. Avascular Necrosis
  30. Leg Ulcers
  31. Pulmonary Hypertension
  32. Renal Complications
  33. Stuttering/Recurrent Priapism
  34. Ophthalmologic Complications
  35. Summary of the Evidence
  36. Hydroxurea Treatment Recommendations
  37. Consensus Treatment Protocol and Technical remarks for the implementation of Hydroxyurea Therapy
  38. Indications for transfusions
  39. Recommendations for Acute and Chronic Transfusion Therapy
  40. Appropriate Management/ Monitoring
  41. Consensus Protocol for Monitoring Individuals on Chronic Transfusion Therapy
  42. Complications of Transfusions
  43. Recommendations for the Management and Prevention of Transfusion Complications
  44. New Research is Needed
  45. Data Systems That Meet the Highest Standards of Scientific Rigor Can Be Invaluable
  46. Improved Phenotyping is needed
  47. Broad collaborations for Research and Care
  48. Beyond Efficacy
  49. Look, Listen, Empathize and Ask
Lesson 14 of 49
In Progress


SCFA_Coach September 25, 2023

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.


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.
2. If the benefits are considered to outweigh the risks, combined hormonal contraceptives (pills, patches, and rings) may be used in women with SCD.