Table 1 Contraceptives for the management of menstruation associated SCD pain
From: Understanding and treating menstruation associated sickle cell pain
Therapy | Mechanism of action* | Route of administration | Clinical evidence in SCD | Comments |
|---|---|---|---|---|
Progestin-only therapies Primary mechanism of pregnancy prevention is thickening of cervical mucus. | Legardy, et al. 2006 [17] Yoong et al. 1999 [10] | No SCD adverse events, hematologic or other biochemical adverse parameters, and no thrombosis have been reported with any of the progestin-only methods. | ||
Depot medroxyprogesterone (DMPA) | LARC Suppress ovulation | Intramuscular injection every 3 months | de Abood et al., 1997 [7] De Ceulaer et al., 1982 [34] Howard et al., 1993 [35] | • Associated with a decrease in menstruation associated SCD pain and frequency. • Side effects: unscheduled bleeding, weight gain, and bone mineral density loss over time. • Higher risk of VTE in the general population, compared with no use CDC MEC 2024 Category 2/3 [34]** |
Levonorgestrel (LNG) IUD | LARC Suppress Menstruation & inconsistently suppress ovulation | Intrauterine device every 5–8 years | Howard et al., 1993 [35] | • High rates of amenorrhea and contraception are achieved with the LNG IUD. CDC MEC 2024 Category 1 |
Etonogestrel (ENG) implant | LARC Suppress ovulation for 3 years and prevents pregnancy for 5 years | Subcutaneous implant every 5 years | Nascimento et al.1998 [21] Ladipo et al. 1993 [22] | • Nomegestrel acetate resulted in a decline in headaches, body weakness, and limb pain in persons with SCD. • Studies with ENG implant and SCD are ongoing. • Unscheduled bleeding and spotting can be unpredictable leading to a higher rate of discontinuation compared with other LARCs. CDC MEC 2024 Category 1 |
Progestin only pill (Norethindrone, Drospirenone) | Inconsistent suppression of ovulation | Oral, daily | Howard et al. 1993 [35] | • Small therapeutic window to maintain the full contraceptive benefits. • Can result in intermittent bleeding. CDC MEC 2024 Category 1 |
Other hormonal and non-hormonal therapies | ||||
Combined hormonal contraceptive (CHC) | Suppress ovulation and produce a regular consistent bleeding pattern | Oral pill, transdermal patch, and vaginal ring | de Abood et al. 1997 [7] Howard et al. 1993 [35] Yoong et al. 1999 [10] | • Few studies evaluate have evaluated CHCs in SCD. • CHCs are associated with a relative increased risk for VTE compared to non-users in the general population. • SCD is a high-risk thrombophilia and CHCs are generally avoided in this population. *A thoughtful discussion and shared decision making weighing the risks and benefits should be had when considering CHC use in SCD. CDC MEC 2024 Category 4 |
Copper (Cu) IUDs | Copper ions prevent sperm mobilization | Intrauterine device every 10 years | N/A | • Can lead to worsening menstrual cramps and increased bleeding, so it is generally not ideal for use in persons with SCD. CDC MEC 2024 Category 2 (Concern exists about an increased risk of blood loss with Cu-IUDs) |