Written by Aderinsola Odetunde, MD

Sickle cell disease (SCD) affects approximately 100,000 people in the United States, with the highest prevalence among those of African descent.^1,2 Many of those living with SCD are not counseled on reproductive health, especially during the transition period from pediatric to adult care.³ Clinicians should regularly discuss reproductive health care with all patients to ensure they are educated and able to make informed decisions. These discussions are particularly important if patients have medical conditions that may negatively affect their sexual and reproductive health.

SCD can carry an increased risk of complications with pregnancy (e.g. increased frequency of sickle cell pain crises, acute anemia, chronic organ damage) though it is not an outright contraindication to pregnancy.^4,5 We must make sure we frame family planning discussions through a reproductive justice lens and ensure we understand our patient’s desires and goals, as opposed to only focusing on preventing pregnancy.

The 2024 update of the US Medical Eligibility Criteria (MEC) from the Centers for Disease Control and Prevention (CDC) changed recommendations for the use of certain contraceptive methods among those with SCD.⁶ Venous thromboembolism (VTE) is a common complication for SCD patients,⁷ so it is vital to take it into account when counseling patients on their contraceptive options. The biggest changes in the MEC regarding SCD are with combined hormonal contraceptives (pill, patch, ring) changing from a category 2/3 to 4 and depot medroxyprogesterone acetate (DMPA) injections changing from category 1 to 2/3, both due to increased VTE risks. Though these ratings have changed, the actual data regarding increased VTE risks with these contraceptives are limited.⁸ The use of DMPA has been associated with a reduction in menstruation-related pain crises,⁹ and has been an important tool for some patients in managing their symptoms. The copper IUD remains a category 2 on the MEC due to the increased risk of blood loss during menstrual bleeding, which could worsen pain crises. Hormonal IUDs and progestin-only pills remain a category 1.

Clinicians should be prepared to have nuanced discussions with SCD patients who are currently using a contraceptive method they are satisfied with, but that has now been reclassified to higher-risk MEC categories due to increased VTE risks. It is essential to approach these conversations with a commitment to informed consent and shared decision-making, ensuring patients understand the potential risks of various contraceptive methods while respecting their individual preferences, reproductive goals, and lived experiences.

RHAP Resources:

Your Birth Control Choices Fact Sheet

Medical Eligibility Criteria for Initiating Contraception

Sources:

1. CDC. Data and Statistics on Sickle Cell Disease. Sickle Cell Disease (SCD). May 22, 2024. Accessed February 4, 2025. https://www.cdc.gov/sickle-cell/data/index.html

2. Sickle Cell Disease in Adults and Adolescents – DynaMed. Accessed February 4, 2025. https://www.dynamed.com/condition/sickle-cell-disease-in-adults-and-adolescents#GUID-41090549-CD49-4835-9D73-702220675C2C

3. Shankar D, Stanek CJ, Bangudi S, et al. Contraception, pregnancy, and STI counseling and care among transitioning young adults with sickle cell disease. Blood Adv. 2023;7(21):6668-6671. doi:10.1182/bloodadvances.2023011008

4. Ibidunni L, Nunez KP, Jonassaint JC, De Castro L. Beliefs and Practices Among Adults with Sickle Cell Disease Regarding Reproductive Health Decisions and Family Planning. Blood. 2019;134(Supplement_1):2101-2101. doi:10.1182/blood-2019-122255

5. Management of Sickle Cell Disease in Pregnancy – DynaMed. Accessed February 4, 2025. https://www.dynamed.com/management/management-of-sickle-cell-disease-in-pregnancy

6. Nguyen AT, Curtis KM, Tepper NK, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. 2024;73(4).

7. Scarpato B, Strykowski R, Lawrence R, et al. Risk factors for Venous Thromboembolism and clinical outcomes in adults with sickle cell disease. Thromb Update. 2022;6:100101. doi:10.1016/j.tru.2022.100101

8. Supplementary Appendix. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. Accessed February 6, 2025. https://stacks.cdc.gov/view/cdc/156516

9. Pecker LH, Sharma D. Menstruation and Sickle Cell Disease: Ease Her Pain. J Womens Health (Larchmt). 2023;32(12):1265-1267. doi:10.1089/jwh.2023.0581

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