Whether women with sickle cell anemia should use hormonal birth control is unknown. Sickle cell anemia is a blood disease. This type of anemia also causes bone pain known as sickle pain crises. A concern is that women with this disease using hormonal birth control may have blood vessels blocked by blood clots or have more bone pain. Clinicians often do not prescribe these types of birth control due to these concerns. However, many women with sickle cell anemia are sexually active, are able to get pregnant and are interested in contraception.
In October 2011, we did a computer search for studies of sickle cell anemia and birth control methods with hormones. We did not find any new trials during the update. Previously, we found one trial of 25 women with sickle cell anemia. This study found that women were less likely to have bone pain while using the injectable birth control known as Depo (a progestin contraceptive). There were no reported serious side effects of Depo.
Since only one study has been done using just a progestin, we have little information about the use of hormonal birth control by women with sickle cell anemia. Depo appears to be a safe birth control option and may reduce the frequency of bone pain.
The limited available data suggest that DMPA is a safe contraceptive option for women in SS disease. In addition to providing effective contraception, DMPA may reduce sickle pain crises.
Whether steroid contraceptives are appropriate for women with homozygous sickle cell (SS) disease remains unresolved. Historically, women with sickle cell disease have experienced difficult pregnancies, characterized by high rates of maternal mortality and morbidity and poor infant outcomes. Unresolved questions about steroidal contraceptives in women with sickle cell disease include whether using them may promote blood clots.
To assess the safety of steroid hormones in this setting, we retrieved and analyzed all randomized controlled trials that examined steroid hormones for contraception in women with SS disease.
In October 2011, we searched the computerized databases CENTRAL, MEDLINE and POPLINE for randomized controlled trials of steroid hormone use for contraception in women with SS disease. We added searches of ClinicalTrials.gov and ICTRP for recent trials. For the initial review, we also searched EMBASE and examined the reference list of each trial as well as that of review articles.
We included any randomized controlled trial in any language that compared steroid hormones for contraception with another contraceptive or placebo. Frequency or intensity of sickle pain crises must have been reported as an outcome.
We assessed for inclusion all titles and abstracts found. We evaluated the methodological quality of the trial found for potential biases by qualitatively assessing the study design, randomization method, allocation concealment, blinding, premature discontinuation rates, and loss to follow-up rates. We entered trial results in RevMan and reported Peto odds ratios with 95% confidence intervals for dichotomous outcomes, such as occurrence of sickle pain crises.
Only one trial met the inclusion criteria. Twenty-five patients were randomized to three monthly depo-medroxyprogesterone acetate (DMPA) or intramuscular saline placebo injections in a crossover design. A six-month washout period was implemented before the crossover; however, pharmacological evidence indicates that levels of DMPA may be detected for more than 200 days after the injection. During DMPA use, women were less likely to experience painful sickle episodes (OR 0.23; 95% CI 0.05 to 1.02). No trial involved estrogen products. We did not find any new trials during the update.