Original Article

Contraceptive Methods and the Impact of Menstruation on Daily Functioning in Women with Sickle Cell Disease

Authors: Melissa E. Day, BS, Sarah-Jo Stimpson, MD, Mark Rodeghier, PhD, Djamila Ghafuri, MBBS, Michael Callaghan, MD, Ahmar Urooj Zaidi, MD, Bryan Hannan, MS, Adetola Kassim, MD, MS, Andra H. James, MD, MPH, Michael R. DeBaun, MD, MPH, Deva Sharma, MD, MS


Objectives: Women with sickle cell disease (SCD) are living longer as a result of advances in the care of their underlying disease. With the population growing of women living with SCD, reproductive health issues in this population have become an emphasized area of medical care. We sought to describe current patterns of contraception use, menstruation, and quality-of-life (QOL) measures in women with SCD.

Methods: Using a cross-sectional study design, we administered paper surveys at two academic medical centers to women aged 10 to 55 years with SCD to capture current contraceptive use, characteristics of menstrual cycles, and QOL metrics.

Results: Of the 103 women who participated, 12.7% (13/102) experienced a duration of menses >7 days (defined here as prolonged menstrual bleeding). Approximately half of women (51.5%, 53/103) used some form of contraception, with depot medroxyprogesterone acetate injections and condoms being the most common. During their last menstrual periods, women with both dysmenorrhea and prolonged menstrual bleeding (6.9%, 7/102) were more likely to experience more days of poor QOL, with more nights with sleep disturbance (P = 0.001) and more days with trouble taking care of themselves (P = 0.003), as well as being unable to do things they previously enjoyed (P = 0.001), compared with those with neither phenomenon (28.2%, 29/103).

Conclusions: Dysmenorrhea and prolonged menstrual bleeding negatively affect the QOL of women with SCD. Menstrual histories and preventive measures for menstruation-related morbidity should be incorporated into routine evaluations of women with SCD.
Posted in: Hematology10 Menopause: Management, Risks, & Benefits of Therapy1 Family Planning & Reproductive Health12

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Hassell KL. Population estimates of sickle cell disease in the U.S. Am J Prev Med 2010;38(4 suppl):S512-S521.
2. Lanzkron S, Carroll CP, Haywood C, Jr. Mortality rates and age at death from sickle cell disease: U.S., 1979-2005. Public Health Rep 2013;128:110-116.
3. Platt OS, Brambilla DJ, Rosse WF, et al. Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med 1994;330:1639-1644.
4. Yoong WC, Tuck SM. Menstrual pattern in women with sickle cell anaemia and its association with sickling crises. J Obstet Gynaecol 2002;22:399-401.
5. Samuels-Reid J, Scott RB. Characteristics of menstruation in sickle cell disease. Fertil Steril 1985;43:139-141.
6. Jones J, Mosher W, Daniels K. Current contraceptive use in the United States, 2006-2010, and changes in patterns of use since 1995. Natl Health Stat Report 2012;60:1-25.
7. Elenga N, Adeline A, Balcaen J, et al. Pregnancy in sickle cell disease is a very high-risk situation: an observational study. Obstet Gynecol Int 2016;2016:9069054.
8. Wun T, Brunson A. Sickle cell disease: an inherited thrombophilia. Hematology Am Soc Hematol Educ Program 2016;2016:640-647.
9. Chesney MA, Tasto DL. The development of the menstrual symptom questionnaire. Behav Res Ther 1975;13:237-244.
10. Zempsky WT, O' EA, Santanelli JP, et al. Validation of the sickle cell disease pain burden interview-youth. J Pain 2013;14:975-982.
11. Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician 2014;89:341-346.
12. ACOG Committee on Practice Bulletins-Gynecology. American College of Obstetricians and Gynecologists. ACOG practice bulletin: management of anovulatory bleeding. Int J Gynaecol Obstet 2001;72:263-271.
13. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377-381.
14. Herndon EJ, Zieman M. New contraceptive options. Am Fam Physician 2004;69:853-860.
15. Deuster PA, Powell-Dunford N, Crago MS, et al. Menstrual and oral contraceptive use patterns among deployed military women by race and ethnicity. Women Health 2011;51:41-54.
16. Samuels-Reid JH, Scott RB, Brown WE. Contraceptive practices and reproductive patterns in sickle cell disease. J Natl Med Assoc 1984;76:879-883.
17. Menezes AS, Len CA, Hilário MO, et al. Quality of life in patients with sickle cell disease. Rev Paul Pediatr 2013;31 :24-29.
18. Dampier C, LeBeau P, Rhee S, et al. Health-related quality of life in adults with sickle cell disease (SCD): a report from the comprehensive sickle cell centers clinical trial consortium. Am J Hematol 2011;86:203-205.