Contraceptive Pearl: contraception and sickle cell disease

Washington State Health Care Authority sent this bulletin at 03/20/2025 07:05 AM PDT

March 20, 2025

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Contraception and Sickle Cell Disease

This bulletin is being sent by the Health Care Authority (HCA) in partnership with the Reproductive Health Access Project (RHAP).

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.

References

See RHAP's original post for sources.

About HCA and RHAP partnership

HCA and RHAP are partnering to support the reproductive health provider community’s access to accurate, evidence-based clinical information.

If you are an enrolled Apple Health provider, HCA will pay to print items from the RHAP resource library.

Materials such as the birth control choices fact sheet or MEC for initiating contraception chart are available for bulk printing.

To order bulk printing

Email: Brandy Bautista
Include the following information:

"Washington Health Care Authority" in the body of the email
Items you'd like to order
Quantities
Business address
Delivery address (if different than your business address)

Contact

Email Andrea Estes, Sexual and Reproductive Health Programs Innovation Manager at HCA, with questions regarding this partnership.

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.