Contraceptive Pearl: Contraception and sickle cell disease

The limited data on the reproductive health of individuals with sickle cell disease (SCD) suggest that rates of unintended pregnancy are higher than average in this population, and use of contraception is lower than average. Among other factors, clinician underprescribing of hormonal contraceptives to people with SCD may be an important barrier.

Progestin-only contraceptives are an excellent choice for people with SCD. Those treated with progestin-only contraceptives have a lower risk of painful sickle cell crisis and a lower level of anemia. The progestin-only pill, injection, implant and IUD all receive a “1” rating (can be used without restriction) from the CDC.

Estrogen-containing contraceptives get a “2” rating for people with SCD. Although patients with SCD have a higher risk of thrombosis, the benefits of estrogen-containing methods usually outweigh the risks. The copper IUD gets a “2” rating due to the possibility of heavier menses with this method.

Pregnancy carries grave health risks for people with SCD. Pregnancy with sickle cell disease is associated with maternal and fetal morbidity and mortality, including fetal growth retardation, increases in crises, and prematurity. A large study showed a maternal mortality rate over 10 times higher for patients with SCD than for those without this illness. Don’t forget to discuss contraception with these patients!

Helpful Resources

Medical Eligibility for Initiating Contraception


Alayed N, et al. Sickle cell disease and pregnancy outcomes: population-based study on 8.8 million births. Journal of Perinal Medicine. 2014;42(4). doi: 10.15/jpm-2013-0275.

Haddad LD, et al. Contraception for individuals with sickle cell disease: a systemic review of the literature. Contraception. 2012;85(6):527-537. doi: 10.1016/j.contraception.2011.10.008

Legardy, JK, Curtis KM. Progestin-only contraceptive use among women with sickle declanemica: a systemic review. Contraception. 2006;73(2):195-204. doi:10.1016/j.contraception.2005.08.010

Smith-Whitley K. Reproductive issues in sickle cell disease. Blood. 2014;124(24):3538-3543. doi:10.1182/blood-2014-07-577619. 



The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.

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