Management of sickle cell disease. Contraception with medroxyprogesterone may be beneficial [letter]
1998
The comprehensive and helpful review by Davies and Oni on the management of patients with sickle cell disease did not include an important aspect of care relating to contraceptive requirements. Some patients with homozygous sickle cell disease have fewer crises while using monthly injections of medroxyprogesterone acetate (MA) 150 mg (Depo-Provera). Work published in 1971 suggests that MA may exert its beneficial action through stabilizing the red cell membrane in sickle cell disease. Therefore this method of contraception is of particular value for women with sickle cell disease. However women who are considering MA as a method of contraception must be informed that the vaginal bleeding pattern after the injections will be completely unpredictable and that they must be willing to accept this. During 1996-97 this method of contraception was used by over 1000 women attending our center mainly those aged 20-24 years. We believe that its advantages of high efficacy ease of compliance and lack of serious adverse cardiovascular effects despite extensive use indicate that it probably should be more widely used for contraception as a positive choice. It has additional benefits for women who have sickle cell disease. (full text)
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