World Sickle Cell Day: How does sickle cell affect menstruation?

Sickle cell disease is a group of red blood cell disorders that affects hemoglobin, which is responsible for carrying oxygen throughout our body. In people with sickle cell disease, red blood cells become rigid, sticky, and shaped like a sickle, rather than the normal flexible, round shape. It can cause fatigue and weakness, and also affect your menstrual cycle. On World Sickle Cell Day, which falls on June 19, let us explore the link between sickle cell disease and periods.

What is sickle cell disease?

Sickle cell disease is an inherent group of red blood cell disorders. It affects hemoglobin, which is the protein meant to carry oxygen in our body. Red blood cells are roundish in shape and flexible to move easily through our body’s blood vessels. If you have sickle cell disease, your red blood cells will become sickle-shaped due to a genetic mutation, and not bend or move easily. They can block blood flow to the rest of your body, leading to problems, including eye problems, stroke and episodes of pain, according to the National Heart, Lung and Blood Institute. It is a lifelong illness that affects about 20 million people in the world.

What are the symptoms of sickle cell disease?

Sickle cell disease can cause a wide range of symptoms that can affect different parts of the body. Some common symptoms are-

• Pain crises, which occur when sickle-shaped red blood cells block blood flow through small blood vessels. These episodes can cause severe pain that can last hours to days.
• Sickle cell disease can lead to chronic hemolytic anemia, where red blood cells are destroyed faster than they can be replaced. This can cause fatigue, weakness, and pale skin.
• Swelling of hands.
• Bacterial infections such as pneumonia.
• Vision problems.

Sickle cell disease and menstruation

A 2023 study published in Pediatric Blood & Cancer found the prevalence of heavy periods and dysmenorrhea (period cramps) high in adolescents and young women diagnosed with sickle cell disease. Sickle cell disease can affect menstruation in several ways, primarily due to the impact of the disease on the body’s oxygen supply and overall health, says gynaecologist Dr Seema Sharma.

Here are some ways in which sickle cell disease may affect menstruation:

1. Delayed puberty

Children with sickle cell disease may experience delayed puberty compared to their friends. This delay can affect the onset of menstruation in girls, says the expert.

2. Irregular menstrual cycles

Women and girls with sickle cell disease may experience irregular menstrual cycles. This irregularity can be due to the effects of chronic anemia and overall stress on the body, which can disrupt the hormonal balance necessary for regular menstruation.

3. Menorrhagia (heavy periods)

Some women with sickle cell disease may experience heavy menstrual bleeding (menorrhagia). This can be related to complications such as chronic anemia, which can cause the body to produce more blood cells to compensate for the destruction of sickled red blood cells.

4. Painful periods

Painful menstruation (dysmenorrhea) may be more common in women with sickle cell disease. Pain crises that affect other parts of the body can also manifest in the pelvic area, exacerbating period pain.

Can you have birth control pills to manage menstrual problems due to sickle cell disease?

Yes, birth control pills can be used to manage menstrual problems in women with sickle cell disease, says Dr Sharma. However, the choice of birth control method should be carefully considered. Combined Oral Contraceptives (COCs) contain both estrogen and progestin, which can help regulate menstrual cycles, reduce menstrual pain and bleeding. But estrogen in COCs can increase the risk of blood clots, which is a concern in women with this disease who are already at risk for clotting episodes. Progestin-only pills contain only progestin, and are generally considered safer for women with SCD, as they do not contain estrogen and so do not increase the risk of blood clots, says the expert.

How to manage menstruation problems and sickle cell disease?

Managing menstruation problems in women with sickle cell disease involves a combination of strategies to address both the underlying disease and the specific menstrual symptoms. Here are some approaches:

1. Pain management

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate menstrual pain (dysmenorrhea) during periods. Stronger pain relievers may be necessary during severe pain crises or if NSAIDs are not sufficient, says the expert.

2. Anemia management

If anemia is present, iron supplements may be prescribed to help restore iron levels. In severe cases of anemia, blood transfusions may be necessary to replenish red blood cells.

3. Treatment of underlying SCD

Hydroxyurea is a medication that can reduce the intravascular sickling. If the frequency of pain crises and complications associated with sickle cell disease reduces, it may indirectly improve menstrual symptoms.

4. Hydration

Drink plenty of fluids to prevent dehydration, which can exacerbate sickle cell crises and may worsen menstrual symptoms. You can have water or fruit juices to prevent dehydration.

5. Stress management

Stress can exacerbate symptoms of both SCD and menstrual problems, says the expert. Practicing relaxation techniques such as deep breathing, yoga or meditation can be helpful.

Sickle cell disease is a lifelong illness that affects the hemoglobin. The disease may lead to heavy periods or severe period cramps.