Menstrual pattern in women with sickle cell anaemia and its association with sickling crises

This was a prospective observational study based on 6-month menstrual diaries in women with sickle cell anaemia (SCA). The aim was to evaluate the natural menstrual pattern and to establish if there was an association between menses and painful crises in these women. The main outcome measures included length of cycle, duration of loss and the occurrence of painful crises in relation to menses. Eighty-two women were recruited initially and 42 returned completed menstrual diaries. A total of 213 continuous natural cycles were evaluated. The mean cycle length was 28.9 (+/- 5.95) days, while the mean duration of menstrual loss was 4.69 (+/- 4.65) days. Thirty-seven per cent of the women had definite cyclical painful crises with each menses and in this group, 61.5% of crises occurred with menstrual flow. An additional 21% had at least three cyclical crises documented in the 6-month period. In 42%, there was no association between menses and crises. In summary, 58% of women had some form of cyclical crises (albeit not severe) in association with menstrual cycles. In severe cases, the use of a continuous combined contraceptive pill regime or Depo-Provera to induce amenorrhoea (as well as to provide contraception) should be considered.