Contraceptive methods used by Brazilian women withsickle cell disease
ESC Congress Library. Guazzelli C. 05/28/14; 50484; A-067
Prof. Dr. Cristina Guazzelli
Prof. Dr. Cristina Guazzelli
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Abstract
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Introduction: Sickle cell disease is a monogenic disease that leads to the formation of hemoglobin S, causing a wide range of complications including death. Its prevalence varies according to the proportion of afro-descendants in the study population. Due to earlier diagnosis, new treatments and the improved management of complications, the lifespan of patients with sickle cell disease has increased. Treatment with hydroxyurea has led to decreased morbimortality. With the increased survival of patients, questions related to quality of life, including safe sex, pregnancy and contraception have been increasingly investigated.


Objective: Assess the use of contraceptive methods by women with sickle cell disease.


Methods: Retrospective cohort of the charts of women with sickle cell disease managed at a single tertiary center (São Paulo Federal University) during a one-year period.


Results: A total of 54 women were included. Their mean age was 32 years, and over 94% of them were Black. Many reported complications related to their disease: renal damage (50%), retinopathy (22%), pulmonary hypertension (15%), thrombotic episodes (17%), hypertension (9%) and cardiopathy (9%).  Mean age at menarche was 15.2 years, and mean age at first intercourse and first pregnancy was at 19,8 and 25,2 years, respectively. On average, these women had started to use a contraceptive method at 22.1 years of age. Among sexually active women, 14,8% had a history of sexually transmitted diseases and 61,1% were currently using some form of contraception: 48.5% used progestagen-only contraceptives, 33,3% used combined hormonal contraceptives, 9,1% had a tubal ligation, 9,1% used condoms. There were no major complications associated with the use of hormonal contraceptives. Hemoglobin and hematocrit levels were significantly higher among those who used combined hormonal contraceptive (P = 0.04).


Conclusion:


Most women with sickle cell disease report the use of a contraceptive method. However, 9.1% were using only condoms, a low efficiency method, while 33,3% of these patients reported the use of combined hormonal contraceptives, a method that would be contra-indicated due to their clinical complications. Health professionals involved in the management of reproductive age women with sickle cell disease need to include contraceptive counseling as part of their routine care.


 


 


 

Introduction: Sickle cell disease is a monogenic disease that leads to the formation of hemoglobin S, causing a wide range of complications including death. Its prevalence varies according to the proportion of afro-descendants in the study population. Due to earlier diagnosis, new treatments and the improved management of complications, the lifespan of patients with sickle cell disease has increased. Treatment with hydroxyurea has led to decreased morbimortality. With the increased survival of patients, questions related to quality of life, including safe sex, pregnancy and contraception have been increasingly investigated.


Objective: Assess the use of contraceptive methods by women with sickle cell disease.


Methods: Retrospective cohort of the charts of women with sickle cell disease managed at a single tertiary center (São Paulo Federal University) during a one-year period.


Results: A total of 54 women were included. Their mean age was 32 years, and over 94% of them were Black. Many reported complications related to their disease: renal damage (50%), retinopathy (22%), pulmonary hypertension (15%), thrombotic episodes (17%), hypertension (9%) and cardiopathy (9%).  Mean age at menarche was 15.2 years, and mean age at first intercourse and first pregnancy was at 19,8 and 25,2 years, respectively. On average, these women had started to use a contraceptive method at 22.1 years of age. Among sexually active women, 14,8% had a history of sexually transmitted diseases and 61,1% were currently using some form of contraception: 48.5% used progestagen-only contraceptives, 33,3% used combined hormonal contraceptives, 9,1% had a tubal ligation, 9,1% used condoms. There were no major complications associated with the use of hormonal contraceptives. Hemoglobin and hematocrit levels were significantly higher among those who used combined hormonal contraceptive (P = 0.04).


Conclusion:


Most women with sickle cell disease report the use of a contraceptive method. However, 9.1% were using only condoms, a low efficiency method, while 33,3% of these patients reported the use of combined hormonal contraceptives, a method that would be contra-indicated due to their clinical complications. Health professionals involved in the management of reproductive age women with sickle cell disease need to include contraceptive counseling as part of their routine care.


 


 


 

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