RESUMO
Forty-three homozygous (SS) female sickle cell anemic patients with a history of at least one painful crisis per month and desiring a reversible contraceptive were administered DMPA/3 months or Microgynon monthly. A third group of 16 surgically sterilized patients served as control. Patients were followed for 1 year to assess possible effects of the contraceptives on the patients' painful crises. No changes were observed in any of the groups in the hematological parameters. At the end of the study, 70% of the patients receiving DMPA were pain-free and only 16% of those still reporting painful crises rated them as intense. Patients receiving Microgynon also had an amelioration of the painful crises, although at a lower rate; after 12 months, 45.5% still experienced some crises. Although less marked than in the other groups, 50.5% of the control patients also reported an improvement of their painful crisis, which may be a result of closer medical care.
PIP: The effects of a combined oral contraceptive (Microgynon 30, containing ethinyl estradiol and levonorgestrel) and a progestogen-only injectable contraceptive (Depo-Provera) on the intensity and frequency of painful crises were investigated in 43 homozygous sickle cell anemia patients at the World Health Organization Collaborative Center for Research in Human Reproduction in Panama. Only women with a history of at least one painful crisis per month were enrolled. The patients were randomly assigned to receive Depo-Provera (n = 13) or Microgynon (n = 14) for 12 months; the remaining 16 patients--surgically sterilized controls-- received no treatment. No changes were recorded throughout the study period in any of the three groups in hematological parameters. In addition, there were no pregnancies or treatment-related side effects. In the Depo-Provera group, the percentage of patients with painful crises diminished steadily from 50% at 3 months to 30% at 12 months. Moreover, 84% of painful episodes experienced by Depo-Provera acceptors were characterized as moderate or mild. Among women in the Microgynon group, the rate of painful crises dropped from 72.7% at 3 months to 45.5% at 12 months. Controls also reported a 50.5% decline in painful crises, presumably as a result of increased individual attention from medical staff. These findings suggest that Depo-Provera can be safely and effectively used for contraceptive purposes in sickle cell anemic patients, with a concomitant beneficial effect on painful crises.
