How to Manage Period Pain in Sickle Cell Disease

“It has been well documented that menstruation can trigger an acute pain crisis in people with SCD who menstruate,” says Layla Van Doren, MD, a hematologist at Smilow Cancer Hospital and a researcher and assistant professor of medicine (hematology) at Yale School of Medicine in New Haven, Connecticut.

The Connection Between Menstruation and Sickle Cell Pain

Follicular Phase Inflammation Triggers

A recent study found that sickle cell pain crises are more common during the follicular phase of the menstrual cycle (days 1 to 14), says Marc Kahn, MD, a hematologist and the chief of hematology at the Kirk Kerkorian School of Medicine at the University of Nevada in Las Vegas.

Hormone Fluctuations and Sickling

Period Stress: Mental and Physical

Period Pain vs. Sickle Cell Crisis: How to Tell the Difference

“Patients tend to know their bodies well and know what an acute SCD pain crisis feels like, so some patients can distinguish between menstrual cramping or dysmenorrhea and an acute SCD crisis,” says Van Doren.

But not everyone can separate their period pain from a SCD crisis, says Van Doren. “I also have many adult patients who have never realized this link until I inquire.”

Medical Options for Period Pain Control

Medical treatment for period pain when you have SCD centers around hormonal birth control. “Hormonal contraceptives that lighten or eliminate periods can be effective in preventing painful crises,” says Kahn.

Home Management Strategies

• Stay hydrated.
• Exercise regularly, but avoid overexertion.

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• Use warm compresses or baths.
• Massage sore muscles.
• Use mindfulness exercises like deep breathing to relax and reduce stress.

For simple period-specific cramping, NSAIDs like ibuprofen (Advil) can be very helpful, or the combination of NSAIDs and acetaminophen (Tylenol), says Van Doren.

When to Seek Immediate Care

Some symptoms mean you need medical attention right away. “Red flag symptoms would be a change in menstruation, such as heavy menstrual bleeding, or severe menstrual cramping out of proportion to previous periods,” says Van Doren, who also recommends telling your provider about a fever.

• Trouble breathing
• Severe worsening pain
• Dizziness or headache
• Pale lips or skin
• Seizures
• Confusion
• Slurred speech
• Sudden abdominal swelling
• Vision changes
• One-sided weakness

Working With Your Care Team

• Is my period triggering my crises?
• Am I a candidate for menstrual suppression?
• How can I manage pain at home?
• When should I come in or call about worsening pain?

How to Manage the Emotional and Social Impact

Find support through these patient advocacy groups and peer support networks.

• Sickle Cell Disease Association of America
• Supporting Our Sicklers (S.O.S.)
• Sickle Cell Society
• American Sickle Cell Anemia Association
• Sickle Cell Warriors
• American Society of Hematology

For extra support, ask your hematologist to refer you to a mental health professional, such as a psychologist or counselor.

The Takeaway

• When you have sickle cell disease, period pain can feel worse, and can sometimes trigger a pain crisis.
• Menstruation can prompt SCD pain through hormone fluctuations, inflammation, and stress.
• Hormonal contraception can help prevent pain crises; home remedies like certain over-the-counter medications, heat, massage, and hydration can help manage pain during your period.
• Follow your SCD pain management plan and let your provider know if the pain gets too severe.