Front Epidemiol. 2026 Oct 16;6:1931488. doi: 10.3389/fepid.2026.1931488. eCollection 2026.
ABSTRACT
Sickle cell disease (SCD) has long been associated with high childhood mortality and reduced life expectancy; however, advances in newborn screening, disease-modifying therapies, and comprehensive care have substantially improved survival. As increasing numbers of women with SCD reach midlife, new challenges are emerging that extend beyond the traditional focus on fertility and pregnancy. Despite growing recognition of reproductive health issues in SCD, menopause remains an underexplored and underrecognized phase of the disease trajectory. In this Perspective, we propose a lifespan framework for women's health in SCD that extends from menarche through menopause and healthy aging. We discuss how the underlying pathophysiology of SCD-including chronic hemolysis, inflammation, endothelial dysfunction, and progressive organ injury-intersects with reproductive transitions across the female life course. We highlight emerging evidence suggesting earlier menopause in women with SCD and examine the potential implications for pain burden, cognitive health, bone health, cardiovascular risk, iron overload, and quality of life. We further explore how symptom overlap between menopause and SCD may contribute to underdiagnosis and undertreatment during midlife. At the same time, we highlight the role of protective factors-including comprehensive multidisciplinary care, the development and evaluation of menopause-specific interventions through dedicated clinical trials in individuals with SCD, reproductive health services, and coordinated lifespan care models-in supporting healthy aging and improving long-term outcomes. Finally, we argue that menopause should be recognized as a critical component of comprehensive SCD care and research. Integrating reproductive aging into clinical practice, research agendas, and health policy represents an important opportunity to improve lifelong health outcomes, strengthen women-centered care, and advance health equity for women living with SCD worldwide.
PMID:42964149 | PMC:PMC13719543 | DOI:10.3389/fepid.2026.1931488