Contraception, or birth control, is really not much difference for a woman with diabetes than for a woman without diabetes. However, if you do have diabetes, it may be even more important for you to choose a method with high effectiveness and minimal risk. You should only become pregnant if your blood glucose levels are under tight control and if you are prepared to handle the physical and emotional burden of carrying a baby. Blood glucose levels can affect a baby’s development as well as your own health, so unless you are prepared for pregnancy, do a little research to find the birth control method that works for you.
Oral contraceptives, intrauterine devices (IUDs) and barrier methods such as the diaphragm and condom are all effective ways to prevent pregnancy when used correctly. The rhythm method relies on predicting ovulation and avoiding intercourse during fertile periods. This is not a desirable method of birth control for someone with diabetes. If you are 100% sue you do not want children of if you have already completed your family, you may want to consider sterilization. But be aware that this procedure is almost impossible to reverse.
As a woman with diabetes, you will want to especially careful with birth control methods that alter hormone levels. These include oral contraceptives, injectable contraceptives, and contraceptive implants. Some of these methods can affect blood glucose control. And some oral contraceptives can be affected by diabetes medications.
Birth control pills, or oral contraceptives, are the most popular and effective contraceptives on the market today. The content of birth control pills have changed substantially since they were first introduced decades ago. Today’s birth control pills ae safer and more effective than ever because they contain lower doses of hormones. But in deciding whether or not they ae right for you, make sure that the risks do not outweigh the benefits.
Three types of pills are available today. Monophasic birth control pills contain fixed amounts of estrogen and progesterone that are taken through your entire menstrual cycle. Tripahsic pills contain doses of estrogen and progesterone that vary every 7 days. Progesterone-only pills contain only progesterone and are taken daily. This type of contraceptive is also available in an injectable form as Depo-Provera and in implantable capsules as Norplant. These forms of progesterone-only contraceptives last for several months. Before committing to one of these longer-lasting forms, consider trying a pill form of progesterone-only contraceptive first. That way, if you do develop some difficulties you can discontinue the medication right away.
Maybe you have heard that birth control pills are not a good idea for someone with diabetes. This may or may not be true for you. Short-term studies have shown that today’s newer low-dose birth control pills are safe and effective for people with diabetes, but no long-term studies have been done. If you are healthy and have type 1 or type 2 diabetes and you are controlling it through diet alone, you probably should avoid progesterone-only forms of birth control because they may cause you to need insulin treatment.
If you find that your blood glucose levels vary throughout your menstrual cycle as a result of changes in insulin sensitivity, then the monophasic pill may be your best bet. The pill contains the same amount of estrogen and progesterone every day of the month. This can level out the ebb and flow of hormones in your blood throughout the month and minimize swings in blood glucose levels. On the other hand, triphasic pills contain varying amounts of hormones and may cause greater swings in blood glucose levels throughout the month.
Oral contraceptives can be risky for some women with diabetes. Oral contraceptives can increase the risk of blood clot formation in some people. If you smoke, are over the age of 35, have high blood pressure, or have a history of heart disease, stroke or peripheral vascular disease, oral contraceptives are not a good choice for you. Smoking clogs up your arteries, which greatly increases the risk of blood clot formation. Do not start with an oral contraceptive unless you first quit smoking. If you develop high blood pressure while on the pill, your risk of retinopathy and kidney disease will increase. Also, if you show signs of poor blood glucose control, such as high HbA1c level, or if you often have symptoms of dehydration, oral contraceptives may be a poor choice, because they increase your chance of forming blood clots.
Oral contraceptives may not be a good choice if you have type 2 diabetes and are controlling your blood glucose levels with troglitazone (Rezulin). Troglitazone can decrease the effectiveness of estrogen-containing pills by 30%. If you are on a low-dose pill and taking troglitazone, you may experience bleeding between periods or may even become pregnant. Talk to your doctor about changing your birth control method if this is the case
What You Should Do
If you do decide to use an oral contraceptive, test your blood glucose levels frequently, especially during the first few months. You may find that the pill changes your insulin sensitivity and you may need to adjust your insulin dose. Keep good records so that you and the members of your health care team can decide whether any changes in food, activities or insulin doses are needed.
Also, ask your doctor about having your glycated hemoglobin, blood pressure, cholesterol, and triglyceride levels checked 3 months after you begin oral contraceptive therapy. You should continue to be checked out on a regular basis.
An intrauterine device (IUD) is a small T-shaped object that is inserted by your doctor into your uterus. Currently two types of IUDs are in popular use: a plastic T-shaped device that releases progesterone that must be replaced each year and a copper-containing T-shaped device that can remain in your uterus for up to 9 years. You ovulate as normal, but if any egg is fertilized, the device prevents the embryo from implanting in your uterus. An IUD must be surgically implanted and can remain in place for more than a year at a time. When properly inserted, they are 97% effective at preventing unwanted pregnancy.
The IUDs, particularly those containing progesterone, have been under scrutiny for increasing the risk of vaginal infections. However, that claim remains debatable. They have been blamed for a higher incidence of pelvic infections and should not be used by anyone who plans on having children in the future. They are not recommended for any women who have multiple sex partners. You may experience more menstrual pain and menstrual irregularities with an IUD
What You Should Do
If you would like to consider an IUD, talk it over with your diabetes care provider and gynecologist. You must have it inserted and removed by a trained professional. If you experience any pelvic pain, contact your doctor at once. Also, check periodically that it is still inserted properly. This can be done by inserting a finger into your vagina and feeling for the string up against the cervix. If you can’t feel anything, the string may have slipped up into the uterus. Use backup contraception until you have your doctor check it. If you feel a hard object, it may have slipped out and you should have it removed by your doctor. Contact your doctor also if you have any signs of vaginal or pelvic infection, foul-smelling discharge, fever or if you believe you may be pregnant.
Barrier methods physically prevent the sperm from travelling to the uterus and Fallopian tubes. Barrier methods are more effective when used with spermicidal foams or jellies. The best barrier methods are the diaphragm used with spermicide jelly and the condom used with a spermicide foam. The diaphragm is a shallow rubber cup that is coated with a spermicide jelly and can be inserted by you or your partner. It must be left in place for 6 hours following intercourse.
Male condoms are thin penis-shaped tubes of latex rubber that are rolled onto an erect penis. When the male ejaculates, the sperm remain in the condom and are unable to enter the woman’s vagina. Condoms are more effective when used in combination with spermicidal foam. Typically, a woman inserts an application of foam into the vagina before intercourse. Condoms alone have a 15% failure rate but are 97% effective when used with foam.
A female condom is another type of barrier method. It is larger than the male condom and is inserted into the vagina before intercourse. When removed after intercourse, it takes the sperm with it.
The greatest risk of barrier method is user failure. Usually, when these methods fail, it is because the user has failed to insert or use it properly. Some women complain about a higher number of vaginal infection while using the diaphragm, but this has not been scientifically documented. Some people also experience an allergic reaction to the latex used in most condoms. Condoms can reduce sensitivity for the male and must be put on the penis in the middle of lovemaking, which many see as a drawback. Also, the condom must be handled carefully to avoid tearing.
What You Should Do
Barrier methods can be very effective if used properly. The best combination is to use a barrier method along with a spermicide. An added advantage is that barrier methods, particularly the condom, protect against sexually transmitted diseases, including AIDS. This is especially important for someone with diabetes.
Before you use a barrier method of birth control for the first time, have your health care professional show you how to properly use it. Diaphragms must be fitted by your doctor and are only available by prescription. It is important to have your diaphragms refitted regularly, especially if you have had a baby or have had a big gain or loss of weight.
Sterilization is available for both males and females. Sterilization should not be performed unless you are absolutely sure you do not want to have children or already have all the children you want. For women, the operation is performed by a surgeon, who ties off the Fallopian tubes (called tubal ligation). This prevents eggs from reaching the uterus and thus prevents pregnancy. For men, a vasectomy can be performed which prevents the release of sperm into the seminal fluid. Some men opt to store their sperm prior to surgery.
Vasectomy and tubal ligation pose no great risks, other than those of any kind of surgery. Sterilization has no hormonal, metabolic or vascular side effects. The greatest risk for permanent sterilization is its permanence. Do not opt for this approach unless you are absolutely sure.
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Diabetes and Oral Contraception by Pierre Gourdy
Fertility Issues in Women with Diabetes by Anna Livshits and Daniel Seidman