As part of Women’s Health Week, we take a look at the challenges and circumstances women face when living with type 1 diabetes.
by Sarit Polsky, MD, MPH
Originally published to DiabetesSisters.org March 2019
There are many choices/options for contraceptive therapy for women with diabetes. Women can use certain forms of contraception to prevent pregnancy, to reduce painful periods or heavy menstrual bleeding, or to improve symptoms of other medical conditions. Contraceptive methods fall into two main categories: hormonal and non-hormonal.
Non-hormonal methods of contraception include the use of barrier contraceptives (like condoms, diaphragms, and cervical caps), spermicides, natural family planning (intercourse planning to avoid timing around ovulation), abstinence, and the copper intrauterine device (IUD). Barrier methods, spermicides, and natural family planning all rely on careful planning and on having necessary contraception/tools on-hand at the time of intercourse. The copper IUD requires insertion by a health care provider.
The above-mentioned methods can be stopped at any time if a woman wants to conceive a child. There is also a non-hormonal option for definitive contraception with sterilization techniques (tubal ligation for women and vasectomy for men). These methods tend to be less effective (with the exception of abstinence, the copper IUD, and sterilization), but some also provide protection against sexually transmitted diseases (STDs), such as condoms, when used appropriately.
Hormonal methods of contraception include birth control pills (combined oral-contraceptive pills and progestin-only pills), skin patches, vaginal rings, Depo Medroxyprogesterone acetate injections (“Depo shots”), an implant in the arm, medicated IUD, and emergency contraception. Most of these methods are “generally used methods” by the World Health Organization in women with diabetes. However, some should be used with caution and only with the approval of a health care provider in women with diabetes for more than 20 years and/or with a history of advanced vascular diseases (such as in the eyes, kidneys, or nerves to the feet), and these include the combined oral contraceptive pills and Depo shots. In addition, some of these methods should not be used in women who smoke as they can increase the risk for dangerous blood clots.
Some hormonal methods require that the user follow instructions carefully in order to provide protection against an unplanned pregnancy (such as the pills, patches, vaginal rings, and Depo shots). For example, skipping pills or taking them later on the same day can result in a pregnancy. Other methods are less reliant on the user as they are inserted in a health care provider’s office into the skin (arm implant) or uterus (IUDs) and thus provide protection against pregnancy for 3-10 years, depending on the device, without having to do something daily or monthly.
None of the hormonal contraceptive methods protect against STDs, so one should consider that in some cases two methods of contraception would be required (for example, IUD and condom use).
The decision to use contraception is a personal one. It is important to consider the health benefits and risks of each method as they relate to a woman’s individual needs. One may also need to consider cost, medical contraindications (reasons why one cannot use a particular method[s]), cultural beliefs, side effects, access to obtaining the preferred method, and future desire to conceive. About 45% of pregnancies in the United States are unplanned. Unplanned pregnancies in women with diabetes are generally associated with worse health outcomes for mothers and their babies.
Depending on the contraceptive methods used, contraception can help reduce the rates of unplanned pregnancies, STDs, and symptoms of certain medical conditions. Thus, there are many reasons why a woman of reproductive age (sexually active or not) should consider whether contraceptive therapy is right for her.
