Birth control for diabetics

Diabetes & Birth Control

Diabetes & birth control at a glance

  • Birth control pills, patches, implants, injections, and rings are generally considered to be safe forms of contraception for diabetic women, according to the American Diabetes Association (ADA).
  • However, the estrogen in birth control pills can raise blood glucose levels, which increase a diabetic’s resistance to insulin and may require an adjustment in the insulin she receives.
  • Because of the effects of estrogen, some physicians do not prescribe hormone-based birth control for some diabetic women.
  • The ADA says that combination birth control pills containing synthetic estrogen and norgestinate are best for women with diabetes.

The effect of birth control on diabetes

The inconclusive results of various research studies have led to controversy over the potential harmful effect of birth control pills for diabetic women. Some studies show that women who take birth control pills or other methods containing estrogen have higher blood glucose levels and blood cholesterol levels. Other studies show no differences in those levels between women taking birth control pills and women who don’t.

Factors to consider

  • Higher glucose levels resulting from the estrogen in birth control pills may require an increase in a diabetic woman’s need for insulin.
  • Higher cholesterol levels increase the risk of heart attack, and diabetics already have an increased risk of heart attack.
  • Some physicians recommend that diabetic women take birth control pills with the lowest dose of estrogen possible for effective contraception.
  • Other birth control methods that employ estrogen, such as implants, patches, injections and vaginal rings, can also affect a woman’s diabetes.
  • Studies indicate that diabetic women who take birth control pills for more than two years may increase their risk of experiencing complications, including:
    • the kidney disease diabetic nephropathy
    • the eye condition diabetic retinopathy
    • the nerve disorder diabetic neuropathy.

For these reasons, some doctors choose not to prescribe birth control pills for diabetic women. The safest course of action for women with diabetes is to discuss birth control options with their physician.

Can birth control pills cause diabetes?

No. While birth control pills may have an effect on diabetes, they do not cause diabetes.

What are the Birth Control Options for Women with Diabetes?

Unintended pregnancy for women with diabetes can be dangerous, especially when blood sugar is not under control. While some forms of birth control carry risks for diabetic women, the benefits outweigh those risks.

According to the American Diabetes Association, women with diabetes have the same birth control options as women without the disorder. However, some birth control medications can affect the body’s glucose. Let’s explore the choices, many of which are available through Nurx.

The Pill

When it comes to oral contraception for diabetic women, experts most frequently recommend low dose combined hormone birth control pills that contain synthetic estrogen and progestin. Popular examples are Aviane and Loestrin Fe 1/20, but Nurx offers many combination birth control pills that are suitable for women with diabetes.

Female hormones can be mysterious, though. Each woman has her own unique body chemistry, so it might take some experimentation with different birth control pills to find the right one. Rarely, the hormones in birth control can affect glucose levels, necessitating a change in the amount of insulin a woman needs.

Your Nurx provider will work with you to recommend a pill that will be safe to use and take into account your diabetes and any other health concerns you may have.

The Ring

A flexible birth control, the ring is placed inside the vagina for three weeks and then removed for a week. At the end of that week, you replace it with a new ring and repeat the process. Like the pill, it is a combination medication, containing both synthetic estrogen and progestin.

Health care providers often suggest NuvaRing for diabetic women because it does not pass through the digestive system. Instead, it is absorbed directly through the vagina. This is beneficial for women with diabetes because the body does not have to metabolize the medication like it does with the pill.

IUDs

There are two types of intrauterine devices available to women. One is a copper IUD, which prevents pregnancy by killing sperm. It does not contain hormones and can last up to 10 years.

The other is a hormonal IUD, known as Mirena, which releases a steady stream of synthetic progestin called levonorgestrel. It lasts up to five years. Many medical providers report that Mirena causes significant blood sugar fluctuations and weight gain, both of which are negative side effects for diabetic women, in addition to acne and mood swings.

Of the two IUD options, doctors are more likely to recommend the copper type. However, it is important to note that IUDs are generally not recommended for women who get pelvic infections easily. Diabetic women should know their A1Cs because higher levels can make them more susceptible to such infections.

Barrier Methods

Traditional barrier methods such as condoms, diaphragms, sponges, and cervical caps are good options for women with diabetes. They do not contain hormones and prevent sperm from fertilizing an egg. However, many barrier devices are used in combination with spermicide, which has been shown to increase the risk of urinary tract infections in some women. And, a high blood sugar level makes diabetic women even more likely to contract a UTI.

Other Options

Two other hormonal birth control methods are possibilities for women with diabetes — the patch and injections. The patch comes with the same risks as combination birth control pills, while injections are more likely to cause weight gain, a side effect that can increase insulin resistance.

In addition, diabetic women can consider natural family planning, sometimes called the calendar or rhythm method. This involves daily tracking of basal body temperature and cervical changes to determine when ovulation occurs.

Finally, there is abstinence, which is 100 percent effective when followed. However, it is often the most difficult to stick to, and, as mentioned, an unintended pregnancy can be quite dangerous for diabetic women. It’s best for women with diabetes to plan ahead and get pregnant when their blood sugar levels are regulated.

To learn more about birth control options, visit Nurx’s website and have a conversation with a knowledgeable health care provider.

This blog pro­vides infor­ma­tion about telemed­i­cine, health and related sub­jects. The blog content and any linked materials herein are not intended to be, and should not be con­strued as a substitute for, med­ical or healthcare advice, diagnosis or treatment. Any reader or per­son with a med­ical con­cern should con­sult with an appropriately-licensed physi­cian or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of Nurx™.

Contraceptive choices, for women with type 1 diabetes

If you are a sexually active woman with type 1 diabetes, it’s important that you talk to your diabetes health professionals about contraception and pregnancy.

There are a number of contraceptive choices available to women with diabetes. Discuss available options with your health professionals. You may have to try a few different methods before you find one that’s right for you.

It is important to use effective contraception until you decide you want to become pregnant.

All types of contraception have benefits and side effects. The most effective are the long-acting reversible methods of contraception. These include hormonal implants and intrauterine devices (IUDs). These are particularly effective at preventing pregnancy.

If you decide to not have any more children, you may want to consider a tubal ligation or discuss a vasectomy with your partner.

Intrauterine contraception

Intrauterine contraception uses a small IUD device that is placed into your uterus (womb). There are two types; the copper IUD and the hormonal IUD (the levonorgestrel-releasing intrauterine system—Mirena®). They are made of flexible plastic with a nylon string attached to the end. Once an IUD is placed in your uterus, it lasts 5–10 years.

These are ‘set and forget’ methods that are extremely reliable. Over the period of one year, less than 1 in 100 women will fall pregnant using this method. They are safe for women with diabetes, including those who have not had children. They are also reversible—once they are taken out, fertility returns to normal.

Benefits

Both the copper and the hormonal IUD have the following benefits:

  • highly effective at preventing pregnancy
  • provide long-term contraception (at least five years)
  • unlike many other methods, you don’t need to remember to take it regularly
  • less expensive than many other types of contraception (more expensive at first but cheaper in the long-run)
  • are reversible—you can try for pregnancy as soon as your IUD is removed
  • are suitable for women who have not had children and for women who have had children.

The hormonal IUD has the added benefit of reducing or even stopping menstrual bleeding. In addition, for a woman who has diabetes complications affecting the eyes or kidneys, intrauterine contraception is often a better choice than contraceptive pills.

The copper IUD does not contain hormones. It is suitable for women who cannot tolerate hormones or are taking medication that may interfere with other contraceptive methods.

The IUD rarely has any effects on blood glucose levels.

Drawbacks

An IUD needs to be inserted by your GP or gynaecologist. You may have to pay for the procedure but, because IUDs last for many years, intrauterine contraception is a very inexpensive method.

Copper IUDs are not recommended if you have irregular or heavy menstrual periods, as they tend to increase the amount of vaginal bleeding. The hormonal IUD can cause some irregular bleeding when first inserted, but afterwards, the bleeding is usually reduced or stops altogether

There is a small risk of pelvic infection around the time of insertion, but the risk is very low. Although uncommon, it is possible for the IUD to be pushed out by the uterus.

Implants

A contraceptive implant (Etonogestrel implant) contains the hormone progestogen and is implanted under the skin using a local anaesthetic. It lasts for three years but can easily be removed if side-effects occur. It is an effective reversible method of contraception. Over a period of one year, less than 1 in 100 women will fall pregnant using this method.

Implants have the following benefits:

  • highly effective at preventing pregnancy
  • less expensive than many other types of contraception
  • long-lasting (up to three years)
  • may reduce period bleeding and pain
  • easily reversible
  • does not affect your fertility
  • unlike many other methods, you don’t need to remember to take it regularly

Most women find that implants do not usually affect blood glucose levels.

Implants can only be inserted and removed by a specially trained doctor, nurse or midwife. You may have to pay for the procedure but, because implants last for three years, this is a very inexpensive method. Your bleeding pattern will change and may be unpredictable. In some cases, you may stop having periods completely.

Oral contraceptive pill

There are two types of contraceptive pill:

  • the combined oestrogen and progesterone pill; and
  • the progesterone only pill (also called the ‘minipill’).

The combined pill is a better option, as it provides good control of the bleeding pattern and women experience less irregular bleeding. It often reduces excessive bleeding and may help with menstrual pain. The combined contraceptive pill contains two types of hormones—oestrogen and progestogen. The combined pill is effective if taken regularly, but 9 in every 100 women will become pregnant every year while using this form of contraception. Many types of combined oral contraceptives are available. These contain varying types and doses of oestrogen and progestogen hormones.

The progestogen-only pill is suitable for women who are breastfeeding or cannot tolerate the oestrogen hormone.

The oral contraceptive pill has the following benefits:

  • may reduce the amount of period bleeding and pain
  • often improves acne

The oral contraceptive pill must be taken every day otherwise it will not be effective.

The combined oral contraceptive pill may also have some unwanted effects. Some women experience headaches and/or nausea and some develop high blood pressure. The combined pill is not recommended for women who have diabetes and eye, kidney or other vascular complications, in such cases, alternative contraception should be used.

While some women find that the combined pill affects blood glucose levels, research suggests that the lower dose oral contraceptive pills used now are less likely to do so. It is a good idea to monitor your blood glucose levels more closely for the first month after you start taking the pill. Talk to your doctor for more information.

The progestogen-only pill needs to be taken even more precisely at the same time each day and will not be effective if pills are missed. It can also cause irregular bleeding.

The oral contraceptive pill may not work properly if you are vomiting. In this case, a different form of contraception (such as a condom) will need to be used, usually until your next period. Most broad-spectrum antibiotics do not interfere with the pill.

Depot injections

Depot injections are given every 12 weeks and contain a progestogen hormone in a high dose. Over a period of one year, 6 in every 100 women will become pregnant using this method. The method may affect your blood glucose levels and insulin requirements, and it can also raise cholesterol levels.

Depot injections have the following benefits:

  • highly effective at preventing pregnancy
  • periods may be lighter and less painful or stop completely
  • effective even if you have diarrhoea or vomiting or are taking other medications

Depot injections cannot be reversed and it may take months for the full effect to wear off. While you are using depot injections, your bleeding pattern will change and may become unpredictable. You may experience some loss of bone density, but this will recover once depot contraception is stopped.

Condoms

Condoms are an immediate, convenient form of contraceptive that also help protect against sexually transmitted infections (STIs). You can purchase condoms in supermarkets, chemists and online. Both male and female condoms are available.

Condoms are not as effective as implants and IUDs at preventing pregnancy. Over a period of one year, 18 in every 100 women will become pregnant using male condoms and 21 in 100 women will fall pregnant using the female condom.

If you are not in a regular relationship, it is best to use both condoms (to prevent STIs), as well as a more reliable method such as implants (to prevent pregnancy).

Acknowledgement: Thank you to Associate Professor Kirsten Black, Joint Head of Discipline of Obstetrics, Gynaecology & Neonatology, Central Clinical School, University of Sydney for kindly reviewing this information.

Type 2 Diabetes and Birth Control

A woman who has type 2 diabetes, formerly called adult-onset diabetes or non-insulin-dependent diabetes, has to face the same issues that confront most women, such as choosing a birth control method. However, unlike women who don’t have diabetes, she must take into account about how the form of contraception she chooses will affect her blood sugar levels, as well as the rest of her body.

Type 2 Diabetes and Birth Control Pills

In the past, birth control pills weren’t usually recommended for women with diabetes because of the hormonal changes the medication could cause. High doses of hormones can have a dramatic effect on blood sugar levels, making it harder for women to control their diabetes. However, research into new formulations has resulted in many different, lighter combinations of hormones. These new pills are safer for many women, not just those with diabetes.

According to Brian Tulloch, MD, endocrinologist at Park Plaza Hospital and Medical Center and clinical associate professor at the University of Texas Medical School at Houston, a woman with type 2 diabetes who chooses to use birth control pills should take the lowest possible dose that is still effective in order to help limit the effects the medication has on the diabetes.

One thing women taking birth control pills should remember is that there is still an increased risk for heart attack or stroke among women who use this form of contraception. Since people with diabetes also have an increased risk of heart disease, this is something that women should discuss with their doctors.

Type 2 Diabetes and Other Hormonal Contraception

Birth control pills aren’t the only way you can use hormones to prevent pregnancy. There are also injections, implants, rings, and patches.

Injections are becoming a popular choice because one shot of depot medroxyprogesterone acetate (Depo-Provera, or DMPA) can prevent pregnancy for three months. With this method, women only have to think about birth control four times a year. However, because the injection uses the hormone progestin, there can be side effects like weight gain, unwanted hair growth, dizziness, headaches, and anxiety.

If you don’t like the idea of having an injection every three months, you may want to try the contraceptive implant. This is a small plastic matchstick-sized rod that’s inserted under the skin of the upper arm. While the implant is in place, it releases progestin, the same hormone as the injection.

Another new entry in the hormonal contraceptive group is the vaginal ring, which is worn for 21 days straight. This ring is placed in the upper vaginal area; when it’s in place, you shouldn’t feel it. The ring provides you with not only progestin, but estrogen as well, which means that women who use it may experience side effects much like those from the Pill.

Finally, there is the patch. Like other medication patches, such as those that help you stop smoking, the contraceptive patch works when applied to the skin. The patch releases estrogen and progestin for one week and is then replaced with a new one; this is done for a total of three weeks in a row. No patch is worn during the fourth week (during which you get your period), and the cycle then starts over. Again, the side effects can be similar to that of the Pill or the vaginal ring, plus there could be some skin irritation where you use the patch.

Like the Pill, other types of hormonal contraception can have an impact on blood sugar. If you choose to use one of these methods, you doctor may need to adjust your diabetes medication.

Type 2 Diabetes and Intrauterine Devices

Intrauterine devices (IUDs) are devices that are inserted into the uterus. An IUD stays in place for a set amount of time until a doctor removes it. For reasons that doctors do not completely understand, the IUD discourages fertilized eggs from implanting into the uterine wall and thus helps prevent pregnancy. Although an IUD is a fairly effective method of birth control, one of the risks of using the device is infection in the uterus.

Women with diabetes are already at a higher risk of developing infections because of their disease, so this type of birth control may not be the best choice if you have type 2 diabetes.

Type 2 Diabetes and Barrier Methods

With the concern over sexually transmitted diseases, barrier methods are becoming more popular among women. By preventing semen from reaching the uterus, the risk of pregnancy, as well as disease transmission, is lowered.

For most women, barrier methods can be an effective contraceptive choice, and condoms and diaphragms won’t affect blood sugar levels. It’s important, however, to understand that these barrier methods do have a failure rate higher than the Pill and must be used properly each and every time it’s possible for semen to enter the vagina. Also, women with diabetes may have a higher risk of getting yeast infections when using a diaphragm.

Type 2 Diabetes and Sterilization

Finally, perhaps the most secure method of birth control, outside of abstinence, is sterilization by means of a surgical procedure called a tubal ligation. This is, however, a permanent method of birth control unless a woman undergoes another surgery to reverse the sterilization procedure. The reliability of this method is the biggest “pro,” while the fact that it is permanent may be a “con” if you are not 100 percent sure you have finished growing your family.

Another point in favor of this method for women with type 2 diabetes is that sterilization doesn’t affect a woman’s blood sugar levels. Still, surgery is not without risk, including infection and other complications.

Whatever you choose, a reliable method of birth control is important for women with type 2 diabetes, since an unplanned pregnancy carries health risks for both mother and baby. Taking charge of your reproductive health puts you in the driver’s seat.

Two USC Annenberg alumni screen their documentaries at Sundance

A new study by USC researchers reveals that the mini-pill – progestin-only birth control pills – may put women who have had gestational diabetes at a higher risk of developing the chronic form of the disease.

“It appears that progestin-only oral contraceptives increase risk by nearly three-fold and should not be widely prescribed in this group of women,” said Siri Kjos, USC associate professor of obstetrics and gynecology.

That caution, however, is tempered by good news.

“The most important finding is that low-dose combination oral contraceptives appear to be a relatively safe method of contraception for these very high-risk women,” Kjos said. The USC team reports its results in the August 12 issue of the Journal of the American Medical Association.

For women who develop diabetes during pregnancy, family planning is critical. Yet, until now, it has not been clear how safe birth control pills are in these high-risk women.

In earlier studies, the USC team showed that women with a history of gestational diabetes mellitus (GDM) who have a subsequent pregnancy face a two-to-three-fold risk of developing chronic diabetes. Contraception is also important for the health of the fetus – if a woman unknowingly gets pregnant while her diabetes is untreated, her fetus faces an increased risk of birth defects, and she is more likely to miscarry or suffer other potentially fatal complications.

For women who wish to breastfeed and take hormonal contraceptives, doctors usually prescribe progestin-only oral contraceptives because they do not interfere with milk production. Low-dose combination birth control pills are more commonly used and contain a mix of estrogen and progestin.

In the study, USC researchers followed 904 Latina women who had developed GDM during a recent pregnancy, but whose ability to process sugars had returned to normal after delivery.

During their initial post-partum visits, about half chose to use hormonal oral contraceptives and half chose a non-hormonal form of contraception. Of the women opting to take birth control pills, 383 were prescribed low-dose combination birth control pills and the 78 women who were breastfeeding received the progestin-only mini-pill.

The research team found that 169 women developed chronic diabetes during the study and that the risk was influenced by the type of contraception they had used.

Of the women taking the progestin-only mini-pill, an average of 26.5 percent per year developed type 2 diabetes, compared to a rate of only 8.7 percent per year of women using non-hormonal contraceptives and 11.7 percent per year of those choosing a low-dose combination birth control pills.

“We found that the longer a woman used the progestin-only oral contraceptives, the higher her risk of later getting diabetes,” Kjos said.

The take home message? “It’s OK to take low-dose combination oral contraceptives even if you have had gestational diabetes,” said Ruth Peters, USC professor of preventive medicine, who helped lead the study. “But while you’re breast feeding, it’s probably better to use a non-hormonal form of contraception rather than the progestin-only mini-pill.”

Type 2 or adult-onset diabetes strikes more than 14 million Americans. Because many patients have no symptoms in its early stages, many unknowingly have the disease for years before being diagnosed by a blood test.

Risk factors include age, obesity, having a close relative with the disease and being a member of certain ethnic groups, such as Latino or African-American. Without treatment, type 2 diabetes can lead to serious complications including heart disease, stroke, nerve disease, vision problems and kidney failure. Early detection is important since lifestyle changes and oral medications can effectively control the disease.

Mini-Pill Increases Risk Of Chronic Diabetes In Women With History Of Diabetes During Pregnancy

LOS ANGELES, August 12, 1998 — Women who develop diabetes during pregnancy face an increased risk of later developing type-2 diabetes. Now, USC researchers say that using the mini-pill — progestin-only birth control pills — may put these women at an even higher risk of developing the chronic form of the disease.

“It appears that progestin-only oral contraceptives increase risk by nearly three-fold and should not be widely prescribed in this group of women,” says Siri Kjos, M.D., associate professor of obstetrics and gynecology at the University of Southern California School of Medicine.

That caution, however, is tempered by good news, Kjos (pronounced KEY-hos) says. “The most important finding is that low-dose combination oral contraceptives appear to be a relatively safe method of contraception for these very high-risk women.” The combination birth control pills are the most commonly used ones and contain a mix of estrogen and progestin.

Kjos and colleagues report their results in the August 12 issue of the Journal of the American Medical Association.

In the study, USC researchers followed 904 Latina women who had developed gestational diabetes mellitus (GDM) during a recent pregnancy, but whose ability to process sugars had returned to normal after delivery.

During their initial post-partum visits to the High Risk Family Planning Clinic at LAC+USC Women’s and Children’s Hospital, about half chose to use hormonal oral contraceptives and half chose a non-hormonal contraceptives. Of the women opting to take birth control pills, 383 were prescribed low-dose combination birth control pills and the 78 women who were breast-feeding received the progestin-only contraceptives.

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For women who wish to breast-feed and take hormonal contraceptives, doctors usually prescribe progestin-only oral contraceptives because they do not interfere with milk production. In the present study, women were switched to the low-dose combination pills once they stopped breast-feeding.

The research team found that 169 women developed chronic diabetes during the study and that the risk was influenced by the type of contraception they had used. Of the women taking the progestin-only mini-pill, an average of 26.5% per year developed type-2 diabetes, compared to a rate of only 8.7% per year of women using non-hormonal contraceptives and 11.7% per year of those choosing a low-dose combination oral contraceptive.

“We found that the longer a woman used the progestin-only oral contraceptives, the higher her risk of later getting diabetes,” Kjos says.

Type-2 or adult-onset diabetes strikes more than 14 million Americans, according to estimates from the American Medical Association. Since it can be asymptomatic in its early stages, many are only diagnosed with a blood test. Most develop the disease in middle age. Obesity, having a close relative with the disease and being a member of certain ethnic groups (including African-American, Latino and Native American) are known risk factors. Without treatment, type-2 diabetes can lead to serious complications including heart disease, stroke, nerve disease, vision problems and kidney failure. Lifestyle changes (such as dietary changes and increasing exercise) and oral medications prove effective in controlling diabetes for most people.

“Family planning is extremely important for women with a history of gestational diabetes,” says study co-author Thomas Buchanan, M.D., USC associate professor of medicine and obstetrics and gynecology. In earlier studies, the same team had found that women with a history of GDM who have a subsequent pregnancy face two-to-three-fold the risk of later developing type-2 diabetes. Contraception is also important for the health of the woman’s future children — if a woman gets pregnant and has uncontrolled diabetes, her fetus faces an increased risk of birth defects, and she is more likely to miscarry or suffer other potentially fatal complications.

“When we started the study we were more interested in finding out whether oral contraceptives in general were safe in these women,” says Ruth Peters, Sc.D., USC professor of preventive medicine who also helped lead the study. “We found that it’s OK to use oral contraceptives even if you have had gestational diabetes. But if you’re breast feeding, and so would be prescribed a progestin-only pill, you may want to choose non-hormonal contraceptives instead,” Peters says.

This study was supported in part by grants from the National Institutes of Health and the National Institute of Diabetes and Digestive Kidney Diseases.

Birth Control & Type 1

Note: This article is part of our Daily Life library of resources. To learn more about the many things that affect your health and daily management of Type 1, visit here.

The subject of birth control with relation to Type 1 diabetes has always been a tricky subject, with inconsistent results. Hormones have been known to have an impact on blood glucose levels, but hormones affect everyone differently, so in terms of contraception, what works for one person might be completely wrong for another.

Here are some observations and facts to keep in mind when considering your birth control options while managing your Type 1!

There are a couple of different types of IUDs that will interact with the body differently. The first type is a copper IUD, which is inserted by your doctor, and can last for up to ten years. It is the copper itself that kills the sperm, preventing pregnancy.

The other type of IUD (Mirena) is plastic, and it is a hormonal IUD. It contains the progestin hormone levonorgestrel, which is also used in the “morning after pill,” and it can last up to five years – half the time span of a copper IUD. There have been many reports of the hormones in Mirena causing severe blood sugar changes as well as acne, weight gain, and mood swings.

IUDs in general are not recommended for women who contract pelvic infections easily. Women with Type 1 diabetes with higher A1Cs can be more susceptible to such infections, so it is important to be in excellent control of your Type 1 before considering any IUD.

The ring is a flexible device that is inserted into the vagina and worn for three weeks. It is then replaced after one week of not wearing one. The hormones in the ring are absorbed directly into the vagina, therefore bypassing the digestive system all together. This makes it easier on the body in the sense that it does not need to metabolize the medication like it does with the pill. This seems to have the potential of avoiding certain blood sugar malfunctions that could be tied to metabolizing hormones.

Warning: The makers of NuvaRing advise women who already have any complications from diabetes should not use the ring.

Birth control pills that contain synthetic estrogen and norgestimate are the most widely recommended pill for women with diabetes. Example: Ortho Tri-Cyclen.

This type of pill is less androgenic, which is defined as containing hormones that induce male characteristics. However, depending on your overall health, your doctor may suggest an entirely different method. One pill could be far less intrusive when it comes to blood sugar control for one woman, but wreak havoc for another. It is important to take the time to find the one that is right for your own body.

It is important to keep in mind that women with diabetes have often reported their basal needs to have nearly doubled when starting on the pill, so be prepared to adjust insulin requirements as needed.

The pill is not recommended for women who suffer from heart disease, blood clots, high blood pressure, and women who smoke or are over the age of 35.

Hormone injections

Hormones to prevent pregnancy can be injected, but have a higher risk of weight gain, which can cause more insulin resistance.

Plan B

The Plan B or “morning after” pill is not often recommended for women with diabetes, due to the flood of hormones that is released all at once, as opposed to the steady release that other methods employ. Women who have tried it have reported varying but severe blood sugar malfunctions immediately following.

Diaphragms & Barrier devices

Barrier devices are safe for women with diabetes, as they do not contain any hormones, however, the spermicides used in some of these devices can increase risk of urinary tract infections. Gel and foam barriers used without the spermicides can be used as well, but only have approximately 70% effectiveness compared to the 99% effectiveness of the pill or the ring.

Read more articles on Daily Life or Sex, Drugs + Rock & Roll

Ask D’Mine: The Best Birth Control for FWDs is…

Need help navigating life with diabetes? Ask D’Mine! That would be our weekly advice column, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil’s done some serious homework on a women-specific issue: Birth Control. But don’t fear, men, this isn’t just a post for those Females With Diabetes (FWDs). There’s something in it for everyone. So, don’t be afraid to read on! (Or print out and read later — this one’s a doozy!)

{Got your own questions? Email us at [email protected]}

Kathleen, type 2 from Texas, asks: What do you think of Mirena as a birth control option for diabetics, especially those on insulin?

[email protected] D’Mine answers: Seriously? The new-style intrauterine device (IUD) that’s implanted into the wall of the uterus? You know I’m a man, right? And as such, I only have the vaguest of idea of where the uterus is in the first place.

But even though I’m out of my league, and out of my gender, your question piqued my interest. I mean, come on, sex and diabetes—what more could I want to totally make my day? So I read up on Mirena, then I started calling all the female diabetes docs I know. They told me that there’s no nationwide standard recommendation for birth control for female diabetes patients, and no one agrees on what’s best.

It turns out that the entire subject of birth control for FWDs is more complex than you’d think. In fact, birth control options for any female are more complex than I had realized, so we’re going to devote today’s entire column to the subject. Not just Mirena, but the full spectrum of options for my diabetic sisters.

Mirena and Garden Variety IUDs

But since you asked about Mirena, we’ll start there. It’s an IUD, a small plastic device that looks a bit like a boat anchor. I should make some sort of joke about sailors and sex, or anchors away at this point, but I’m still trying to figure out where the uterus is.

Oh yes, and speaking of the uterus, that’s where an IUD goes. IUDs, which come in two flavors, are inserted by a doc into the wall of the uterus. And like an anchor, an IUD has a little string that threads down through the cervix (man alert: not the same as the clitoris), and into the vagina.

You know what guys? Please review this road map to the female reproductive system before going on. It will save us all a lot of time.

A traditional IUD (not to be confused with an IED) is clad in copper and can be left in place to prevent pregnancy for up to ten years. How on earth does that work? Copper is toxic to sperm. It kills the little swimmers. Penny for your thoughts? Well, it’s actually a little more complicated than that, but that explanation will have to do for today.

Mirena, on the other hand, is a hormonal IUD. It’s loaded with levonorgestrel, a progestin hormone that’s also used in the “morning after pill,” some birth control pills, and the now-off-the-market Norplant. Oh, yes, and Mirena is only good for five years, half the lifespan of a copper IUD. If you were paying out-of-pocket it would cost you around $600, not including the doctor’s visit. That’s about the same price as a copper IUD like ParaGard, but of course, Mirena only lasts half as long as the traditional copper—so it would cost twice as much if you used it long-term

But is Mirena, or any IUD, a good choice for an FWD?

First, that depends on your control, because IUDs aren’t recommended for women who get any sort of pelvic infections easily, and we all know that high blood sugar almost guarantees a wide assortment of “down there” infections in ladies with diabetes. So for IUDs in general, Kathleen, I don’t think that insulin use comes into play at all. If an FWD’s A1C is excellent, regardless of her diabetes therapy, an IUD would probably be fine.

What about the Mirena IUD? My first thought was it would probably be OK, but then I got two emails. Both from health care providers who work with FWDs extensively. Neither want to be quoted by name, but they both tell me that they’ve seen break-through bleeding, blood sugar changes, acne, personality changes such as depression and mood swings, and weight gain on their patients who tried Mirena. One of the two told me she found these effects in most of her patients who tried it, and the other said “it does have an effect on many women, perhaps not all, but quite a few.” They both prefer traditional copper IUDs for their FWDs. One added “Every OB we’re talked with acts like ‘Oh that doesn’t happen,’ with Mirena, but after seeing and talking to the patients I disagree.”

Meanwhile, diabetes doesn’t exist in a vacuum, and Mirena has other contraindications to consider as well, like large fibroids, breast cancer, abnormal Pap smear, liver disease, heart disease, and high blood pressure. So ultimately the choice of any kind of birth control Rx needs to be made by the doc and the patient together.

And just what are the choices?

Patches and Plan B

There are pills, more formally known as “oral contraceptives.” There are condoms, more informally known as “rubbers.” There are diaphragms. And rings. And injections. And foams. And patches. And the rhythm method. And abstinence. Yeah, right. And the ethically controversial Plan B.

To help us wade through all of this, I emailed Dr. Kathleen Colleran, a practicing endo, clinical researcher, and professor with the University of New Mexico School of Medicine. Dr. C is one of those overworked people without much time to spare, so I’ve learned to keep my communications with her simple. I asked her to list her favorite top two birth control methods for both type 1s and type 2s. Dr. C felt there was no difference in her recommendations between the two flavors of diabetes, so she gave us her top three birth control choices for all FWDs: condoms, rings, then pills. In that order.

In number one place, Dr. C likes condoms. Ummm… that might not have been the best choice of words, but you know what I mean. Her reason is that in addition to preventing unwanted pregnancy, they “prevent ugly diseases that have pretty names.” Good point. Of all the assorted types of birth control, only condoms and total abstinence can prevent sexually transmitted diseases.

I think we’re all up to speed on condoms, so I won’t spend too much time on them today. But while I was looking for a good link for those of you who wanted to know more, I actually stumbled on a place called Condom Depot, that has a mind-numbing inventory, featuring, no shit, 25 different brands, each with multiple styles. Not your grandpa’s Trojans. I just have to share some of the current brand names with you: Vibrating Johnny, Bravo, Caution Wear, Impulse, Natural Lamb, Night Light, Paradise, and Vivid.

And don’t forget there’s also a female condom, sometimes called a “femidom,” not to be confused with femdom.

In number two place, Dr. C likes the ring, as she feels it is less systemic, meaning fewer body systems are involved in metabolizing the medication. The ring looks like a … ring, and is placed in the vagina. It’s flexible, about two inches in diameter, and is worn for three weeks, removed, and then replaced with a new one after a week off.

On the pharmacologic level, the ring is sorta like the pill, but the hormones are absorbed directly through the wall of the vagina, bypassing the digestive system altogether. It shares the same 99% effectiveness in preventing pregnancy that the pill boasts.

Merck, makers of NuvaRing, warns us that women who already have diabetes complications shouldn’t use their product.

In third place, Dr. C likes the oral pill ortho tri-cyclen, as she feels it is less androgenic than other pills. Andro-what? It’s one of those fancy-pants medical terms. It means “to develop male characteristics.” Because if your birth control pill causes you to grow a beard you won’t be getting pregnant, that’s for damn sure.

The American Diabetes Association also favors this kind of pill, which uses synthetic estrogen and norgestimate. But the pill isn’t for every FWD. Like all other hormonal birth control methods, it isn’t recommended for ladies who have high blood pressure, heart disease, blood clots, are over the age of 35, or smoke cigarettes.

Smoking? Really? Yes. Really. Taking the pill and smoking greatly increases your risk of a heart attack. Also be aware of the fact that some women need to increase their insulin dose when on the pill.

Well, we’re running out of time today, but just to quickly review the other keep-yourself-NOT-knocked-up options: there’s the patch. It’s another hormonal solution, this time using a transdermal patch — like NicoDerm for quitting smoking. So if you need to quit smoking and need birth control, you could be wearing two patches. It carries the same risks and contraindications that pills do. Hormones can also be injected, but injections seem more likely than pills to cause weight gain, which can increase insulin resistance (and lower self-esteem).

Last up on the hormone front is Plan B, a.k.a. “the morning after pill.” I don’t want to get bogged down in the storm of controversy surrounding the ethics of this approach to birth control, just know that Plan B unleashes a flood of hormones compared to proactive hormone birth control, and there are some reports of blood sugar control issues after taking Plan B.

Getting away from hormones, another birth control option is a diaphragm, and its cousins the sponge and the cervical cap. These are collectively called “barrier” devices, as their function is to create a barrier to prevent the sperm from getting to its destination. Most barriers are used with an spermicidaljell, foam, or tablet. And of course, gels and foams can be used by themselves as well, but are only about 70% effective in preventing pregnancy when used alone.

Barriers are safe and effective for FWDs, but the spermicides have been shown in some women to increase the risk of urinary tract infections, so if your blood sugar is already high, you might not want to risk adding a second risk factor.

Of course you can also use the rhythm method. The theory behind this system is that a woman’s basal temperature will change when she starts ovulating. By tracking basal temperatures, you can, in theory, avoid sex when you’re most fertile. I think that’s where my nephew came from… so enough said about that.

Oh, and I forgot to mention the… umm… withdrawal “method.” What do I think of that? Don’t trust men. Enough said about that, too.

And last, and least effective, is abstinence. It only works when applied 100% of the time, and has been proven time and time again to fail in the face of human nature.

The Ultimate Risk

I wanted to end today’s column with a good joke, a witty play-on words, or a return to the running uterus gag—I love that kind of “circular construction.” But while sex can, and should, be funny and edgy to talk about, birth control for FWDs is a serious topic.

Of course, high blood sugars can be a side effect when talking about the pill. Some FWDs who’ve been on birth control say their basal insulin amounts nearly doubled when going on the pill. So it’s important to recognize that the birth control could be causing insulin resistance, and you’re not doing something wrong like being off in carb counting. Some women also say they need a lot less insulin during the time they’re on placebo pills, so that’s something to keep in mind, too.

Sadly for my D-sisters, most of the forms of female birth control carry some degree of medical risk, and those risks seem to inflate for all FWDs. But it’s the lesser of evils. The largest risk to an FWD’s health is an unplanned pregnancy when her blood sugar control isn’t optimum. A high-blood sugar pregnancy is extraordinarily dangerous.

Both for the mother and for the baby.

“This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.”

Explore Methods

Have diabetes? Want to have lots and lots of great sex without worrying about getting pregnant or messing with your blood sugar?

Just like food or exercise when you have diabetes, there are a few things to keep in mind—but don’t worry. Whether you have type 1 or type 2 diabetes, you’ve got options.

When it comes to birth control, “nothing is off the table,” says Dr. Robin Goland, endocrinologist and Co-Director of the Naomi Berrie Diabetes Center in New York. It’s a matter of talking through the risks and benefits of each method with your doctor—and weighing them against your risk of getting pregnant.

Here are some things to talk about with your health care provider:

  • Heart health. People with diabetes, especially type 2, are at a greater risk for cardiovascular issues. Some birth control methods also slightly increase your risk for those problems, so your provider may want to talk to you about your heart health when helping you pick out a birth control method.
  • Hormones and your blood sugar. Some hormonal birth control methods can raise your blood sugar.
  • Infections. People with diabetes are more prone to infections than people without diabetes—including pelvic infections. If you choose an IUD, avoiding pelvic infections is important. Use a condom every time you have sex, and consider using lube, too. Diabetes can sometimes lead to vaginal dryness, causing skin ruptures in and around your vagina which can get infected. Lube can help you avoid that. (Plus, it can make sex feel even better!)

Monitor your blood sugar for changes in the weeks and months after you start a new birth control method. If you see any major changes, talk with your provider about how you can adjust. You may need to take more insulin or other medicine, change your diet, or switch to another birth control method.

Everyone reacts a little differently to birth control, even people without diabetes. Sometimes it takes a couple tries to find the right method, and that’s totally normal. By paying attention to your body and talking with your provider, you can take care of your diabetes AND your sex life.

Emily Pisacreta is a type 1 diabetic New Yorker who studies journalism at Columbia Journalism School, writes about health and social justice issues, and loves peanut butter.

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