Birth Control

It is important to consider which method of birth control is right for you.

Birth control is an important issue for women with diabetes because there are greater risks for a woman with diabetes and her baby when pregnancy is unplanned.

The contraceptive options for women with diabetes are the same as for any woman and are based on individual preferences. This is a decision that should be made between you, your partner and your doctor. Talk to your partner about safer sex and how the two of you can protect each other. The regular use of condoms can prevent many sexually transmitted infections. The effectiveness of various birth control options is the same for women with or without diabetes.

There is a wide range of birth control options for women with diabetes. It is important to find the method that works best for you. Details about all of these options are offered in our Sexual Health Centre. Here is some information specific to women with diabetes.

The birth control pill is the most popular form of birth control for women, including the woman with diabetes. In the past, women with diabetes were advised to avoid taking the "pill" because of its effect on blood glucose and the risk for heart disease and stroke. These concerns were based on the doses of estrogen and progestin ( the synthetic form of progesterone) used in the "pill". In the last 20-30 years, the doses have decreased greatly, thereby decreasing the risk for these problems. However, the risk of heart disease and strokes remains high for women who also smoke.

Today the "pill" is available in different forms: combination estrogen and progestin, or progestin alone. Some women find the lower dose combination pill can affect their blood glucose. Regular blood glucose monitoring and adjustment of diabetes medication can help resolve blood glucose fluctuations. Your doctor will assess hemoglobin A1C (average blood glucose over a 2-3 month period), total cholesterol, LDL and HDL, triglyceride levels and blood pressure before and after starting the pill. If the results are elevated, an alternative method of birth control may be necessary.

Some doctors may suggest progestin-only pills to avoid the blood glucose fluctuations that may occur with combination pills. These "mini-pills" are effective but some side effects are more common such as break-through bleeding, breast pain, weight gain and irritability. Any concerns should be discussed with your doctor.

The intrauterine device (IUD) is often a preferred option for women with diabetes who are in a stable relationship where neither partner has sexual intercourse with anyone else. In the past, there was concern that IUDs might pose an increased risk for pelvic infection or trauma to the uterine wall and that women with diabetes might be particularly vulnerable to these infections. The newer generation of IUDs appears to be safe in this respect.

The diaphragm is a barrier method that is 95 percent effective in preventing pregnancy when fitted properly and used with spermicidal foam or gel. It does not affect blood glucose but there may be an increased risk for yeast infections for women who have diabetes.

The condom, used with spermicidal foam or gel, is another barrier method that does not affect blood glucose in women with diabetes. It is 85 percent effective against pregnancy when used correctly. Where there is a risk of a sexually transmitted infection, a condom should be used even if other methods of birth control are also used.

Other hormonal contraceptives, such as Norplant or Depo-Provera, are some of the options available to women with diabetes. Norplant comes in the form of a small capsule that is placed under the skin of the arm and slowly releases medication to prevent pregnancy for approximately 5 years. Depo-Provera is given by injection every 3 months. It does not contain estrogen, therefore it is a better form of contraception if you smoke. This is not a preferred method if you find it difficult to see your doctor regularly. Both implantable options may affect blood glucose, therefore regular blood glucose testing and adjustment to diabetes medications may be necessary.

Sterilization or tubal ligation is often the method of choice for the woman who has completed her family or who does not wish to conceive. Women who already have complications of diabetes, such as advanced kidney or eye complications, may want to consider this option.

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