Birth Control and Diabetes

Practicing birth control and safe sex are important for anyone, but they are especially important for women with diabetes. The outlook for women with diabetes and their babies has improved dramatically in recent years. Part of the reason is that more women are planning pregnancies and getting the guidance and care they need before conception and during pregnancy.

A baby’s organs are formed in the first six weeks after conception. Most women are not even sure that they are pregnant during this critical time. High blood glucose levels can interfere with this development, and the baby has a greater chance of a birth defect. Also, when blood glucose levels are high, the risk of spontaneous miscarriage may double in early pregnancy.

You increase your chances for a healthy child when you plan your pregnancy and have an A1C level that is as near to normal as possible before you conceive.  In fact,  when blood glucose levels are close to normal, the risk for birth defects is about the same as for women without diabetes. Choosing and using an effective form of birth control allows you to plan your pregnancies.

For Women
Women with diabetes have the same birth control options as other women. The pill, intrauterine device (IUD), barrier methods,  and spermicides are all ways to reduce the risk of unplanned pregnancy. The rhythm method, in which women predict ovulation and avoid intercourse during fertile times, is generally not a sufficiently reliable method of birth control for women with diabetes. A tubal ligation may be an option if you are sure you never want to become pregnant,  because it is nearly impossible to reverse.

Many birth control methods work by altering hormone concentrations. The methods of birth control that rely on hormones, such as birth control pills and the IUD that releases progesterone, can affect your blood glucose levels. Birth control methods that don’t rely on hormones are not likely to change your blood glucose levels. Which method you choose will depend on your own personal and family health history and your individual preferences. If you have any special concerns, be sure to bring them up with your health care team.

Hormonal Methods. Oral contraceptives (“the pill”)  are the most popular and effective birth control method available.

Hormonal methods of birth control prevent pregnancy by preventing ovulation. Hormonal methods are available as pills, patches, vaginal rings, and by injection. Hormonal contraceptives are about 95 to 99 percent effective. But whether the pill is right for you depends on many factors.

There are two types of birth control pills on the market today: pills that contain estrogen and progesterone (such as Yaz, although Yaz side effects are coming to light that range from depression to DVT) and pills that contain only progesterone (called mini pills). A newer form of oral contraceptive is based on a 90-day cycle rather than 28 days. This means you only have four periods a year. Hormones can also be given in a patch, through a small circular device (ring)  inserted into your vagina,  or by injection.

The patch contains both estrogen and progesterone. You leave it on for 21 days and then remove it for seven days. The vaginal ring also contains estrogen and progesterone. You insert it deep into your vagina and leave it there for 21 days. The injection is called Depo-Provera and contains only progesterone. It is given at your provider’s office every three months. Before committing to any long-lasting method, you may want to try a progesterone-only pill, which you can stop at any time, to see how you respond.

Pill Precautions
If you use the pill or other hormonal contraceptives

  •   check your blood glucose levels frequently, especially during the first couple of months. Some women need to slightly increase their insulin dose. By keeping complete records, you and your health care team can decide whether you need to make changes in food, activity, or diabetes medication.
  •   have your A1C, blood pressure, cholesterol, and triglyceride levels checked 3 months after you go on the pill, and then as often as recommended.
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