The effects of combined oral contraceptives containing low-dose ethinylestradiol associated with norethisterone,levonorgestrel or gestodene compared to copper IUDs were also evaluated in 103 women with insulin dependent diabetes mellitus(IDDM) or previous gestational diabetes mellitus (GDM). None of these women developed microalbuminuria during the study. Compared to normal women, was found reduced insulin sensitivity in the women with previous GDM using the pill(10). So,COCs can be used in women with uncomplicated diabetes and in women with previous gestational diabetes, if clinical and monitoring can be ensured. Type 1 diabetes mellitus is common in Europeans. Glucometabolic control at conception and during early pregnancy is necessary to reduce the risk of early miscarriage and congenital malformations.
Safe and effective contraceptive methods are essential for these women in order to have a “planned pregnancy” under optimal conditions. Many teens lacke awareness of pregnancy-related complications with diabetes and are unaware about preconception counselling(PC).
Adverse Effects of Hormonal contraception
- Moderate adverse effects
- - Severe hepatobiliary complications
- - Carbohydrate and lipid metabolism complications
- - Headache as adverse effect
- - Dermatological Adverse effects
- Cardiovascular Effects
- Other Effects
- Cancer Risks
- Hazardous prescription
- Contraception in women HIV infected
- Mild Adverse effects
- New Perspectives immunocontraception
- Contraceptive counseling
The role of PC is focused to prevent complications for women with diabetes and to offer then a highly effective birth control method for preventing an unplanned pregnancy (11,12). So, women with diabetes need safe, effective contraception. Although intrauterine devices provide available contraception, concerns remain that progestin absorbed systemically from the levonorgestrel-releasing device may impair carbohydrate metabolism.
A recent randomized study examines the effect of the levonorgestrel-releasing intrauterine system on glucose metabolism in 62 women with uncomplicated insulin-dependent diabetes mellitus. The women were randomly assigned to either a levonorgestrel-releasing or a copper T 380A intrauterine device. Outcome data were available for 29 women using the levonorgestrel-releasing and 30 using the copper device.
At 12 months, mean glycosylated levels were similar for both groups. The same was registered for mean fasting-serum glucose levels and daily insulin doses (35.1 units compared with 36.4 units). No important differences were noted at either 6 weeks or 6 months(13). So, levonorgestrel-releasing device had no adverse effect on glucose metabolism, even at the 6-week observation when systemic levels of levonorgestrel would have been higher than at later observations(13). Concern about a potential adverse effect of this contraceptive on glucose control is unwarranted, and its use in women with diabetes should be liberalized.
Another open-label, randomized study compared the influence on the lipid profile of two oral contraceptives containing 30 mcg EE /3 mg drospirenone (DRSP) and 30 mcg EE/ 150 mcg desogestrel (DSG). A slight increase in mean total HDL cholesterol was found for both groups, after 13 treatment cycles ; whereas, HDL2 cholesterol did not change remarkably in both groups. The mean LDL cholesterol values increased by 10.6% in the DSG group and remained nearly stable in the DRSP group(+1.8%).
A slight rise in mean total cholesterol was found for all cycles after the initiation of treatment. The mean increase after 1 year of treatment was approximately 8% in both treatment groups. Mean triglyceride levels increased for both treatment groups. For total phospholipids, an increase of +13.6% (DRSP) and +18.5% (DSG) over 13 cycles was measured. In conclusion, the combined oral contraceptive EE/DRSP, as well as the reference preparation, had little impact on the lipid profile(14).
Similar results of drospirenone were obtained analyzing the effects on lipid metabolism of a preparation containing 30mcgEE/ 2mg chlormadinone acetate(CMA)over a period lasting 12 cycles. The effects on the lipoproteins checked were favorable,as the atherogenic index LDL/ HDL dropped from 2.2 prior to therapy to 1.7 in 12th cycle of the treatment period. There was a significant increase in cholesterol and triglycerides, while the LDL fraction remained almost constant as for EE / DRSP.
The antiandrogenic activity of the formulations containing EE/DRSP and EE/CMA may be regarded as responsible for the stable LDL cholesterol levels.
As a result, the atherogenic index, ratio of total HDL/LDL was increased, a pattern that is usually considered clinically beneficial with respect to cardiovascular disease risk (15,16). The observed changes were not suggestive of a clinically relevant deterioration of carbohydrate metabolism. The effects of Norplant compared with medroxyprogesterone acetate (DMPA) and low-dose oral contraceptive pill in diabetic women were evaluated.