Diabetes and contraception

Diabetes is the most common medical condition that can cause complications in pregnancy [1]. For women with diabetes, becoming pregnant and giving birth can have important implications for their health [1].

Reliable and effective contraception is essential to prevent unintended pregnancies [1]. This is important for everyone, but especially for young people who may have unstable diabetes [1]. In these cases, an unintended pregnancy could be high-risk [1].

Despite the importance of careful planning around pregnancy and childbirth, a US-based survey in the early 2000s found that women with diabetes are less likely to use contraception than women without diabetes [1].

If you have diabetes and want to know what forms of contraception could be suitable for you, then this article may be able to help.

If you have diabetes, what types of contraception can you use?

There are many different methods of contraception available, and you will need to decide with your doctor which is most suitable for you and your needs [1]. 

If you have any concerns or want to discuss whether individual methods work with your diabetes, talk to your healthcare team.

Hormonal contraception

Hormonal contraception can be taken as a contraceptive pill (either the combined pill which contains oestrogen and progesterone, or the progesterone-only pill), a transdermal contraceptive patch, injection or as other methods [1]. 

The progesterone-only pill (POP) is usually suitable for women with diabetes, regardless of any complications of your diabetes that you might have [1]. 

If you are considering taking combined hormonal contraception (CHC), it is recommended that you discuss this with your diabetes care team. This is because some complications of diabetes, or risk factors for them, may increase the chance of health problems when you take combined hormonal contraception [1].

Long-acting contraception

This includes methods such as the intrauterine device (IUD), the intrauterine system (IUS), the progesterone-only injection and hormonal implants [1]. 

Barrier methods

These methods include (but are not limited to) condoms and diaphragms [1]. Their reliability depends on how effectively they are used; using barrier methods alone may be too unreliable in preventing pregnancy for women with DM [1]. 

One advantage is that they can also reduce the chance of getting sexually transmitted infections (STIs) when used in conjunction with a more effective contraceptive [1]. 

Fertility awareness methods

These ‘natural’ methods involve being aware of where in the menstrual cycle you are and avoiding sex at times that could lead to pregnancy [1]. These may not be suitable for women with type 1 diabetes, as diabetes can sometimes cause menstrual cycles to be erratic and unpredictable [1].

Sterilisation

This permanent method of contraception involves a small operation [1]. If you have this surgery, your blood glucose management will need to be considered because of the potential risk for post-operation infection [1]. The chances of hypoglycaemia and ketoacidosis occurring also increase the risk of complications after surgery [1]. If you are considering sterilisation, you should discuss this with your diabetes team [1].

Emergency contraception

Women with diabetes at risk and not wanting to be pregnant are advised to seek emergency contraception at the earliest opportunity [1]. There are no contraindications to taking emergency progestogen-only contraceptive pills within the recommended time frame if you have diabetes [1].

Can hormonal birth control affect diabetes?

Hormonal contraception usually consists either of combined hormonal contraception (CHC), containing oestrogen and progesterone, or progesterone-only medication [1].

Historically, women with diabetes were not given combined hormonal contraception, due to a possible effect on how the body handles fats and carbohydrates [1]. More recent data suggests that CHC is generally lower risk in women with diabetes who do not have complications [1].

If you have complications from your diabetes, then the picture may be a bit more complicated, with studies suggesting caution if you are considering using combined hormonal contraception [1]. One review suggested that the risks outweigh the benefits of CHCs for women with complications of diabetes, such as heart disease, eye problems or kidney issues [1].

Combined hormonal contraception may also not be suitable for you if you have other risk factors for complications such as smoking, being overweight, or high blood pressure, as these may slightly increase your risk of blood clots, heart attacks, or having a stroke [1].

Overall, the risk of blood clots in women with diabetes has been judged to be low, but is raised in women using combined hormonal contraception [2].

Contraception risks and complications

 Unexpected failure of contraception — when it doesn’t work as it should — could result in an unplanned pregnancy and lead to serious complications [3]. If you have any concerns about your contraception and whether you are using it correctly, then your healthcare team will be able to help.

One thing you might be concerned about is whether particular types of contraception might alter your blood glucose management. Combined hormonal contraception when given at high doses has been shown to have a slight effect on blood glucose levels [4].

Some combined oral contraceptives have also been shown to have a minor effect on how well your body manages the level of fats in your blood (though others appeared to slightly improve this) [4].

These effects may well differ from person to person, so if you wish to use these methods of contraception, a discussion with your doctor is a good idea.

Why is it important to plan your pregnancy?

Good management of diabetes before and after conception is really important [1]. Despite this, only half of women with diabetes plan their pregnancies [1].

Poor blood glucose management at the time of conception and during pregnancy increases the risk of medical problems that can affect the baby [1]. These can include birth defects, being stillborn, or dying shortly after birth [1, 5]. Poor blood glucose management also increases the chance that your baby might be larger than they should be [5].

Having blood glucose that is not well managed also increases the risk of problems for you during pregnancy, including pre-eclampsia [5], hypoglycaemic (low blood glucose) episodes, and diabetic ketoacidosis (DKA) [1].

Preconception care is really important, but it has been found that some women are reluctant to attend due to previous negative experiences, getting pregnant too quickly, or practical difficulties attending the services [1].

Choosing the right contraception for you

Deciding on the contraceptive method that works for you is an individual choice. Overall there are no contraceptive methods that are completely advised against for women with diabetes [3]. To choose the right method for you, you will need to speak with your healthcare team [1].

The right contraceptive for you needs to be effective and take into account any risks you have that are related to your diabetes [1].

How you feel about getting pregnant in the future may also determine what method is best, as some long-acting contraceptives can mean that it takes a while for your fertility to return [1].

Which contraceptive method to use is a very personal decision.

As with any concern with your health or diabetes, for more information, you should talk to your healthcare team, who can help you choose a method that works for you.