How Contraceptives Affect Diabetes

Pattyannruss · 07-16-2003, 02:09 PM

HOW CONTRACEPTIVES AFFECT DIABETES

Birth control is no different for people with diabetes than it is for anyone else-with one major exception. Contraceptives that rely on hormonal action may alter blood glucose levels. Hormonal contraceptives include birth control pills, intrauterine devices (IUDs), injected Depo-Provera, and Norplant, the implanted birth control capsules.

IF YOU USE THE PILL ANY HORMONAL CONTRACEPTIVE:

Be sure to tell your family planning provider that your have diabetes. This is critical. Test your blood glucose frequently, especially during the first few months of using the method. You may need to increase your dose, and tinker with your diet and exercise program. Be sure to have your glycated hemoglobin, blood pressure, cholesterol, and triglyceride levels checked three months after beginning the method, and then periodically after that. Short-term studies of diabetic women taking the Pills suggest that it is as safe for them as it is for other women. However, long-term studies have not been reported. The Pill increases risk of cardiovascular problems, especially in women who smoke. Diabetes also increases risk of cardiovascular complications, which is why women using hormonal contraceptives should work to maintain tight control. No diabetic woman should smoke.

Condoms and diaphragms don’t affect blood levels or control. But birth control pills and IUDs do. These latter methods work by altering hormone levels in the blood. Depending on your personal and family medical history, your health care team can help you decide which method is best for you. The most popular method is the Pill. Some birth control pills contain estrogen and progesterone, in either fixed or variable doses. Others contain only progesterone. Progesterone-only contraceptives are also available by injection (Depo-Provera) and as implants (Norplant). Before trying injections or implants, try a progesterone-only pill, which you can stop at any time, to see how it works. Progesterone-only contraceptives do not cause changes in blood glucose levels, but some women find that they interfere with menstrual regularity.

No matter what’s in it, the Pill is not for everyone. If you are over 30, smoke, or have a history of heart disease, stroke, high blood pressure, or peripheral vascular disease, the Pill may be too risky for you. If you develop high blood pressure while on the pill, your risk of retinopathy and kidney disease increases. If you are reasonably healthy and use insulin to manage either type 1 or type 2 diabetes, your illness should not stop you from using oral contraceptives. If your insulin sensitivity varies with your menstrual cycle, it may be best to take a “monophasic” pill. These pills contain fixed amounts of estrogen and progesterone, and may help minimize blood glucose swings. “Triphasic” pills contain varying amounts of hormones, and might change your insulin needs. If you take them, you may have to adjust use accordingly.

Oral contraceptives can raise insulin resistance in some women. If you have type 2 diabetes and this happens to you, you may have more difficulty keeping your blood glucose level well controlled. Discuss your options with your doctor. Recent studies show that women who developed gestational diabetes while pregnant, and shortly afterward used oral contraceptives for six months or more significantly increase their risk of developing type 2 diabetes. The Pill with the greatest risk was the progestin-only variety. The ones causing the least risk of later diabetes were combination pills with low doses of progestin. IUDs are small T-shaped objects placed in the uterus by a physician. They work by keeping a fertilized egg from implanting in the uterine wall. Some IUDs contain copper; others release progesterone. Copper IUDs have not been shown to increase vaginal infections in diabetic women, but IUDs with progesterone have.