Contraception & Diabetes Interview

September 24, 2017
Rebecca Gillen, Virtual Intern + Jessica Lynn, CNM, CDE

Virtual Intern, Rebecca, recently interviewed Jessica Lynn, a Nurse Midwife who specializes in T1D.

1) What contraception methods would you recommend for college-age women with type 1 diabetes?

Contraception is very personal. There’s no one size fits all approach, including for women and girls with type 1. First, I would suggest asking yourself some questions to help guide you to a method you’ll be happy with (it’s ok if some of the answers are unclear):

Do you want to be pregnant in the next few years?
How do you feel about trying something with hormones?
Are you ok using something that goes into your body?
How important is keeping your method to yourself?
Do you want something that will make your periods lighter?
Would you be bothered by spotting or no periods at all?
Are you likely to forget to take a pill at the same time daily?
These days we have lots of contraceptive options. If you’re young with type 1, have normal blood pressure and lipids and don’t have vascular complications, you really have your choice of methods. Even if you do have an additional risk factor above, you still have many options.

One of the most important considerations is effectiveness, as having an unplanned pregnancy with type 1 is no fun and can be downright dangerous. The methods all have various efficacies. They range from withdrawal at 78% to condoms at 85% to pills at 91% to LARC methods at 99% effective. The percentage indicates the number of pregnancies per 100 women in the course of a year, with typical use.

“Contraception is very personal. There’s no one size fits all approach, including for women and girls with type 1. ”
If you want something as close to 100% as possible, you’re looking at LARC methods, which are an appropriate choice for nearly all women with diabetes. LARC stands for Long Acting Reversible Contraception. LARC methods include IUD (both hormonal and non-hormonal) as well as implants.

2) What recommendations do you have for women with diabetes who use hormonal methods of contraception?

Know the difference between estrogen and progestin. Estrogen carries some complication risks for women with type one. The most effective pills, as well as the patch and the ring, contain estrogen and progestin. Other methods contain progestin-only and those include IUDs, implants and progestin-only pills.

For all women on estrogen methods with or without diabetes, be aware of what’s called ACHES (Abdominal pain, Chest pain, Headache that’s severe, Eye problems or changes in vision, and Severe leg pain) which can indicate a life-threatening problem. This is extremely rare with or without type 1 diabetes, but important to be aware of.

3) How do contraceptive methods potentially influence blood sugars?

An ideal method would have no effect on blood sugars. However, some women are affected by hormone resistance and may have higher blood sugars with hormone-containing contraceptives. Also, if a contraceptive causes weight gain, that can lead to increased insulin requirements. Occasionally, women have had lower blood sugars using estrogen. LARC methods, which only have progestin or no hormones are less likely to affect blood sugars.

4) What are some of the risks associated with different contraception methods?

All contraceptives are very low risk relative to pregnancy risks. However, there are occasional side effects such as weight gain, headaches, and spotting which may influence your choice of method.

“No contraceptive method is guaranteed to improve blood sugars.”
5) What recommendations do you have for people with diabetes who are about to start a new form of contraception?

Be aware of potential blood sugar changes without assuming you’ll have them! Try to be open-minded and give any method a few months before judging it.

6) Can certain types of contraception help to improve blood sugars and A1Cs? If so, which ones?

No contraceptive method is guaranteed to improve blood sugars. However, some women find they have increased insulin requirements around the time of their periods. If you experience this, your blood sugars may benefit from a hormonal method. Hormonal contraception often minimizes period symptoms (lighter flow, fewer days of bleeding, less pain) and may reduce premenstrual insulin requirements.

7) If a contraception method is causing rapid blood sugar changes, what do you recommend to the patient?

It’s unusual for any contraceptive method to cause rapid blood sugar changes, so be sure to look into other potential causes. If you suspect it’s your contraception, I’d recommend giving it a little time to see if it improves. With an IUD for example, you may have spotting for the first 3-6 months and then it becomes a light period or no bleeding at all. It’s possible those blood sugar changes may resolve as well. But if you’re unhappy with any method, try a different one. Though no method is perfect, you do have choices.

8) Is there anything else you want people with diabetes to know about the various contraception methods?

Plan pregnancy at least three to six months in advance, and always let your health care providers know.

If you’re not planning pregnancy, do your best with your diabetes to avoid complications and you’ll continue to have contraceptive choices and many health benefits.

Look for a health care provider who understands that you can have your choice in contraception.

Remember that only condoms prevent sexually transmitted infections.

Check out Planned Parenthood’s website filled with detailed information about all the methods mentioned above.

Be safe and have fun!

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