Contraception

Young women

Contraceptive choices

If you are a sexually active young woman with diabetes, it's vital that you plan ahead and talk to your health professionals about contraception and pregnancy.

There are a number of contraceptive choices available to women with diabetes. Discuss available options with your diabetes health professionals or GP. You may have to try a few different methods before you find the one that’s right for you.

It is important to use effective contraception until you decide you want to become pregnant.

All types of contraception have benefits and side effects. The most effective are the long acting reversible methods of contraception. These include hormonal implants and intrauterine devices (IUDs). These are the ones that are particularly effective at preventing pregnancy.

Intrauterine contraception

Intrauterine contraception is a small device that is placed into your uterus (womb).There are two types; the copper IUD and the hormonal IUD (the levonorgestrel-releasing intrauterine system - Mirena®). They are made of flexible plastic with a nylon string attached to the end. Once an IUD is placed in the uterus, it lasts five to ten years.

These are ‘set and forget’ methods that are extremely reliable. Over a year, less than 1 in 100 women will fall pregnant using this method. They are safe for women with diabetes, including women who have not had children. They are also reversible - once they are taken out, fertility returns to normal.

Benefits 

Both the copper and the hormonal IUD have the following benefits:

  • Highly effective at preventing pregnancy.  
  • Provide long-term contraception (at least five years).
  • Unlike many other methods, you don’t need to remember to take it on a regular basis.
  • Less expensive than many other types of contraception (more expensive at first but cheaper over the long-term).
  • Are reversible; you can try for pregnancy as soon as your IUD is removed.
  • Are suitable for women who have not had children as well as those who have.

The hormonal IUD has the added benefit of reducing or even stopping menstrual bleeding. In addition, for a woman who has diabetes complications affecting the eyes or kidneys, intrauterine contraception is often a better choice than contraceptive pills.

The copper IUD does not contain hormones. It is suitable for women who cannot tolerate hormones or are taking medication that may interfere with other contraceptive methods.

The IUD rarely has any effects on blood glucose levels.

Drawbacks

An IUD needs to be inserted by your GP or gynaecologist. You may have to pay for the procedure but, because they last for many years, intrauterine contraception is a very inexpensive method. 

Copper IUDs are not recommended if you have irregular or heavy menstrual periods as they increase the amount of vaginal bleeding. The hormonal IUD can cause some irregular bleeding when first inserted, but afterwards this bleeding is usually reduced or stops altogether

There is a small risk of pelvic infection around the time of insertion, but the risk is very low. Although uncommon, it is possible for the IUD to be pushed out by the uterus.

Implants

A contraceptive implant  (Etonogestrel implant) contains the hormone progestogen and is implanted under the skin using a local anaesthetic. It lasts for three years but can easily be removed if side-effects occur. It is an effective reversible method of contraception. Over a year, less than 1 in 100 women will fall pregnant using this method.

Benefits

Implants have the following benefits:

  • Highly effective at preventing pregnancy.
  • Less expensive than many other types of contraception.
  • Long lasting (up to three years).
  • May reduce the amount of period bleeding and pain.
  • Easily reversible.
  • Does not affect your fertility.
  • Unlike many other methods, you don’t need to remember to take it on a regular basis.

Most women find that implants do not usually effect blood glucose levels.

Drawbacks

Implants can only be inserted and removed by a specially trained doctor, nurse or midwife. You may have to pay for the procedure but, because it lasts for three years, this is a very inexpensive method. Your bleeding pattern will change and may be unpredictable. In some cases you may stop having periods completely.

Oral contraceptive pill 

There are two types of contraceptive pill: the combined oestrogen and progesterone pill and the progesterone only pill (also called the ‘minipill’).

The combined pill is the better option for most women as it provides good control of the bleeding pattern and women experience less irregular bleeding. It often reduces excessive bleeding and may help with menstrual pain. The combined contraceptive pill contains two types of hormones - oestrogen and progestogen. The combined pill is effective if taken regularly, but 9 in 100 women every year will fall pregnant while using this form of contraception. Many types of the combined oral contraceptives are available. These contain varying types and doses of oestrogen and progestogen hormones.

The progestogen only pill is suitable for women who are breastfeeding or cannot tolerate the oestrogen hormone.

Benefits

The oral contraceptive pill has the following benefits:

  • May reduce the amount of period bleeding and pain.
  • Often improves acne.

Drawbacks

The oral contraceptive pill must be taken every day otherwise it will not be effective.

The combined oral contraceptive pill may also have some unwanted effects. Some women experience headaches and/or nausea and some develop high blood pressure. The combined pill is not recommended in women with diabetes with eye, kidney or other vascular complications and alternative contraception should be used.

While some women find that the combined pill affects blood glucose levels, research suggests that the lower dose oral contraceptive pills used now are less likely to do so. It is a good idea to monitor your BGLs more closely for the first month after you start taking the pill. Talk to your doctor for more information.

The progestogen only pill needs to be taken even more precisely at the same time each day and will not be effective if pills are missed. The progestogen only pill can cause irregular bleeding.

The oral contraceptive pill may not work properly if you are vomiting. In this case a different form of contraception (such as a condom) will need to be used, usually until your next period. Most broad spectrum antibiotics do not interfere with the pill.

Depot injections

Depot injections are given every 12 weeks and contain a progestogen hormone in a high dose. Over a year 6 in 100 women will fall pregnant using this method. The method may affect your blood glucose levels and insulin requirements, it can also raise cholesterol levels.

Benefits

Depot injections have the following benefits:

  • Highly effective at preventing pregnancy.
  • Periods may be lighter and less painful or stop completely.
  • Effective even if you have diarrhoea or vomiting or are taking other medications.

Drawbacks

Depot injections cannot be reversed and it may take months for the full effect to wear off. While you are using depot injections, your bleeding pattern will change and may become unpredictable. You may experience some loss of bone density, but this will recover once depot contraception is stopped.

Vaginal ring

A vaginal ring is another type of hormonal contraception. It is a soft plastic ring that contains the hormones oestrogen and a progestogen (similar to the combined oral contraceptive pill). The ring is placed in your vagina and the hormones are absorbed into your body. Over a year, 9 in 100 women will fall pregnant while using this form of contraception.

Benefits

The vaginal ring has the following benefits:

  • Remains in place for 3 weeks, does not need to be remembered everyday.
  • Does not need to be ‘fitted’ by a doctor.
  • Provides good control of bleeding patterns.
  • It is reversible once removed.  

Drawbacks

In Australia, the vaginal ring is an expensive form of contraception as it is not currently listed on the pharmaceutical benefits scheme (PBS), which means it is not available at a subsidised price.

If you choose to use a vaginal ring, you have to remember to remove and replace it at the correct time. This form of contraception is not recommended in women with diabetes with eye, kidney or other vascular complications and alternative contraception should be used.

Condoms

Condoms are an immediate, convenient form of contraceptive that also help protect against sexually transmitted infections (STIs). You can purchase condoms in supermarkets, chemists and online. Both male and female condoms are available.

Condoms are not as effective at preventing pregnancy as implants and intrauterine contraception. Over a year, 18 in 100 women will fall pregnant using male condoms and 21 in 100 women will fall pregnant using the female condom.

If you are not in a regular relationship it is best to use both condoms (to prevent STIs), as well as a more reliable method such as implants (to prevent pregnancy).

 

Acknowledgement: Thank you to Associate Professor Kirsten Black, Joint Head of Discipline of Obstetrics, Gynaecology & Neonatology, Central Clinical School, University of Sydney for kindly reviewing this information.