Diabetes and Birth Control
By Julia Kenney
For people with diabetes, using a reliable and safe method of birth control is essential in avoiding an unplanned, and potentially dangerous, pregnancy. By understanding the different forms of contraceptives and working with a healthcare team, you can find the right birth control for you.
Birth control, often referred to as contraception, is a tool used to avoid unplanned pregnancies and sexually-transmitted infections (STIs). There are many forms of birth control, each with unique benefits and side effects.
Planning ahead
While pregnancy comes with added health risks for people with and without diabetes, having diabetes adds another level. Getting pregnant puts a person with diabetes at risk for serious health complications such as high blood pressure, low blood sugar, and life-threatening birth defects for the fetus. Aside from the health risks, an unplanned pregnancy can be an extremely challenging experience for those who are not mentally, emotionally, or financially ready to have a child.
The key to a safe pregnancy for a person with diabetes and their baby is to plan ahead. Using a reliable form of birth control gives people with diabetes the power to decide when they would like to become pregnant so they can make a plan with their healthcare team and prepare for a pregnancy. Working with a healthcare team to create a birth control plan can also help those who never plan to become pregnant.
Contraception “should be a discussion that each woman has with her provider for diabetes whether or not she is planning a pregnancy,” said Dr. Elizabeth Buschur, Clinical Assistant Professor of Internal Medicine at The Ohio State University Wexner Medical Center.
Know your options
To make a birth control plan, you need to understand your options. While birth control comes in many forms, there are two main methods of birth control:
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Barrier contraception – These forms of birth control involve a physical barrier to prevent sperm from fertilizing eggs during heterosexual sex. They can also help to prevent STIs by minimizing sexual contact and disease transmission. Common barrier methods of birth control include condoms, diaphragms, cervical caps, and cervical sponges. Click the link to learn more about the different forms of barrier contraception.
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Hormonal contraception – This method of birth control is used regularly by a person who can become pregnant; methods of hormonal contraception are not available for men. Hormonal contraception prevents a pregnancy by releasing hormones that disrupt the body’s monthly preparation of the uterus and ovaries for a pregnancy. Hormonal methods of contraception can stop the ovaries from releasing an egg, thin the uterine lining, or thicken mucus around the cervix to prevent the preparation and fertilization of an egg. Common hormonal methods of birth control include pills, hormonal intrauterine devices (IUDs), implants, and vaginal rings. Learn more about the different forms of hormonal contraception here.
The length of time a birth control method lasts can vary depending on the form. Contraception typically comes in the following forms:
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Use only at the time of sex – Many barrier methods of birth control are meant to be used only while having sex to prevent a pregnancy or STIs. Condoms, diaphragms, and cervical caps and sponges all fall within this category.
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Short-acting contraception – Forms of birth control that are short-acting do not last long and can easily be stopped at any time. For example, birth control pills must be taken daily over the course of the entire menstrual cycle, but this routine can be stopped if you intend to become pregnant. Vaginal rings and birth control patches are also forms of hormonal short-acting contraception. Short-acting birth control is a good option for people who plan to become pregnant within a few years and those who can reliably take their contraception on a schedule.
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Long-acting reversible contraception – This form of contraception can reliably protect you from a pregnancy for several years and is recommended by the American Diabetes Association for people with diabetes who are not planning a pregnancy in the short-term. One IUD can prevent pregnancy for 3-10 years depending on which kind you choose. Other forms of long-acting contraception include implants and injections. Long-acting reversible contraception is a great option for those who are not planning to become pregnant in the short-term, those who never plan to become pregnant, and those who are looking for a low maintenance birth control option.
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Sterilization – If you are confident that you do not want to have children, you or a partner can opt for a sterilization operation. These operations include a tubal ligation or a vasectomy.
Dr. Buschur urges people with diabetes to “make sure you are working with a provider who can counsel you on the different options for contraception.” While most methods are deemed safe and effective for people with diabetes, certain methods might be most effective for your body and life plans.
What is recommended for people with diabetes?
As Dr. Buschur explained, “You know yourself better than others,” and only you can help determine which birth control method seems right for your schedule and ability to use reliably (or regularly). It is important to discuss your options with a gynecologist and your diabetes care team to build a plan that fits your life plans and health needs. This conversation will look different for everyone, but these are a few things to keep in mind:
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More protection is better – Because people with diabetes are encouraged to plan ahead for a pregnancy, using more than one form of birth control is recommended. Using both a barrier method of contraception (i.e. a condom) at the time of sex and a short or long acting form of birth control is the best way to prevent a pregnancy and STIs.
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Consider long-acting reversible contraception – Short-acting contraception can be less reliable because of human error. For example, if you do not take birth control pills on the right schedule or if you put a condom on incorrectly, the contraception is less effective. That is why long-acting reversible contraception such as IUDs, implants, and injections are recommended for those with diabetes who are not planning to become pregnant in the short-term. These methods are the most reliable and are low-maintenance.
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Know the impact of hormones – Hormonal birth control methods typically release estrogen and/or progestin – hormones that can disrupt ovulation to prevent a pregnancy. The release of these hormones in the body impacts everyone differently and may cause changes in your menstrual cycle, body composition, and mood, among other factors. If you are considering hormonal birth control, understand the side effects and how it impacts your body. For people with diabetes, some studies indicate that estrogen can increase a person’s blood sugar, but more research is needed on this topic. Instead of estrogen, progestin-only contraception methods should be used for anyone who is breastfeeding, who smokes, or has a history of blood clots or a pulmonary embolism.
If your birth control method fails
If your birth control plan fails or you are otherwise at risk for becoming pregnant, taking an emergency contraceptive, often called the morning after pill, within 3 days of unprotected sex can prevent a pregnancy. Emergency contraception should not be used instead of your birth control plan but it is a valuable option if you are at risk for an unplanned pregnancy. Emergency contraception is available at most pharmacies and Planned Parenthood health centers.
If you do experience an unplanned pregnancy, the decision for how to move forward is between you and your healthcare provider alone. If you decide to move forward with the pregnancy, work closely with your diabetes care team to assess how to do it safely. If you decide that you need to terminate the pregnancy, a medication or in-clinic abortion is a valuable and safe option. In most US states, there are significant barriers to accessing and affording an abortion. Look here for resources on accessing a safe abortion in the US.
