Birth Control and Diabetes

For years, many doctors have been hesitant to prescribe women with diabetes hormonal contraceptives — forms of birth control that include oral contraceptives (“the pill”) as well as injections, patches, intrauterine devices (IUDs), and subdermal (under-the-skin) implants. That’s because some hormonal contraceptives have, in the past, been associated with a higher risk of blood clots, heart attacks, and strokes in women with diabetes.

In a recent study, researchers decided to reexamine the link between hormonal birth control and cardiovascular complications in women with diabetes. Published in November 2016 in the journal Diabetes Care, the study analyzed prescription records to identify women with Type 1 or Type 2 diabetes (as shown by a prescription for insulin or an oral diabetes drug) along with which form of birth control, if any, they were prescribed and whether they experienced a heart attack, stroke, or blood clot between 2002 and 2011. About 150,000 women and girls ages 14–44 were included in the study.

As noted in an article earlier this month in The Sacramento Bee, the overall rate of the cardiovascular problems the study looked at was low — about 6.3 events per 1,000 women per year, which indicates the overall safety of these forms of birth control, according to the researchers. But not all forms of hormonal birth control had an equal level of risk. The lowest risk was found with subdermal implants, which were associated with 0 events per 1,000 women per year, followed by IUDs at 6 events per 1,000 women per year. Oral contraceptives were only slightly less safe than IUDs. In comparison, contraceptive injections were associated with 12.5 events per 1,000 women per year, and patches were associated with 16 events per 1,000 women per year.

But along with this relatively good news about hormonal birth control, the study also found a concerning result: Based on the prescription data the researchers looked at, only about 28% of women of reproductive age with diabetes were taking any form of hormonal birth control. It’s possible, of course, that the remaining 72% of women were either not having sex or carefully using barrier methods of birth control, like condoms and diaphragms. But given the overall popularity of hormonal birth control in the general population, it seems reasonable to conclude that a decent fraction of women with diabetes aren’t using an effective form of birth control at all. This is particularly troubling in women with diabetes because good blood glucose control is essential to a healthy pregnancy, and an unplanned pregnancy may arrive at a time of less-than-optimal control.

What’s your take on this study — if you’re a woman of reproductive age, would you be willing to use hormonal birth control, or do you already? Which form do you use, and are you satisfied with it? Or do you think that barrier methods are still the way to go, given the slight increase in cardiovascular risk associated with some hormonal methods? Have you talked to your doctor about your birth control options and the diabetes-related risks associated with them? Leave a comment below!