Type 1 diabetes and birth control: 5 options to consider

It's important to be fully informed of your options when considering Type 1 diabetes and birth control. Like so many other factors, the method of birth control you select might have an impact on your blood glucose levels.

Choosing a contraceptive is a personal choice that women make for a range of reasons. A national study cited by the Guttmacher Institute found that birth control is most frequently sought to prevent pregnancy — but it's also used to reduce menstrual pain, regulate cycles, treat acne, and help manage endometriosis.

Each woman's body may react differently to the hormonal influence of birth control, so proactively educating yourself on the options available is the first step in making the right choice for you! Here's what you need to know if you're living with diabetes and considering birth control.

Your blood sugars on birth control

Birth control is generally considered safe for women living with diabetes, particularly in contrast to the risks associated with an unplanned diabetes pregnancy. According to the Cleveland Clinic Journal of Medicine, in preparation for pregnancy, it's vital to closely manage blood glucose with the help of your medical team to mitigate potential complications for mom and baby. Consistently elevated blood glucose levels can result in birth defects, high birth weight, and preeclampsia, among other concerns (worsening existing diabetes complications).

The University of Colorado noted that research studies have often been inconclusive in determining whether certain birth control methods may be harmful for women living with diabetes. Meanwhile, other studies have shown that women using birth control containing estrogen often have higher blood glucose levels and cholesterol.

Accordingly, it's wise to anticipate that introducing hormonal birth control into your life will likely impact blood glucose levels. With this knowledge, you can monitor your levels more closely and make effective changes to your insulin dosing as needed.

5 common birth control options

When choosing a contraceptive, it's a good idea to explore your options — and there are a lot of them!

1. Long-acting reversible contraceptives (LARCs)

This form of birth control includes intrauterine devices (IUDs) and implants.

• Generally, two types of IUDs are available, according to the U.S. Department of Health & Human Services. One is made of copper (which is non-hormonal and lasts up to 10 years), while the other is composed of plastic, containing the progestin hormone levonorgestrel (lasting up to five years). These devices are inserted by your doctor for long-term use, which can be helpful for those who struggle to remember a daily pill. IUDs are typically not recommended for women who have frequent pelvic infections. Additionally, women with higher A1Cs may need to look at alternative options, as they are more susceptible to infection overall.
• The implant is a flexible plastic rod (about the size of a matchstick) inserted into the upper arm. It's an estrogen-free option that lasts up to three years at a time. Women with a history of blood clots or a risk for blood clots are advised not to use the implant.

2. Contraceptive injections

The birth control shot is a contraceptive injection that lasts three months. It's also available in a lower dose for those who need it.

The shot may be recommended for women who are also living with anemia, seizures, sickle cell disease, endometriosis, or uterine fibroids. However, the potential side effects of insulin resistance and weight gain may have a negative effect on diabetes management.

3. Patch

The birth control patch looks like a square bandage, worn for one week at a time, three weeks out of the month. It releases estrogen and progestin into the bloodstream.

This option is not recommended for women who have diabetes complications of the kidneys, eyes, blood vessels, or nerves.

4. Ring

The birth control ring is a small, flexible ring worn internally that releases estrogen and progestin throughout the month. The hormones are absorbed directly into the body through the vaginal lining.

Some women with diabetes may experience high blood sugar and elevated levels of cholesterol and triglycerides while using the ring.

5. Pill

"The pill" is a catchall reference to a large category of hormonal birth control pills that can be prescribed to prevent pregnancy and address other concerns.

• Combination birth control pills contain both estrogen and progestin, while the mini-pill contains only progestin.
• Conventional pill packs have 21 active pills and seven inactive pills, or 24 active and four inactive pills.
• Continuous dosing or "extended cycle" packs vary the amount of active and inactive pills.
• Some pill packs contain the same amount of estrogen and progestin in each pill, whereas others have varying amounts.
  

With so many options in the pill category, it's important for the patient and physician to weigh personal preference, medical need, possible risk factors, and the potential impact on diabetes management when making a selection.

Understanding emergency contraception

It's also important to understand the implications of using emergency contraception (also known as Plan B or "the morning after pill") for women with diabetes. While the five birth control options listed above are used to proactively prevent pregnancy, emergency contraception is taken in the case of missed preventative action or failed birth control.

Taken within 72 hours of unprotected intercourse, the pill releases levonorgestral in a one-time dose. It's important to consult with your doctor to understand how your diabetes management may be affected by the hormones from a one-time dose of emergency contraception, as this varies by the individual.

Making your choice

Due to the potential risk of an unplanned pregnancy for women with diabetes, most methods of contraception are generally safe. With this in mind, be sure to schedule an appointment with your primary care physician, endocrinologist, and/or your OB-GYN specialist to discuss potential side effects or risks before selecting your birth control method.

Be sure to also emphasize additional questions about Type 1 diabetes and birth control to fully understand all options and possibilities to feel confident in your decision.

Every woman's experience with birth control is unique to them. Some women will notice a significant impact on their diabetes management from hormonal birth control, while others won't. Work with your trusted physician to determine what option is best for your body.

Interested in learning more about how hormonal changes affect diabetes management? Check out the Edgepark HealthInsights blog post about hormonal imbalance and diabetes.