Medical eligibility criteria for using modern oral contraceptives in women
with type 1 diabetes
Department of Reproductive Gynecology, ‘Andromeda’ Clinic, St.
Objectives: At present in Russia a single tactic of contraception
choice in diabetic women is absent.
Dosing & Methods: A total of 60 women with Type 1 diabetes were
included in this study: 20 women received COCs consist of 20 mcg
ethinylestradiol (EE) and 150 mcg desogestrel (DSG); 20 women received COCs
consist of 30 mcg EE and 150 mcg DSG; 20 women received COCs consist of 30 mcg
EE and 300 mcg norgestrel (NGS); 20 women received only progestagen pill with
500 mcg lynestrenol. Evaluation (indices of carbohydrate, lipid metabolism and
hemostasis system) was performed before and after 3 and 6 months.
Results: The contents of lipids in blood among diabetic women, factor
VII, activity of antithrombin III and platelet functions correlate with HbA1c
level. The increase of platelet functions occurs with HbA1c level more that 7%,
with the one more that 8% hyperlipidemia occurs for sure more often increase of
HbA1c level (9% and higher) associated with hypercoagulability (decrease of
factor VII, activity of antithrombin III). COCs containing 20 mcg EE and DSG, as
for containing only progestagen pill has not occurred the negative influence to
the lipid metabolism. The use of COCs containing 30 mcg EE has been accompanied
by the reduction of total cholesterol, cholesterol LDL levels and by the
increase of cholesterol HDL level. The long duration and/or unsatisfactory
compensation of diabetes, presence of hyperlipidemia may have their own place in
the realization of venous thrombosis. COCs containing 20 mcg EE/DSG and only
progestagen pill lead to the less expressed increase of platelet functions that
of COCs containing 30 mcg EE and NGS. The use of COCs and only progestagen pill
has not occurred clinically significant influence to the indices of plasma link
and fibrinolytical system of blood plasma.
Conclusions: These data suggest that COCs can be used in women with
uncomplicated Type 1 diabetes if clinical and metabolic monitoring can be
ensured (HbA1c, 8%). Low-dose combined oral contraceptives and progestogen-only
pill do not influence the glycemic control and have no adverse impact on plasma
lipids. The results indicate that the intake of COCs associated with risk of
venous thromboembolism, connected with a platelet activity and dependent from
estrogen dose and progestogen type – the lowest risk for venous thromboembolism
was founded for the combined COCs with the lowest estrogen dose (0.02 mg EE) and
modern progestogen (desogestrel), and progestogen-only pill.