Hormonal contraception in women with diabetes mellitus: a review of the literature

Hormonal contraception in women with diabetes mellitus: a review of the


J Shawe, R Lawrenson

Post Graduate Medical School, University of Surrey, Guildford, UK

Introduction: Contraception is an important issue for women with

diabetes as unplanned pregnancy can present major maternal and peri-natal

complications. The rising incidence of diabetes worldwide means increasing

thought needs to be given to contraceptive options for these women.

Professionals need to consider potential metabolic effects of hormonal methods

in relation to an individual’s diabetic profile and their need for effective

contraception. There has been concern that use of hormonal contraception may

increase the risk of developing diabetes for certain populations. Significant

differences in prescribing practice have been identified.

Objective: To review current evidence and recommend best practice in

prescribing hormonal contraception to women with diabetes. Methods: A systematic

review of the literature was carried out using specified search terms. Medline,

Embase, CINAHL, Cochrane and other databases were searched, as were secondary

references and the Internet.

Results: Vascular disease is the major concern, and for women with

diabetes who have macrovascular or microvascular complications, non hormonal

methods are recommended. Studies of young women with diabetes showed no evidence

of adverse outcomes for those taking low dose combined oral contraceptives

(COC). There is little evidence that any changes in glycaemic control caused by

hormonal contraception is of clinical relevance. Serum lipid profiles appear

minimally changed by most COC use, however, third generation products have been

shown to decrease LDL and increase HDL’s and therefore might be preferred in

women with diabetes. Studies concerning progestogen only methods highlight

possible negative effects on lipid metabolism for users of progestogen only

pills (POPs) and injectable contraception but not implants. The low dose COC

does not appear to increase the risk of developing Type 1 or Type 2 diabetes for

women without diabetes. However in populations at higher risk of developing Type

2 diabetes, studies have found increased risks in Latina women taking POPs when

breast feeding and with Depot Medroxyprogesterone.

Conclusions: Research in this area has mainly been carried out in

healthy populations and there is a need for longer term and larger studies in

women with diabetes. The WHO has established medical eligibility criteria to

assist in assessing risks and it is now recognised that low dose COCs are a safe

and effective option for younger women with uncomplicated well-controlled

diabetes. Progestogen only methods are often prescribed for women with diabetes

but are only recommended for low risk women due to possible negative changes in

lipid profiles.

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