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