Contraception and type 1 diabetes

Remember that what works well for some people may not work well or be suitable for you. Your healthcare provider and diabetes care team can help you to choose the right contraception method and the following information should help you to have an informed conversation with them.

Can people with type 1 diabetes take contraceptive hormonal birth control?

The short answer is yes. However, it’s important to find the right method for you, one that suits and supports your goals, your body and its needs.

Options include the birth control pill, intrauterine devices (IUD) such as the Mirena or copper coil, vaginal rings, implants, hormone injections, condoms, female condoms and the morning after pill.

How does hormonal birth control affect insulin?

Some people with type 1 diabetes experience some insulin resistance and higher blood glucose levels with hormonal birth control, such as the pill, hormonal coil, implant, or vaginal ring. Some may see that blood glucose can fluctuate at first but are then able to stabilize it with a slight change to their insulin treatment.

As with menstruation and menopause, hormones affect everyone differently and monitoring your blood glucose regularly will help you to better identify side effects. Using a continuous glucose monitor (CGM) or flash glucose monitor (Flash GM) can help you better keep your blood glucose in range.

The contraceptive pill

The two main types of contraceptive pill are a combined estrogen and progesterone pill and a progesterone-only pill. Both contain hormones that, when taken correctly, prevent pregnancy.

Do birth control pills affect blood glucose?

Some people with type 1 diabetes won’t experience any side effects when taking the pill. Others may find that they become more resistant to insulin and have nausea or headaches.

Lower-dose contraceptive pills are less likely to impact your blood glucose. A combination pill that uses synthetic estrogen and a type of progesterone hormone called norgestimate is often recommended for people with type 1 diabetes.

The combined pill might not be suitable for anyone who has diabetes with complications or who has lived with the disease for more than 20 years.

In the past, people with type 1 diabetes had been advised to avoid taking the pill because of an effect on blood glucose and a risk of heart disease. Changes to the level of hormones in the newer generation of birth control pills means that these risks have greatly reduced, although you should still ask your healthcare provider about possible risks and whether these new gen birth control pills are right for you.

You will need to monitor your blood glucose levels and keep an eye on how you are feeling in the first few months of taking the pill. If you have any doubts about managing your insulin needs, talk to your healthcare provider who prescribed you the pill.

IUDs

An intrauterine device or IUD is a small T-shaped plastic (and sometimes plastic and copper) device that is placed inside the uterus by a healthcare professional.

They are highly effective if fitted correctly but both have a small risk of infection after fitting. You can ask the healthcare provider who implanted the IUD to check it after a few weeks to make sure that everything is ok.

An IUD may be a better contraception option for people who have T1D complications affecting the eyes or kidneys. Speak to your healthcare provider about whether this might be a good option for you.

There are two types of IUD: non-hormonal and hormonal.

Non-hormonal IUD

The non-hormonal option – a copper coil – releases copper in the uterus to protect you against pregnancy and can last for five to ten years. In the first few months after having the IUD implanted, you might experience heavier, longer or more painful periods.

Because hormones are not being released, there are none of the usual side effects like headaches and breast tenderness. Copper coils rarely affect blood glucose levels.

Hormonal IUD

A hormonal IUD (Mirena) releases the hormone progesterone to stop you from getting pregnant and lasts for three to five years. It can be used by people who may not be able to take the combined pill.

There are different strengths and sizes depending on whether you’ve already given birth or are sensitive to hormones, among other factors. It may not be considered a suitable option if you have had cancer, liver disease or heart disease.

With a hormonal IUD, you may have shorter or lighter periods, or they may stop altogether which might help if you usually see blood glucose changes while on your period. Some people experience side effects such as headaches and breast tenderness, but these usually eventually subside.

Progesterone can impact blood glucose levels so as with any new treatment, you will need to monitor your levels on an ongoing basis.

Vaginal rings

A vaginal ring (NuvaRing) is a small dome-shaped plastic ring that is placed into your vagina and which releases hormones – estrogen and progestogen – to prevent pregnancy.

There are a number of people for whom it may not be suitable. This includes people with type 1 diabetes who have experienced complications like kidney, eye, nerve or blood vessel damage.

Generally, because the hormones in the ring are absorbed directly into the vagina, there is little or no impact on blood glucose management. As with starting any new treatment, it’s best to monitor your levels and discuss any changes with your healthcare provider who prescribed the vaginal ring.

Implants

Nexplanon, or Implanon, is a contraceptive implant that is placed under the skin of the upper arm and releases the hormone progestogen into the bloodstream to prevent pregnancy. Highly effective, it’s a discreet plastic rod that can last for three to four years. It can be a good option for anyone who might not be able to use contraception containing estrogen.

Implants are largely thought safe for people with type 1 diabetes to use but, as with most other birth control methods, their effects can be different for everyone. Keep monitoring your blood glucose after insertion to see how your levels react to the progestogen.

Some medicines can make the implant less effective so speak to your healthcare provider first if you are on any other treatment or if you have a history of heart disease, stroke, liver disease or breast cancer.

Hormone injections

It’s possible to prevent ovulation, and therefore pregnancy, with an injection of the hormone progesterone either into your buttocks or your upper arm (depending on the brand). It lasts for two or three months (again, depending on which injection you have) and can be an option for anyone who cannot use contraception containing estrogen.

Because of the hormone release, there is a higher risk of weight gain which could lead to being more insulin resistance. People with T1D might be advised by their healthcare professional to start on a lower dose and to monitor blood glucose levels closely.

Condoms

There are two types of condom – external worn on the penis and internal worn inside the vagina. They are a good choice for people with type 1 diabetes because they do not contain hormones and therefore have no effect on blood glucose.

Morning after pill

The morning after pill is an emergency contraception that can prevent pregnancy after unprotected sex, or if your regular birth control method failed (for example, a missed pill or broken condom).

Most menstruating people can take the morning after pill but because of the amount of hormones it contains, it can create big swings in blood glucose. If you have T1D, you will need to monitor your levels and insulin needs closely in the days after taking it.

Information provided and reviewed by Healthcare Professional Dawn Adams.

*content taken from JDRF UK and revised for the Canadian type 1 diabetes community