Birth Control Options for Women with Type 1 Diabetes

There are numerous methods available when it comes to birth control. You already know that anything can affect your blood sugar if you have type 1 diabetes (T1D), and birth control is no exception. Hormonal birth control methods can raise blood sugar levels and affect insulin resistance, according to some T1D patients.

When deciding which birth control technique is best for you, it is crucial to consult your healthcare team, but you should first educate yourself on the available options.

Remember that if a particular treatment works for your friend or family member who has diabetes, it may not work for you.

To find out more about the different alternatives and considerations for people with diabetes, continue reading. Please note, other than condoms, this page covers birth control alternatives for persons with uteruses.

Vaginal Rings

This is a flexible device that is in the shape of a dome and is placed into the vagina to be kept there for three weeks before a woman’s menstrual cycle. It is then removed 5 days during the week of menstruation and is replaced with a new ring afterwards.

To work properly, the ring must be replaced after five days of being taken out. If the menstruation lasts longer than five days, a new ring can be inserted and if inserted later than five days, a different form of contraception will be needed as it will take several days with the ring inserted to prevent pregnancy.

Pros

• does not need a healthcare practitioner for insertion or extraction

  
  

• may make periods lighter, more frequent, and less painful.

  
  

• can assist with PMS symptoms.

  
  

• does not interfere with sexual activity.

Cons

• may result in spotting or bleeding during the first few months

  
  

• may result in higher-than-normal vaginal discharge and mood shifts as side effects.

  
  

• does not mitigate sexually transmitted infections(STI)

  
  

• generally shorter in duration than other options.

  
  

• this method is not permanent, but can take months for normal fertility to resume following usage.

How to get it and at what cost

A healthcare professional has to prescribe a vaginal ring, and the user carries out the insertion and removal.

Vaginal rings are priced differently depending whether they your insurance or what plan you have. A nuva ring ranges from $0-200 and lasts up to 5 weeks, while an Annovera ring lasts 1 year but ranges from $0-2200.

Are there any specific concerns regarding blood sugar levels or complications related to Type 1 Diabetes (T1D)?

The hormones contained in vaginal rings, which serve as a contraceptive method, are directly absorbed through the vaginal wall, eliminating the necessity for the body to metabolize the medication. As a result, vaginal rings typically exert minimal to no influence on blood sugar control.

It is crucial to highlight that the manufacturers of NuvaRing, a prominent producer of vaginal rings, have advised against their use for individuals who have suffered damage to the kidneys, eyes, nerves, or blood vessels as a consequence of diabetes.

The Pill

The Pill is among the most prevalent methods of contraception, requiring users to take a small tablet daily to avert pregnancy. There are two primary categories of contraceptive pills: the combined estrogen and progesterone pill, and the progesterone-only pill.

Combined pills are more frequently utilized and offer effective regulation of menstrual cycles, particularly for individuals with irregular bleeding. They can also diminish menstrual flow and alleviate some menstrual discomfort. While combination pills are generally reliable in preventing pregnancy, they must be taken consistently at the same time each day. Research indicates that 9 out of 100 individuals (9 percent) may conceive while using the Pill.

On the other hand, progesterone-only pills, though less common, may be advantageous for specific demographics and lifestyles, such as those who are breastfeeding, suffer from heavy menstrual bleeding, have a history of blood clots, or are unable to tolerate estrogen.

For individuals with diabetes, the use of the Pill may lead to an increase in insulin resistance. According to the University of Colorado, this heightened demand for insulin may be linked to the estrogen present in the Pill. Birth control pills containing synthetic estrogen and norgestimate, a type of progestin hormone, are frequently recommended for those with diabetes.

It is also crucial to recognize that hormonal birth control can adversely affect individuals experiencing depression, anxiety, or other mental health issues, as the hormones may disrupt the balance of brain chemicals.

Pros

- Can lessen menstrual bleeding and discomfort

- May enhance skin condition by improving acne

- Non-invasive method

- Generally affordable

Cons

- Requires daily intake at the same time for optimal effectiveness

- Potential to elevate insulin resistance, thereby increasing insulin requirements

- Associated with a higher risk of kidney disease (diabetic nephropathy), vision problems (diabetic retinopathy), and nerve disorders (diabetic neuropathy) in diabetic users, according to research

- May lead to irregular bleeding

- Does not provide protection against sexually transmitted diseases (STDs)

- Effectiveness may be compromised if vomiting occurs, necessitating the use of an additional contraceptive method, such as condoms, until the next menstrual cycle

Acquisition and Cost

Compared to other birth control methods, obtaining the Pill is relatively straightforward, although a prescription is necessary.

Costs vary based on insurance coverage and the specific brand chosen. Typically, a month's supply of pills ranges from $0 to $50. Most health insurance plans cover the cost of the Pill, and in many states, it can be prescribed and delivered through Planned Parenthood’s Direct app.

Furthermore, since a prescription is required, you may incur charges for a consultation with a healthcare provider, which can range from $35 to $250. However, under the Affordable Care Act, most insurance plans are mandated to cover family planning-related visits.

Are there any specific concerns regarding Type 1 Diabetes (T1D)?

Birth control pills can yield varying effects for individuals with diabetes. While some may not experience adverse effects, others might face increased insulin resistance along with symptoms such as headaches and nausea.

Combination birth control pills containing synthetic estrogen and norgestimate are often recommended for individuals with diabetes, as they are less likely to affect blood sugar levels. Recent studies indicate that lower-dose contraceptive pills are also associated with a reduced impact on blood sugar levels. If you decide to use the Pill, it is essential to monitor your blood sugar closely and consult with your healthcare team to ensure that your insulin requirements are appropriately managed.

Feedback from women with T1D who have utilized this method:

“My daughter with T1D struggled significantly with various birth control pills. She experienced such high insulin resistance that it felt akin to being on prednisone. Ultimately, she discovered a low-hormone IUD that did not affect her blood sugar.” — Mamaliz, @mamaliz1969, on Twitter

“I have consistently used the Pill without any complications. In fact, it helped stabilize my blood sugar, as I previously suffered from severe menstrual issues.” — Alex, age 23

“At 16, I tried the Pill for a month, but it caused my insulin requirements to double. Once I discontinued it, my insulin levels returned to normal, and I have not used the Pill since.” — Lilly, age 26

IUDs

Intrauterine devices (IUDs) are a form of contraception that involves a small T-shaped device made from flexible plastic, which has a nylon string attached to its end. This device is inserted into the uterus through a minor procedure that typically lasts about 15 minutes and is performed by a healthcare professional.

There are two primary categories of IUDs: copper and hormonal. Depending on the type selected, these devices can remain effective for a duration ranging from 3 to 10 years. Furthermore, IUDs are suitable for individuals who have not given birth and are reversible; fertility typically returns to normal once the device is removed.

Pros

• Highly effective in preventing pregnancy, boasting a success rate of over 99 percent.

• The "set and forget" approach eliminates the need to remember daily medication, unlike oral contraceptives such as the Pill.

• Reversible; fertility normalizes after removal.

• Suitable for both individuals who have had children and those who have not.

• Provides long-term contraception, lasting a minimum of 3 years, depending on the chosen device.

• After the initial cost of the procedure, IUDs can be more economical compared to ongoing monthly medication expenses.

• May reduce menstrual periods, as indicated by a 2016 study where 21 percent of users reported lighter periods after one year of having a hormonal IUD.

• Offers convenience and privacy, as only the user is typically aware of its presence; however, in some instances, partners may feel the nylon strings. If this occurs and it is bothersome, it is advisable to consult a doctor to have the strings trimmed.

Cons

• requires placement by a healthcare professional

• the procedure is relatively quick but may cause discomfort

• initial costs can be high, depending on insurance coverage

• copper IUDs may lead to an increase in vaginal bleeding

• there is a potential for irregular bleeding during the initial phase of hormonal IUD use

• a slight risk of pelvic infection exists at the time of insertion for individuals with uteruses

• although rare, there is a chance that the IUD may be improperly positioned or expelled by the uterus; the American College of Obstetricians and Gynecologists reports a misplacement rate of 1.4 per 1,000 (0.14 percent) for hormonal IUDs and 1.1 per 1,000 (0.11 percent) for copper IUDs

• does not provide protection against sexually transmitted diseases.

How to Acquire It / Cost

As reported by Planned Parenthood, the cost of IUDs can range from $0 to $1,300, depending on your insurance coverage and the specific type you select. This price encompasses essential medical evaluations both before and after the procedure, as well as the insertion of the IUD. Typically, IUDs are available at no cost or at a reduced price through private insurance plans, Medicaid, and various government programs.

To obtain an IUD, it is necessary to have it inserted by a qualified healthcare provider. If you believe an IUD may be suitable for you, consult with your OB-GYN or another trusted physician to schedule an appointment for the insertion.

Are There Any Specific Concerns for Individuals with T1D?

Both hormonal and copper IUDs are unlikely to impact blood sugar levels, making them a potentially suitable option for individuals with Type 1 Diabetes (T1D).

Moreover, hormonal IUDs can help reduce or eliminate menstrual bleeding, which may benefit those who experience blood sugar fluctuations during their menstrual cycle. IUDs are often considered a preferable contraceptive choice for individuals with diabetes complications, particularly those affecting the eyes or kidneys.

Testimonials from Women with T1D Who Have Used This Method

“The Mirena IUD (a hormonal IUD) has been extremely effective for me. I began using the Pill at 16, and it nearly doubled my insulin requirements. My doctors at the time claimed this was quite rare, which I later discovered was not accurate, but they suggested I switch to the IUD. Once I made the change, my insulin levels returned to normal, and I have experienced no issues since. Additionally, it has been incredibly beneficial as it eliminated my periods, preventing the significant blood sugar fluctuations I used to have during that time.” — Micheala, age 22

Nexplanon Implantable

The Nexplanon implantable is a small rod that is inserted beneath the skin of the upper arm, releasing hormones that effectively prevent pregnancy. This rod must be implanted by a qualified healthcare professional and can provide protection for up to five years.

Pros

- Highly effective in preventing pregnancy, with a success rate of 99 percent.

- Offers a long-lasting contraceptive solution, providing protection for up to five years.

- Discreet; only the individual will be aware of its presence.

- May reduce menstrual flow or eliminate periods entirely.

- Reversible; fertility typically returns to normal after removal.

Cons

- May lead to irregular bleeding patterns.

- Initial costs for implantation can be significant.

- Does not offer protection against sexually transmitted infections (STIs).

Acquisition and Cost

The Nexplanon implant must be inserted and removed by a healthcare professional, such as a gynecologist or family health provider. Your healthcare team can help determine if this method is suitable for you and may conduct a physical examination.

During the insertion procedure, the healthcare provider will administer a local anesthetic to numb the upper arm area and then utilize a specialized inserter tool to place the implant beneath the skin. The entire process takes only a few minutes, and patients typically report only a minor pinch or stinging sensation.

Under most insurance plans in the United States, the cost of Nexplanon is either minimal or covered entirely. In the absence of insurance, the insertion may cost up to $13,000, while removal can reach up to $300. Although the initial expense may be high, it could lead to savings over time by eliminating the need for monthly birth control prescriptions. It is advisable to consult with your insurance provider and healthcare team to clarify the associated costs.

Are there any specific concerns regarding Type 1 Diabetes (T1D)?

Implants are generally deemed safe for individuals with T1D; however, their effects can differ from one person to another.

Research indicates that most individuals who have received this implant did not experience any significant changes in their A1C levels, body mass index (BMI), or insulin resistance. While the implant can be an excellent option for those with T1D, it is crucial to consistently monitor blood sugar levels and be vigilant for any potential adverse effects following the procedure.

Feedback from women with T1D who have utilized this method:

"I received Nexplanon a few weeks after my diabetes diagnosis, and I initially believed my blood sugar levels were excessively high as a result. However, I later discovered that this was not the case… I only realized it after having the implant removed." — @thehangrywoman

"I experienced significant insulin resistance during the first six weeks after the Nexplanon insertion, but it seems to have stabilized, or my insulin rates have adjusted, and I no longer notice it." — @femmanism

Hormone Injections

Hormone injections, commonly referred to as the Depo-Provera shot, are administered every three months. This injection works to prevent pregnancy by delivering the hormone progestin, which inhibits ovulation. Furthermore, progestin impedes the movement of eggs through the fallopian tubes and thickens cervical mucus, thereby obstructing sperm from traversing the uterus.

Pros

- Highly effective in preventing pregnancy.

- Offers longer-term protection compared to other methods; only four injections are required annually, eliminating the need for additional medications or devices in between doses, which simplifies usage.

- Provides convenience and privacy, as only the individual receiving the injection is aware of its administration.

- May offer protection against uterine cancer and ectopic pregnancies.

- Reversible; fertility typically returns to normal within approximately one year after discontinuation of the shot.

- Can alleviate menstrual bleeding and discomfort.

- Menstruation may cease after one year of receiving the injection.

Cons

- Does not offer protection against sexually transmitted diseases (STDs).

- Requires a shot every three months.

- Must be administered by a healthcare professional, although some providers may allow for home administration.

- Potential for adverse side effects, usually occurring during the initial 2–3 months as the body adjusts to the hormones, which may include irregular bleeding, nausea, headaches, weight gain, breast tenderness, or depression.

- It may take 9 to 10 months after stopping the injection to achieve pregnancy; the contraceptive effect generally diminishes after 15 weeks from the last shot, but some individuals have reported that their fertility did not normalize until 10 months post-injection.

How to Acquire It / Associated Costs

The injection must be administered by a qualified healthcare professional every 12 to 13 weeks, or approximately every three months. While some physicians may permit self-administration at home, this practice varies among different healthcare providers. If home administration is not an option for you, it is essential to schedule regular appointments to maintain effective and continuous birth control.

The cost of the injection is largely influenced by your health insurance coverage. Some healthcare providers may require an examination to determine your suitability for this method, which could incur a fee of up to $250. Subsequent visits and injections may cost as much as $150 each.

Are There Any Specific Concerns for Individuals with Type 1 Diabetes?

The hormones present in the injection can increase the risk of weight gain, which may lead to heightened insulin resistance.

Research indicates that individuals with diabetes may experience a slight rise in blood sugar levels and, consequently, an increase in insulin requirements when using hormonal injections for contraception. However, after approximately 30 months (2.5 years), blood sugar levels and insulin resistance typically return to baseline. Furthermore, individuals who are overweight or classified as clinically obese may exhibit higher glucose levels while using hormonal injections compared to those of average weight.

Your healthcare team may opt to prescribe a slightly reduced dosage due to your diabetes and will likely advise you to monitor your blood sugar levels closely after your initial injection.

Morning-after Pills

The morning-after pill serves as an emergency contraceptive option that can be effective for up to five days following unprotected intercourse. This form of contraception is intended for use when other birth control methods have either been overlooked or have failed, such as in the case of a broken condom.

There are several types of morning-after pills available, and the choice may depend on factors such as the timing of unprotected sex, your body weight, whether you are breastfeeding, and the accessibility of the medication. The primary categories of morning-after pills include levonorgestrel-based options, such as Plan B or My Way, and the ella pill.

The ella pill is recognized as the most effective morning-after option, although it requires a prescription. It can reduce the likelihood of pregnancy by 85 percent if taken within five days after unprotected intercourse, with increased effectiveness the sooner it is administered. For individuals weighing 155 pounds or more, ella is more effective than Plan B; however, its efficacy may diminish for those exceeding 195 pounds.

Levonorgestrel-based morning-after pills must be taken within three days of unprotected sex, with their effectiveness increasing the sooner they are taken. These pills may also be less effective for individuals over 155 pounds. For those with higher body weight, the ella pill or a copper IUD may be recommended as alternative emergency contraceptive options.

Pros

- Convenient and easily accessible options at pharmacies

- Administered in a single dose

Cons

- May cause significant fluctuations in blood sugar levels due to high hormone concentration

- Effective for only a limited duration

- Certain medications can reduce its effectiveness

- May not work effectively for individuals weighing over 195 pounds

Acquisition and Cost

Some morning-after pills can be purchased over the counter at local pharmacies. Prices vary by brand, with options ranging from $20 (such as Take Action or Next Choice One Dose) to $50 (Plan B). The typical cost for most morning-after pills falls between $40 and $50.

For those wishing to use ella, a prescription from a doctor is required, and it generally costs around $50 at most pharmacies.

Considerations for Individuals with Type 1 Diabetes

Individuals with diabetes should proactively consider their family planning and prefer regular birth control methods over emergency contraceptives. The high hormone dosage in morning-after pills can lead to significant and severe blood sugar fluctuations in the days following ingestion. If emergency contraception is necessary, it is crucial to closely monitor blood sugar levels and adjust insulin dosages accordingly to ensure safety.

Condoms

Condoms serve as a barrier, typically made from materials such as latex, plastic, or animal skin, that individuals wear over the penis during sexual intercourse. Their primary function is to prevent sperm from entering the uterus, thereby inhibiting fertilization of an egg.

Pros

- Highly effective in preventing pregnancy, with an efficacy rate of 85 percent.

- Most condoms offer protection against sexually transmitted diseases (STDs).

- Readily available, affordable, and can be found in most pharmacies and drugstores.

- Can enhance sexual pleasure, with options that include features like ribbing to increase stimulation.

- Provide a means of preventing unintended pregnancies when used alongside other contraceptive methods.

- Have no associated side effects.

Cons

- There is a risk of breakage.

- A condom must be used for every sexual encounter.

- They are not reusable.

- The application of a condom may interrupt the flow of sexual activity.

Acquisition and Cost

Condoms are a practical choice for many individuals, as they can be purchased at most grocery stores, pharmacies, and convenience stores. They are also quite affordable, generally costing around $2, and do not require a prescription.

Considerations for Individuals with Type 1 Diabetes

Condoms are particularly suitable for those with diabetes, as they do not influence blood sugar levels. Since they do not contain hormones, condoms do not lead to fluctuations in blood sugar or an increase in insulin resistance.

Feedback from Women with Type 1 Diabetes Who Have Used This Method

"I consistently choose to use condoms. I have experimented with various birth control methods, including the Pill and the implant, but they have consistently resulted in elevated blood sugar levels. The condom is the only option that has no impact." — Ashley, age 32

In conclusion, when choosing a birth control method, it is essential to select one that aligns with both your lifestyle and your diabetes management.

Contraceptive options are not universally applicable; what works for one individual may not be suitable for another. It is crucial to take an active role in your healthcare by communicating with your medical team if a particular method is ineffective for you. Additionally, consistently monitoring your blood sugar levels can help mitigate any potential negative side effects.