Diabetes and Birth Control

Diabetic women of child-bearing age may well wonder if the birth control pill is a healthy option for them. The answer depends upon her age and her general health, experts say.

Young, healthy diabetic women should not have a problem with the birth control pill, says Millicent Comrie, MD, chair of the department of obstetrics and gynecology at Long Island College Hospital in New York.

"However, if you have a very obese diabetic patient with end-stage diabetes and vascular damage, that woman is not a good candidate," Comrie explains. "And if she smokes or has high cholesterol, she also is not a good candidate. In this case, you are setting her up for problems."

All women who take oral contraceptives, especially smokers and those over age 35, have a very small risk of certain complications, says Bresta Miranda-Palma, MD, a practicing clinician at the Diabetes Research Institute in Florida. These include a slight risk of a blood clot and the possibility of an increased LDL, or "bad cholesterol." But these risks are much smaller than they once were since modern birth control pills contain much less estrogen than they used to. Many of the pills now on the market have 20 micrograms of estrogen, Comrie says.

Whether or not to go on the pill is a personal decision that is best made with your doctor. It's also a risk versus benefit situation. If a woman whose diabetes is not well controlled were to become pregnant, this could be dangerous for the unborn baby as well as for her.

"The risk of an unplanned pregnancy in a diabetic woman who is not in good blood sugar control is higher than the risk of using the pill," Miranda-Palma says.

If you decide that birth control pills are for you, there is absolutely no reason why you cannot stay on them until perimenopause, Comrie says. "Again, this advice is for diabetic women who do not smoke, who do not have an elevated cholesterol level, and who are not big drinkers," she says.

As for what birth control options are best for diabetic women who should not be taking the birth control pill, Comrie says that the progesterone-only pill is an option. "You take out the estrogen and give only progesterone," she says. This pill is not for everyone, though, as a progesterone-only pill can make a person feel bloated. Also, the progesterone-only pill should be taken every day and hopefully at the same time every day. "The reliability in terms of not getting pregnant is much better when it is taken at the same time each day," Comrie says.