The two most effective hormonal birth control methods for women in general are also excellent options for women with diabetes, according to a new study. Intrauterine devices (IUDs) and contraceptive implants that are placed under the skin, both of which are highly effective, were linked with the lowest risk of blood clots in these higher-risk women.
Hormonal contraceptives boost women’s risk for clots, which can lead to heart attack and strokes. That’s a particular problem for women with diabetes, who are at increased risk for blood clots to begin with. While many contraceptives use a combination of two hormones, estrogen and progestin, the World Health Organization advises that women at increased risk of a blockage caused by a blood clot – known as a thromboembolism – use contraceptives containing only progestin.
Women with advanced diabetes and those with diabetes and other risk factors for heart disease are in that high-risk group, according to the authors of the new report. Dr. Eleanor Bimla Schwarz of the University of California, Davis in Sacramento and her colleagues analyzed data on 146,080 U.S. women with diabetes, ages 14 to 44.
As reported in Diabetes Care, the majority were not using hormonal contraceptive pills or devices during the study. Only 28 percent were using hormonal contraception, and most of those were taking estrogen-containing pills. Only 4 percent were using progestin-only contraception. During the study, the researchers identified 3,012 so-called thrombotic events.
Blood clots were most common among women using estrogen-containing contraceptive patches, with 16 events each year for every 1,000 women. Progestin injections were tied to 12.5 blood clots per 1,000 women each year, the researchers found.
Rates of blood clots were lowest for women using progestin-only IUDs and under-the-skin (subdermal) contraceptives. There were an average of only 3 events each year for every 1,000 women using the IUDs and less than 1 event per year among women using the subdermal implant.
“In some ways, that’s a convenient finding, because . . . IUDs and implants are the most effective form of contraceptive,” Schwarz told Reuters Health.
She noted, however, that the best form of birth control is the one women want to use.
Schwarz also emphasized that the absolute risk of thromboembolism with contraception is low, even for women with diabetes.
Dr. Natalie Whaley, an obstetrician/gynecologist and family planning provider at the University of Rochester Medical Center in New York, said the findings confirm earlier research about women’s risk for thromboembolism with diabetes.
“For women with chronic medical conditions where you can have poor obstetric outcomes including risk for fetal anomalies, it’s even more important that women are getting highly effective contraception,” said Whaley, who wasn’t involved with the new study.
She told Reuters Health that women with diabetes need to time their pregnancies for a number of reasons, including the fact that having good control of their blood sugar will reduce the risk of miscarriage and fetal anomalies.
The new study had some limitations. The researchers did not have data on the women’s family history of blood clots, and their information on whether women smoked or were obese may have been incomplete. Also, most women were enrolled in commercial health plans, and the results may not be applicable to uninsured women or those in publicly funded insurance programs.
More information about “IUDS” from University of Rochester Medicine:
Intra Uterine Device (IUD)
IUD stands for Intra Uterine Device, which is a small “T shaped” device that is inserted through the vagina and cervix into the uterus. This form of birth control prevents pregnancy but does NOT protect against sexually transmitted infections.
These Types of IUDs Currently Used in the US.
Mirena – Releases small amount of progestin (hormone); works for up to five years.
Liletta- Releases small amounts of progestin (hormone); works up to 3 years
Paragard – Contains copper; works for up to 10 years
Skyla – Releases small amounts of progestin (hormone); works for up to 3 years
These IUDs work by preventing sperm from joining with an egg. Additionally, the progestin in the Mirena helps thin the lining of the uterus and reduces the frequency of ovulation. When inserted there are small strings that hang into the vagina. A woman can touch the strings with a finger to know her IUD is in place. The IUD is removed in a physician’s office by using the strings. The IUD is 99% effective at preventing pregnancy.
The Mirena IUD tends to cause lighter menstrual bleeding. Initially irregular or heavy bleeding may occur for up to 3 months. Eventually, many women stop having menstrual cycles all together. The Paragard IUD may cause slightly heavier or stronger menstrual bleeding and cramping but works for twice as long and does not have any potential hormonal side effects.
Possible Complications
Expulsion: infrequently the IUD can partially or totally slip out of the uterus. It is more likely in younger women. If partially expelled it will need to be removed. Another form of birth control will need to be used immediately until the IUD can be replaced.
Uterine Perforation: rarely the IUD can go through the wall of the uterus. The IUD will need to be removed right away. Surgery may be needed to remove the IUD.
Uterus Infection: increased chance within first twenty days after insertion. After the first twenty days, the risk of having an infection is the same as everyone else
Painful Intercourse: this is rare and often improves with adjustment of the string length or change in sexual positioning.
Warning Signs
It is important to call your doctor immediately if you:
Find the string length has become shorter or longer
Cannot find the string
Feel the hard plastic bottom of the IUD
Worry that you may be pregnant
Periods are much heavier or longer
Have abdominal pain
Have pain or bleeding after sex
Have unexplained fever / chills
Have flu-like symptoms
Have unusual vaginal discharge
Are late for your period
Have abnormal vaginal bleeding
You Should Not use an IUD If you:
Have had a pelvic or uterine infection in the past three months
Have or may have a sexually transmitted infection
May be pregnant
Have cervical cancer that is not treated
Have uterine cancer
May be allergic to copper (ParaGuard has copper)
May have liver disease (Mirena only)
May have or have had breast cancer (Mirena only)
IUD Maintenance
It is important to check for your string between yours periods. To do this, wash your hands, then put your index or middle finger into your vagina until you feel the cervix (it feels like the tip of your nose). Feel for the string ends coming through. If you find the strings then the IUD is in place and working. If the strings are longer or shorter than before call the doctor and use another form of birth control.
IUD Removal
Having an IUD removed is easy and should be done in the office. A new IUD can be replaced right after removal of the old one. Fertility usually returns quickly after removal.