Contraception for women with diabetes: an update.

Today several effective contraceptive methods are available for women with IDDM. Contraceptive guidance as part of the pre-pregnancy counselling needs to be more widely implemented by general practitioners and in non-specialized obstetrical and gynaecological departments. Women with diabetes are generally well motivated, and thus the barrier methods may prove both acceptable and reliable contraceptive agents for some of these women. When, however, a high risk of user failure can be predicted, the IUD or hormonal contraception may be the only reversible alternative. According to our findings, IUDs can be recommended without reservation to women with IDDM. In women with previous GDM it seems that low dose oral contraceptive compounds may be administered without running the risk of inducing glucose intolerance, but long-term results are still unavailable. Natural oestrogens may be administered in combination with a progestogen for a limited period as an efficient and acceptable mode of contraception in women with IDDM without any concomitant adverse effects on diabetic control. From our investigations it also appears that short-term administration of combined low dose OCs containing the traditional progestogens (e.g. norethisterone or levonorgestrel) or the new gonane progestogens (e.g. gestodene) does not alter glycaemic control in women with IDDM. Similarly, these compounds do not cause any significant changes in lipid/lipoprotein levels during short-term treatment, although the intake of monophasic ethinyloestradiol/norethisterone preparations may result in higher triglyceride levels and tends to increase lipid levels more than triphasic ethinyloestradiol/levonorgestrel compounds. The results from our clinic have shown that OCs can be safely recommended at pre-conception counselling so that women with diabetes can obtain both optimal glycaemic control and efficient spacing of their pregnancies.