Birth Control Options for Women with Type 1 Diabetes

A vaginal ring is a dome-shaped flexible device that is inserted into the vagina for 3 weeks before menstruation occurs. It is then taken out during the week of menstruation for 5 days, and a new ring is placed.

To work effectively, a new ring must be inserted after 5 days of the prior ring being taken out. If menstruation lasts longer than 5 days, a new ring can still be inserted, but if you wait more than 5 days to insert a new ring, you will need to use a backup form of birth control as the ring will take up to another 7 days to help prevent pregnancy once inserted.

Pros

• does not require a healthcare provider for placement or removal
• potential for periods to become lighter, more regular, and less painful
• can help with premenstrual symptoms
• does not interrupt sex

Cons

• can cause spotting or bleeding during the first few months of use
• can cause temporary side effects, like increased vaginal discharge and mood changes
• does not protect against sexually transmitted infections (STIs)
• is not as long lasting as other options
• reversible but may take several months for fertility to return to normal after use

How to obtain it / cost

Vaginal rings must be prescribed by a healthcare professional, but the user is responsible for placing and removing them.

Vaginal rings vary in price depending on whether you have insurance and which type of plan; they can cost anywhere from $0 to $200. One NuvaRing can cost between $0 to $200 and lasts up to 5 weeks, while the Annovera ring lasts for 1 year but costs anywhere from $0 to $2,200.

Any special T1D blood sugar or complications concerns?

The hormones in vaginal rings that prevent pregnancy are absorbed directly into the vagina and do not require the body to metabolize the medication. Without the need to digest the medication, vaginal rings often have little to no impact on blood sugar management.

It is important to note that the makers of NuvaRing, one of the leading creators of vaginal rings, have stated that people who have experienced kidney, eye, nerve, or blood vessel damage due to diabetes should not use vaginal rings.

The Pill is one of the most widely used forms of birth control and requires users to consistently take a small pill to prevent pregnancy. There are two main types of contraceptive pills: a combined estrogen and progesterone pill, and a progesterone-only pill.

Combination pills are more common and provide good control of a person’s bleeding pattern and for people who experience less irregular bleeding. They can also reduce bleeding and help some with menstrual pain. Combination pills are generally effective at preventing contraception, but they must be taken every day at the same time. Experts report that 9 in 100 people (9 percent) will become pregnant while using the Pill.

Progesterone-only pills, although less common, may be more beneficial for certain groups and lifestyles, like for those who breastfeed, experience heavy periods, have a history of blood clots, or cannot tolerate the estrogen hormone.

For those with diabetes, the Pill may increase your insulin resistance. Per the University of Colorado, the increased need for insulin may be attributed to the estrogen used in the Pill. Birth control pills that use synthetic estrogen and norgestimate (a type of progestin hormone) are often recommended for people with diabetes.

Additionally, it’s important to keep in mind that birth control can impact people with depression, anxiety, or other mental health occurrences negatively as the hormones in birth control can also impact the balance of a person’s brain chemicals.

Pros

• can reduce the amount of menstrual bleeding and pain
• can improve acne
• non-invasive procedure
• can be inexpensive

Cons

• must be taken every day at the same time to be effective
• potential to increase insulin resistance, thus increasing a person’s insulin intake needs
• increased risk of kidney disease diabetic nephropathy, eye conditions, diabetic retinopathy, and nerve disorder diabetic neuropathy for people with diabetes who use birth control pills, per research
• can cause irregular bleeding
• does not protect against STDs
• may not work properly if you’re vomiting, which means you may need to use an additional form of contraception, like a condom, until your next period

How to obtain it / cost

In comparison with some of the other birth control options, the Pill can be easy to get, but you will need a prescription.

Prices depend on your insurance and which brand you select. In most cases, one pill pack lasts for 1 month and can cost $0 to $50. With most health insurance plans the Pill is free, and in most states, you can get the Pill prescribed and mailed to you using Planned Parenthood’s Direct app.

Additionally, since the Pill requires a prescription, you may need to pay for an appointment with a doctor or nurse. Visits can range from $35 to $250, but under the Affordable Care Act, most insurance plans are required to cover visits that are related to family planning.

Any special T1D concerns?

Birth control pills can produce a variety of results for people with diabetes. Some have no negative side effects, while others may experience increased insulin resistance and other issues, such as headaches and nausea.

Combination birth control pills that use synthetic estrogen and norgestimate are recommended for people with diabetes due to their decreased likelihood of impacting a person’s blood sugar. Additionally, new research shows that lower-dose contraceptive pills are less likely to impact your blood sugar. If you choose to use the Pill, be sure to monitor your blood sugar and talk with your healthcare team to ensure your insulin need fits for what you need.

Input from T1D women who’ve used this method

“My T1D daughter had a horrible time with various birth control pills. She was so insulin resistant, it was like she was on prednisone. Finally, she found a low-hormone IUD that didn’t impact her blood sugar.” — Mamaliz, @mamaliz1969, on Twitter

“I’ve always used the Pill and never had any issues. Honestly, it helped my blood sugar stable out because I used to have really bad periods before using it.” — Alex, age 23

“I used the Pill for a month when I was 16, but it doubled my insulin rates. As soon as I stopped, all of my rates went back to normal, and I have never used the Pill again.” — Lilly, age 26

Intrauterine contraception, or IUDs, use a small T-shaped device made of flexible plastic with a nylon string attached to the end that is placed inside your uterus. To have an IUD placed, you have to go through a 15-minute minor procedure in which a healthcare professional inserts the device.

There are two types of IUDs: copper and hormonal. Depending on which type you use, they can last from 3 to 10 years. Additionally, IUDs can be used by people who have not had children and are reversible; once they’re taken out, fertility returns to normal.

Pros

• highly effective at preventing pregnancy, at more than 99 percent success
• “set and place” method, meaning you don’t have to remember to take medication, such as with the Pill
• reversible; once removed fertility returns to normal
• can be used by both people who have had children and people who haven’t
• long-term form of contraception (at least 3 years or more, depending on which device you choose)
• after the upfront cost for the initial procedure, can save you money otherwise spent on monthly medication refills
• may stop periods, as reported by 21 percent of users in a 2016 study after 1 year of having a hormonal IUD inserted
• convenient and private, only you will know you have it; in some cases, possibility of your partner feeling the nylon strings that are attached to the end of the device; if so, call your doctor to arrange for the strings to be cut if bothersome

Cons

• needs to be placed by a healthcare provider
• quick procedure but can be painful
• expensive upfront cost, depending on how much your insurance covers
• copper IUDs can potentially increase the amount of vaginal bleeding
• potential increased risk for irregular bleeding at first with use of hormonal IUDS
• potentially small risk of pelvic infection around the time of insertion for people with uteruses
• although very uncommon, possibility of the IUD to be incorrectly placed or be pushed out by your uterus; according to the American College of Obstetricians and Gynecologists, just 1.4 out of 1,000 times (or 0.14 percent) for hormonal IUDS being misplaced and 1.1 out of 1,000 (0.11 percent) for copper IUDs being misplaced
• does not protect against STDs

How to obtain it / cost

According to Planned Parenthood, IUDs can cost anywhere between $0 to $1,300 depending on your insurance and what kind you choose. The price includes necessary medical exams preoperative and postoperative and IUD insertion. IUDs are often free or low cost with private insurance plans, Medicaid, and some other government programs.

To use an IUD, you must have it placed by a healthcare professional. If you decide an IUD is right for you, talk with your OB-GYN or another trusted doctor about making an appointment to have it placed.

Any special T1D concerns?

Both hormonal and copper IUDs rarely have any effect on blood sugar levels, which can make them an ideal solution for people with T1D.

Additionally, hormonal IUDs can reduce or stop menstrual bleeding. This may help those who experience blood sugar fluctuation while on their period. IUDs are often a better contraception option for people who have diabetes complications, specifically those that affect their eyes or kidneys.

Input from T1D women who’ve used this method

“The Mirena IUD (a hormonal IUD) has worked super well for me. I started using the Pill when I was 16, and it nearly doubled all my insulin rates. My doctors, at the time, told me this is super uncommon, which I now know is untrue, but they recommended I consider changing to the IUD. As soon as I switched, my insulin rates went back to normal, and I have had zero issues since. I’ve also found it super helpful since it stopped my periods because I no longer have crazy fluctuations in my blood sugar that usually occurred while I was on it.” — Micheala, age 22

The Nexplanon implantable is a very small rod that is placed underneath the skin of a person’s upper arm and releases hormones that prevent you from getting pregnant. The rod must be implanted by a healthcare professional and can last up to 5 years.

Pros

• very effective at preventing pregnancy, 99 percent
• long lasting form of contraceptive (up to 5 years of protection)
• discrete, only you will know you have it
• can lighten periods or stop menstruation altogether
• reversible; once removed, your fertility should return to normal

Cons

• can cause irregular bleeding
• may have expensive upfront costs to implant
• does not protect against STIs

How to obtain it / cost

The Nexplanon implantable must be inserted and removed by a healthcare professional, typically a gynecologist or family health provider. Your healthcare team can advise you on whether this is a good option for you, and they may perform a physical exam.

During the procedure, the healthcare provider will give you a shot to numb the area of your upper arm and then use a special inserter tool to place the implant under your skin. The insertion only takes a few minutes, and patients report they only experience a small pinch or stinging sensation.

Under most U.S. insurance plans, Nexplanon is either free or low cost. Without insurance, the insertion can cost up to $13,000, and the removal expense can be up to $300. Although the implant may have a high initial cost, it may save you money in the long term because you’ll no longer be paying for monthly birth control prescriptions. Be sure to talk with your insurance company and healthcare team to understand how much this will cost you.

Any special T1D concerns?

Implants are generally considered safe for people with T1D, but as with all things, their effects can vary from person to person.

According to several studies, the majority of people who received this implant did not see any change in their A1C, BMI, or their insulin resistance. The implant can be a great option for people with T1D, but it is important to always monitor your blood sugar and ensure that you are not facing any adverse side effects after implantation.

Input from T1D women who’ve used this method

“I got Nexplanon in a couple of weeks after my diabetes diagnosis. So, I thought I had ridiculously high blood sugar [as a result]. Turns out, I did not… Didn’t know until I got it removed.” — @thehangrywoman

“I was super insulin resistant for the first six weeks after Nexplanon insertion, but it’s either leveled out or my rates have adjusted and I don’t notice it any more.” — @femmanism

Hormone injection, also known as the Depo-Provera shot, is an injection you receive every 3 months. The shot prevents pregnancy by injecting the hormone progestin, which prevents ovulation. Additionally, progestin prevents eggs from easily moving through the fallopian tube and also makes the cervical mucus thicker, thus preventing sperm from traveling through the uterus.

Pros

• highly effective at preventing pregnancy
• longer-term protection than other options; requires 4 shots per year to prevent pregnancy, no medications or other devices needed in between dosages, which can make it an easier option to use
• convenient and private, only you will know you have it
• can help protect you from uterine cancer and ectopic pregnancy
• reversible; once you stop taking the shot, your fertility should return to normal within roughly a year
• can reduce menstruation bleeding and pain
• menstruation may stop after one year of using the shot

Cons

• does not protect against STDs
• need to get a shot every 3 months
• must be administered by a healthcare professional (in some cases you can take the shot home, but this varies by healthcare provider)
• potential to cause negative side effects (typically only for the first 2–3 months as your body adjusts to the hormones), like irregular bleeding, nausea, headaches, weight gain, sore breasts, or depression
• can take 9 to 10 months after stopping the shot to become pregnant; pregnancy protection typically wears off after 15 weeks of the last shot, but some people have reported that their fertility did not return to normal until 10 months after their last shot

How to obtain it / cost

The shot must be administered by a healthcare professional every 12 to 13 weeks, or every 3 months. Some doctors may allow you to do the shot at home, but this varies among healthcare providers. If you’re unable to take the shots at home, you must make regular appointments to ensure you have effective, continual birth control.

Cost depends greatly on your health insurance plan. Some doctors require you to have an exam to ensure you are a good candidate for this option, which can cost up to $250. Every subsequent visit and shot can then cost up to $150.

Any special T1D concerns?

Due to the hormones used in the shot, you face a higher risk of weight gain, which may result in higher insulin resistance.

One study shows that people with diabetes experienced a slight increase in blood sugar levels, and thus insulin needs, when using hormone injections as a contraceptive. However, after about 30 months (2.5 years), however, blood sugar levels and insulin resistance returned to normal. Additionally, people who were overweight or had clinical obesity showed higher glucose levels while on hormone injections than those who were average weight.

Your care team may decide to give you a slightly lower dose than others due to your diabetes and will ask you to closely monitor your blood sugar levels following your initial shot.

The morning-after pill is an emergency contraceptive that can work up to 5 days after having sex; emergency contraceptive is meant to be used if other birth control methods were forgotten or failed (such as a broken condom).

There are a couple of different pills that you can use depending on when you had sex without protective methods, your weight, whether you’re breastfeeding, and which type is easiest for you to get. The main types of morning-after pills are a levonorgestrel morning-after pill, like Plan B or My Way, and the ella pill and Plan B.

ella is the most effective morning-after pill, but you need a prescription to access it. ella lowers the chance of becoming pregnant by 85 percent if you take it within 5 days of having sex, but the sooner you take it, the more effective it will be. ella works better than Plan B for people who are 155 pounds or have more weight, but it may lose its effectiveness if you weigh more than 195 pounds.

Levonorgestrel morning-after pills must be taken within 3 days of having sex without protective methods but are more effective the sooner you take them. These pills also may not work if you are over 155 pounds. If you have more weight, you may need to use the ella pill or copper IUD as an emergency contraceptive.

Pros

• convenient, easy to access some options at a pharmacy
• one dose

Cons

• can create severe swings in blood sugar levels due to the concentration of hormones
• effective only for a limited time
• certain medications may decrease its effectiveness
• may not be effective if you weigh over 195 pounds

How to obtain it / cost

Some morning-after pills are available over the counter at your local pharmacy. Depending on the brand, the morning-after pill can range from $20 (from brands like Take Action or Next Choice One Dose) to $50 (Plan B). The average range for most morning-after pills is from $40 to $50.

If you want to use the ella, you will need a doctor’s prescription. It typically costs $50 at most drugstores.

Any special T1D concerns?

While family planning, people with diabetes should plan ahead and try to use other forms of birth control rather than emergency contraceptives. Due to the morning-after pill’s concentrated, high dosage of hormones, blood sugar swings are common and quite severe in the following days after consumption. If you need to take emergency contraceptives, closely monitor your blood sugar and keep an eye on insulin dosing to keep yourself safe.

Condoms are a barrier, typically thin and stretchy (made from latex, plastic, or animal skin), that a person wears around their penis while having sex. Condoms work by preventing sperm from entering the uterus so that it is unable to reach an egg for fertilization.

Pros

• effective at preventing pregnancy, 85 percent
• most condoms protect against STDs
• easily accessible, inexpensive, and available at most drugstores
• can be used for additional pleasure; can have extra features, such as ribbing, that may increase pleasure during sex
• can help prevent unplanned pregnancies while using other forms of birth control
• no side effects

Cons

• can break
• have to use a condom every time you have sex
• not reusable
• may disrupt sex to put on

How to obtain it / cost

Condoms are a good option for many people, as they’re available at most grocery stores, pharmacies, or even convenience stores. They’re also relatively cheap, typically around $2, and require no prescription.

Any special T1D concerns?

Additionally, condoms are a great choice for people with diabetes as they have no effect on blood sugar. Since there is no use of hormones, the condom itself will not cause any blood sugar fluctuations or create an increase in insulin resistance.

Input from T1D women who’ve used this method

“I always opt for a condom. I’ve tried different forms of birth control, the Pill, the implant, but I’ve always faced higher blood sugars as a result. The condom is the one thing that has zero effect.” — Ashley, age 32

When selecting a birth control method, it’s important to choose an option that not only works for your lifestyle but also for your diabetes.

When it comes to contraceptives, there is no one size that fits all. It’s important to advocate for yourself if a certain option is not working for you. Talk with your healthcare team and be sure to monitor your blood sugar to help ensure there are no adverse side effects.

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