Hormonal Contraceptives and Risk of Heart Diseases in Diabetic Women

Highlights

• Hormonal contraceptives are effective in preventing pregnancy.
• Women with diabetes are more likely to experience stroke and cardiovascular events.
• Intrauterine devices and subdermal birth control implants can reduce the risk of heart events in diabetic women.

Hormonal contraceptives are considered to be safe among women with diabetes and other chronic conditions. A new research published in the Diabetes Care found that diabetic women who use hormonal contraceptives such as intrauterine devices (IUDs) and under- the-skin implants were rarely affected with stroke and heart attacks.

Eleanor Bimla Schwarz, professor of internal medicine at UC Davis Health System, said, "Clinicians need to get beyond the idea that birth control just means 'the pill.”

"There are options that are safe and effective for all women, including those with diabetes."

Birth control methods that have a direct effect on the endocrine system is referred to as Hormonal contraception. These techniques prevent ovulation. Hormonal contraceptives are available in various forms such as pills, patch, vaginal ring, shots and intrauterine devices.

Doctors are unwilling to prescribe contraceptives for women with diabetes as it may increase the risk for heart attacks, strokes and blood clots. Diabetes patients are two to four times more likely to die from heart attacks.

The research study investigated the risks of heart diseases among diabetic women with differing types of hormone birth control devices.

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The data was collected from Clinformatics, a health claims database, from 2002-2011 on reproductive females with type 1 and type 2 diabetes. Around 150,000 women who took hormonal birth control prescriptions and people with stroke and heart attack were evaluated.

The findings showed that 72% of diabetic women did not receive any prescription contraception. Sarah O’ Brien, associate professor, Nationwide Children’s Hospital, said,"This was alarming, since women with diabetes become pregnant as often as other women."

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"Pregnancy timing is critical for women with diabetes. It's best to carefully plan pregnancies and ensure that the diabetes is under good control, because high sugars can cause an increased chance of birth defects."

Intrauterine devices and subdermal implants were found to be less likely to be associated with thrombosis. Thrombolic events were found to be low and around 6.3 events per 1000 women every year.

Schwarz, said, that "The next step is to understand the best ways to share this information with women who have diabetes and make sure they are consistently offered a full range of contraceptive options."

Intra Uterine Device (IUD)
The intra uterine device is a long acting reversible contraception for women. It is a small T shaped device that is fixed inside the womb and works by preventing the fertilization of the egg.

Two types of IUD
Copper containing IUD
Hormonal IUD (Progesterone containing IUD)

Advantages

• Long acting
• Effective for about 99%
• Does not increase the risk of cancer
• Reduces menstrual bleeding
• Limited side effects as it contains low levels of hormones

Subdermal Birth Control Implants
Birth control implants is a flexible, matchstick size implant which is placed under the skin of the upper arm to prevent pregnancy. It is capable of preventing pregnancy for upto 4 years.

Advantages

• Can be used by women who cannot take estrogen
• Safe for women during breast- feeding
• Reduces menstrual cramps and pain at ovulation

References

1. Sarah H. O’Brien et.al. Hormonal Contraception and Risk of Thromboembolism in Women With Diabetes. Diabetes Care ; (2016) https://doi.org/10.2337/dc16-1534
2. Intra Uterine Device (IUD) - ( http://www.familyplanning.org.nz/advice/contraception/intra-uterine-device-iud)
3. Birth Control Implant - ( https://www.plannedparenthood.org/learn/birth-control/birth-control-implant-implanon)

Source-Medindia