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IUDS, implants are best birth control for women with diabetes

Holding an IUD birth control copper coil device in hand, used for contraception – front view

(flocu)

The two most effective hormonal contraception for women in general, are also excellent options for women with diabetes, according to a new study.

Intra-uterine devices (Iuds) and contraceptive implants that are placed under the skin, both of which are highly effective, was associated with the lowest risk of blood clots in these higher risk women.

Hormonal contraceptives boost women’s risk of blood clots, which can lead to heart attacks and strokes. This is especially a 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 (who) recommends that women with an increased risk of a blockage caused by a blood clot – known as a thromboembolism – use of contraceptives containing only progestin.

Women with advanced diabetes and those with diabetes and other risk factors for heart disease are in a high-risk group, according to the authors of the new report.

Dr. Eleanor Bimla Schwarz of the University of California, Davis in Sacramento, and colleagues analyzed data on 146,080 AMERICAN women with diabetes in the age group of 14 to 44.

As reported in Diabetes Care, the majority are not using hormonal birth control pills or devices during the study. Only 28 per cent use hormonal contraception, and most were taking estrogen-containing pills. Only 4 percent use of progestin-only birth control.

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During the study, the researchers identified 3,012 so-called thrombosis.

Blood clots were the most common among women with estrogen-containing contraceptives patches, with 16 events each year for every 1,000 women.

Progestin injections were tied to 12.5 blood clots per 1,000 women per 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 per year per 1000 women using the Iuds and less than 1 case per year and among women using the subdermal implant.

“In some ways, this is a useful finding, because . . . Iuds and implants are the most effective form of birth control,” Schwarz told Reuters Health.

They noted, however, that the best form of birth control is a women want to use.

Schwarz also stressed 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 diseases where you can go for poor obstetric outcomes including the risk for fetal abnormalities, it is even more important that women are getting very effective birth control,” says Whaley, who was not involved in the new study.

She told Reuters Health that women with diabetes should have their pregnancy for a number of reasons, including the fact that having a good control of the blood sugar level reduces the risk of miscarriages and fetal abnormalities.

The new study has a number of limitations. The researchers have no information about the women of the family history of blood clots, and the information about whether women smoked or were obese may be incomplete. Also, most of the women were included in the commercial health plans, and the results may not apply to non-insured women or women in government-funded insurance programs.

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