My 17-year-old daughter has had type 1 diabetes for nine years. She has occasional headaches but no complications from diabetes. She experiences severe menstrual pain during her period and has no relief using Aleve, Advil, etc. Her doctor suggested she try Yaz to help regulate her periods (which are not extremely irregular) and to reduce the pain. I have concerns with respect to the vascular side effects of birth control pills. I would like your opinion and information regarding what the standard protocols are.

This is a fairly standard treatment for women with heavy, uncomfortable periods. The use of the OCP, in this case Yaz, is associated with less bleeding and less cramping. There are also issues to address related to the effect of the estrogen and progesterone with the OCPs. Remember that most women experience slightly more insulin resistance, and potentially higher blood sugars, when the progesterone is higher in the latter part of the cycle. Because the amount of estrogen experienced by women during their reproductive years is similar to the amount of estrogen in the OCPs, the concern about atherosclerosis is not as high as if you consider the estrogen exposure to post-menopausal women. In young women, the exposure is not considered a vascular risk factor. The exception is smoking. Smoking and oral contraceptives are a bad combination and there have been reports of even young women having strokes or vascular events when they smoke and are on high-dose oral contraceptives. The more recent OCPs on the market are usually associated with less estrogen and progesterone than were used even a decade ago.

JTL