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April 10, 2001

Family Planning

Question from Minneapolis, Minnesota, USA:

How dangerous are combination (estrogen/progesterone) birth control pills for a 29 year old with well-controlled type 1 diabetes of 27 years duration? My endocrinologist says not very, but my ob-gyn [obstetrics and gynecology] clinic says extremely.

Answer:

In the big picture, pregnancy is more of a risk than the birth control pills. This doesn’t mean women with type 1 diabetes cannot become pregnant and have a good outcome. It does mean that pregnancy is associated with increased medical risk. The reasons the pill have increased medical risk is that they can antagonize blood sugars to some degree. This is addressed by adjusting insulin therapy. The pill is also associated with an increased risk of blood clots, especially if the women who use them smoke.

After a discussion of risk/benefit analysis, I feel oral contraceptives are a reasonable therapy. Please realize there are some risks with any treatment.

JTL