Is there really a difference in cardiovascular risk for a diabetic using a progestin-only birth control pill versus the traditional combination pill? I recently moved to Germany from the U.S. and have been on a regular estrogen/progestin pill for control of endometriosis for about seven years. The ObGyn here was very surprised to hear that in the U.S. a type 1 diabetic was prescribed a pill with estrogen. She suggested that I switch to the progestin-only type because the detrimental effect on blood vessels is much lower. I’m 34 and have no diabetic complications. My blood pressure is usually around 120/75 and I’m on an ARB for kidney protection. However, I am quite overweight. What is your opinion?

I do not see the emphasis on the progestin-only agent. It is true that when using the estrogen-progestin pill, there are side effects of which one must be aware. The side effects include an increase in blood pressure and an increase in lipids. These are especially important to people who have diabetes. It is also true that both estrogen and progesterone have insulin resistance effects, but progestins are probably more potent inducers of insulin resistance. I would also make the point that this is a very important issue for women with diabetes since the risk of pregnancy, especially in the presence of complications, is a very serious matter. Complications are known to worsen with pregnancy. The point is that there also have to be forms of reliable birth control to prevent these scenarios from causing further complications in women with diabetes.

JTL