IUDs and implants ‘least likely to cause stroke in diabetic women’

New research has shown that strokes and heart attacks are rare for diabetic women who use hormonal contraception, with the safest options being intrauterine devices (IUDs) and implants.

The study - by the University of California (UC), Davis, US - is one of the first to evaluate hormonal contraception and health outcomes in women with a chronic condition, and it is hoped it will encourage physicians to include implants and IUDs in birth control discussions with diabetic patients.

Study senior author 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 containing oestrogen - including oral contraceptives, transdermal patches and vaginal rings - prevent pregnancy by suppressing ovulation. While effective contraceptives, these methods increase women’s risks for heart attacks, strokes and blood clots.

Physicians have been especially reluctant to prescribe hormonal birth control to women with diabetes, as adults with diabetes are two to four times more likely to die from heart disease than adults who do not have diabetes.

The study authors wanted to know to what extent the risks of cardiovascular events for diabetic women differed with various types of hormonal birth control. They examined information from 2002 to 2011 on women of reproductive age with type 1 or type 2 diabetes.

They studied the records of nearly 150,000 women for hormonal birth control prescriptions and the occurrence of strokes, heart attacks or blood clots, also known as thromboembolism.

It was found that the vast majority of diabetic women - 72 per cent - did not receive prescription contraception of any kind, even though pregnancy planning is critical for this population.

Lead author Sarah O’Brien, associate professor with Nationwide Children’s Hospital, Ohio, said: “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.”

Overall, thromboembolic events among women in the study were low, with 6.3 events per 1,000 women each year. The researchers found that the contraceptives least likely to be associated with thrombosis were IUDs and subdermal implants.

However, oestrogen patches and progestogen-only injections were both associated with slightly increased risks of thromboembolism.ADNFCR-2094-ID-801830354-ADNFCR