Your Guide to Birth Control + Type 1 Diabetes

Birth control and type 1 diabetes (T1D) can be tricky. There is no one-size-fits-all option because different methods work for different people who menstruate. Hormones are known to affect blood sugar levels, but they also affect everyone differently, so in terms of contraception, what works for one person with diabetes might be totally wrong for the next.

Hormonal birth control can affect insulin resistance too, and therefore, lead to higher blood sugar levels. Some people already see this when they experience higher insulin needs or higher blood sugar levels right before their period starts.

Choosing the best birth control to manage your T1D can be complicated, but not impossible! Just like every case of diabetes is different, every birth control experience is different. 

In this guide, we review various birth control options, their side effects and their potential impact on your diabetes management, so you can make the best choice for your body alongside a healthcare provider (HCP) you trust.

Intrauterine devices (IUDs)

There are several different types of IUDs. Each interacts with the body differently. IUDs must be placed and removed by a healthcare professional. In general, IUDs are not recommended for people who contract pelvic infections easily. If you live with diabetes, you may generally be more prone to infections if you have consistently high blood sugar levels.

You should know if this is the case if you wear a continuous glucose monitor (CGM) and are in tune with your data, or have recently had your A1C or time-in-range (TIR) checked by your HCP. 

If you are interested in an IUD but your blood sugar levels are often high, talk to your HCP about ways to lower them before getting an IUD. You might also consider other birth control options that suit your current health, so you don’t have to wait and are adequately protected from unwanted or unplanned pregnancies.

Non-hormonal IUDs: ParaGard

ParaGard is a non-hormonal form of birth control. It is a copper IUD that triggers an inflammatory response in the uterus, preventing pregnancy. Your HCP inserts ParaGard into your uterus, and it can last for up to 10 years. 

Like other IUDs, it should be inserted and removed by a healthcare professional. Occasionally, ParaGard may come out on its own, but that isn’t its purpose, and you should not attempt to remove it yourself. Cases of IUDs coming out are rare but not unheard of. Contact your HCP immediately if anything feels off so they can help you check.

Some people prefer ParaGard because it is hormone-free, whereas other ParaGard users report heavier bleeding and more intense cramps and backaches. Because of these potential side effects, people with diabetes (PWD) should consider how this could affect blood sugar management. Managing blood sugar levels is difficult enough without intense cramping!

Hormonal IUDs

Hormonal IUDs are small plastic devices that contain the progestin hormone levonorgestrel. There are several strengths and sizes of hormonal IUDs—variations are suggested for folks who may be more sensitive to hormones or who have a smaller or larger uterus due to genetics, prior childbirth, etc.

Brand-name hormonal birth control options in IUD form that contain levonorgestrel include:

• Mirena (most commonly prescribed)
• Skyla
• Liletta
• Kyleena

Depending on hormone levels, hormonal IUDs can last from three to five years. Your HCP will let you know when yours needs to be replaced. Like any hormonal treatment, hormonal IUDs can cause changes in blood sugar, as well as acne, weight gain and mood swings. 

Remember: No form of IUD birth control should be inserted or removed by anyone other than a healthcare professional.

“The ring”

The vaginal ring is a flexible device inserted into the vagina and worn for three weeks, during which time your period (bleeding during the menstrual cycle) does not occur. Current U.S. options include NuvaRing and Annovera. For both brands, the ring is removed during the week of your period, and a new vaginal ring is placed. 

This ensures that hormones to prevent pregnancy are released during parts of the cycle when pregnancy could occur. A HCP must prescribe the vaginal ring, but unlike with IUDs, a healthcare provider is not needed for placement and removal.

The hormones in the ring are absorbed directly into the vagina. This is easier on the body because the medication does not need to be metabolized through the digestive system, like with birth control pills. For many people, this minimizes the impact on blood sugar levels. This is a key reason some HCPs recommend the vaginal ring to PWD.

However, it is important to note that Annovera may affect blood sugar tolerance due to its estrogen content. Some PWD find that it makes blood sugar management more difficult and increases the risk of blood clots. Meanwhile, the makers of NuvaRing advise that people with kidney, eye, nerve or blood vessel damage from diabetes complications should not use the ring. 

Talk to your HCP to understand these warnings and determine what’s best for you. Drugmakers must list all side effects, even those that occur infrequently.

Birth control pills

Birth control pills are taken daily and contain hormones that—when taken consistently—prevent pregnancy. There are many types of birth control pills with various hormonal formulations. 

PWD should speak with their HCP about their specific needs because everyone is different, with varying hormonal needs and tolerances. People may find that one type of birth control has no side effects, while another may wreak havoc on blood sugar management or mental health.

As with any medication, PWD should pay close attention to blood sugar levels and how they feel physically and mentally in the weeks and months after starting a new hormonal birth control method.

For PWD, birth control pills containing synthetic estrogen and the progestin norgestimate are the most widely recommended. These pills contain little or no androgens—steroid hormones that give men their male characteristics and can affect insulin resistance and, consequently, blood sugar management.

Due to fluctuations in hormone levels, some PWD have reported that their insulin needs nearly doubled when starting the pill, so be prepared to adjust insulin requirements as needed. The estrogen in some birth control pills can lead to higher blood sugar levels.

Additionally, birth control pills are generally not recommended for people who take a GLP-1,  have heart disease, blood clots or high blood pressure, as well as for people who smoke or are over the age of 35. People with a history of depression, anxiety or other mental health conditions should also keep a close eye on their symptoms, as the hormones in birth control pills can affect the balance of brain chemicals.

Common birth control pill brand names in the U.S. include:

• Sprintec
• Junel Fe
• Apri
• Yasmin
• Yaz
• Tri-Sprintec
• Ortho Tri-Cyclen
• Kariva
• Lo Loestrin Fe
• Amethyst
• Seasonique
• Camila
• Errin
• Slynd
• Opill

There are many options to choose from, so it’s best to have a conversation with your HCP about which type(s) may be right for you. Some pills contain more than one hormone, which may affect blood sugar management differently than those that contain just one. Some are lower-dose than others, too, which is important to keep in mind for overall health and tolerance.

Hormone injections

Hormone injections can prevent pregnancy, but they may lead to weight gain, which can increase insulin resistance. The most common form is called Depo-Provera and contains a synthetic hormone called depot medroxyprogesterone acetate (DMPA). Depo-Provera works by preventing the release of an egg from the ovaries.

Other birth control shot options include:

• Sayana
• Noristerat

Shots typically must be given about every 13 to 15 weeks.

The morning-after pill

There are two types of morning-after pills, intended to be used when other birth control methods fail or are forgotten. If you find yourself in this situation, you can go to any drugstore or pharmacy, where it will be in the aisle or behind the counter. If you see it behind the counter, just ask the pharmacist for it—you don’t need a prescription, and the medication usually costs around $50.

One type of morning-after pill is called Ella and contains the hormone ulipristal acetate. It is the most effective morning-after pill. Folks who weigh 195 pounds or more should speak with their HCP about dosing, as this pill is known to be less effective for those over 195 pounds.

Another type of morning-after pill is available under multiple brands, such as Plan B and AfterPill. This type of pill contains the hormone levonorgestrel. Folks who weigh 155 pounds or more should speak with their HCP about dosing for this type as well, because this pill is known to be less effective for those over 155 pounds.

While preventing an unplanned pregnancy is very important, people with disabilities should only use the morning-after pill in urgent situations when other birth control methods fail or are forgotten—not as a default birth control method. The hormones in morning-after pills can cause significant changes in blood sugar in the following days. Be sure to watch your insulin needs carefully to stay safe and healthy!

Diaphragms, barrier devices, condoms and more

Barrier devices are safe for PWD because they do not contain hormones. Still, it’s important to read labels and know about any other chemicals used alongside your barrier device of choice; the spermicides used in some of these devices can increase the risk of urinary tract infections (UTIs).

Talk to your HCP about birth control and T1D

Talk to your HCP or another healthcare provider you trust about the birth control that may be right for you. This list is not exhaustive and is constantly changing. Just like your body with T1D! One management strategy may work for a while, but you can outgrow it and find that other, more evolved methods work better.

While trial and error is not ideal with birth control, it may require some testing to find which option you respond to best. Be open to the process to stay safe, prevent unplanned or unwanted pregnancies and feel your best with the option you choose.

Are you newly diagnosed with diabetes, or do you want to empower yourself more in managing it? It’s time to thrive out loud! Download our Beyond Diagnosis guides to start soaring in your management and inner confidence.