Diabetes Effects on Body Animation 3D
Contraception and vasectomy
I have diabetes and want to start on the Pill. Are there any extra risks that women with diabetes run in using it?
Use of the oral contraceptive pill is the same in both women with diabetes and women without diabetes. It is now well known that the pill carries with it small risks of rare conditions such as venous thrombosis (where a vein becomes blocked by a blood clot) and pulmonary embolus (where an artery in the lung becomes blocked by a blood clot), as well as occasionally high blood pressure, although these risks are obviously less than those of pregnancy itself. This is why all women should be examined and questioned before starting the pill because there are a few conditions where it is best avoided and other methods of contraception used. The same arguments apply equally to women with and without diabetes. Healthy women with diabetes who have been checked the same way as those without diabetes may certainly use the pill and there are no additional risks.
When women with diabetes start using the pill there is sometimes a slight deterioration of control. This is rarely a problem and is usually easily dealt with by a small increase in treatment, which in those taking insulin may mean a small increase in the dose. It is a simple matter to monitor the blood or urine level and make appropriate adjustments.
There is nothing to suggest that the pill causes diabetes. It is all right for the relatives of people with diabetes to use the pill but of course they, like others, should attend for regular checks by their general practitioner or family planning clinic.
My doctor prescribed the pill for me but on the packet it states that they are unsuitable for people with diabetes. As my doctor knows that I have diabetes is it safe enough for me?
Yes. There used to be some confusion about whether the pill was suitable for women with diabetes but there is now general agreement that they may use the pill for contraceptive purposes without any increased risks compared with those who do not have diabetes.
I want to try the progesterone-only contraceptive pill. Is it suitable for women with diabetes?
Yes, although recently these have become less popular for all women.
I have just started the menopause and wondered if I have to wait two years after my last period before doing away with contraception?
Although periods may become irregular and infrequent at the start of the menopause, it is still possible to be fertile, and this advice is a precaution against unwanted pregnancy. It applies equally to women with diabetes as to those who do not.
I have diabetes and I am marrying a man with diabetes in 8 weeks’ time. Please could you advise me on how to stop becoming pregnant?
We are not quite clear whether you wish to be sterilized and not have children at all or whether you are just seeking contraceptive advice. If you and your fiancé have decided that you do not wantto have the anxiety of your children inheriting diabetes and have made a clear decision not to have children, you have the option of your fiancé having a vasectomy or being sterilized yourself.
These are very fundamental decisions and will require careful thought because they are probably best considered as irreversible procedures. If you are quite certain about not having children, one of you having sterilization would be the best plan.
We would advise you both to discuss this with your doctor and seek referral either to a surgeon for vasectomy for your fiancé or to a gynaecologist for sterilization. Whichever you decide, you must both attend since no surgeon will undertake this procedure unless he is convinced that you have thought about it carefully and have come to a clear, informed decision.
If our interpretation of your question has not been right and you are merely looking for contraceptive advice, then the best source of this is either your doctor or the local family planning clinic.
All the usual forms of contraceptives are suitable for women with diabetes, so it is just a question of discovering which best suits you and your partner.
Can you please give me any information regarding vasectomy and any side effects it may have for men with diabetes?
Vasectomy is a relatively minor surgical procedure, which involves cutting and tying off the vas deferens – the tube that carries sperm from the testes to the penis. Vasectomy may be carried out under either local or general anaesthesia usually as a day case. It would be simpler to have it under local anaesthesia as this will not disturb the balance of your diabetes. Side effects of the operation are primarily discomfort although infections and complications do rarely occur.
There are a few medical reasons for avoiding this operation but they apply equally to men without diabetes as they do to men with diabetes and your doctor will be able to discuss these with you.
I have been warned that IUDs are more unreliable in women with diabetes. Is this really true?
IUDs (intrauterine contraceptive devices) are generally regarded as slightly less reliable contraceptives than the pill, and there has been one report suggesting they may be even less reliable when used by women with diabetes. Not all experts agree about this, as there are no other reports confirming this observation. There has also been a report suggesting that women with diabetes may be slightly more susceptible to pelvic infections when using an IUD.
On balance, our recommendation is that IUDs should be considered as effective and useful in women with diabetes as in those who do not have diabetes.
Thrush
I keep getting recurrence of vaginal thrush and my doctor says that, as I have diabetes, there is nothing that I can do about this – is this correct?
Thrush is due to an infection with yeast that thrives in the presence of a lot of glucose. If your diabetes is badly controlled and you are passing a lot of glucose in your urine, you will be very susceptible to vaginal thrush and, however much ointment and cream you use, it is likely to recur. The best line of treatment is to control your diabetes so well that there is no glucose in your urine, and then the thrush will disappear, probably without the
need for any antifungal treatments, although these will speed the healing process. As long as you keep your urine free from glucose you should stay free from any recurrence of the thrush.
I suffer with thrush. My diabetes has been well controlled for 10 years now. I do regular blood tests and most of them are less than 10 mmol/litre and, whenever I check a urine test, it is always negative. I have been taking theoral contraceptive pill for 3 years and I understand that both diabetes and the pill can lead to thrush. Can you advise me what to do?
Since your diabetes is well controlled and your urine consistently free from glucose, diabetes can probably be excluded as a cause of the thrush. One has to presume that in your case you are either being reinfected by your partner or that it is a relatively rare side effect of the pill, and you would be best advised to seek alternative forms of contraception.
Hormone replacement therapy (HRT)
Can you tell me if hormone replacement therapy for the menopause is suitable for people with diabetes?
Hormone replacement therapy (HRT) for the menopause consists of small doses of oestrogen and progesterone given to replace the hormones normally produced by the ovaries. Oestrogen levels in the blood at this time begin to decline and, if they decline rapidly, they can cause unpleasant symptoms, such as hot flushes. Replacement therapy is thus designed to allow a more gradual decline in circulating hormones. Hormone replacement therapy is not usually advised in people with certain conditions such as stroke, thrombosis, high blood pressure, liver disease or gallstones. HRT may have a slight worsening effect on diabetes similar to the contraceptive pill. Some doctors are reluctant to give HRT to any woman and may use diabetes as an excuse for not prescribing it.
However, small doses of female hormones can cause dramatic relief of menopausal symptoms and there is no reason why you should not benefit from them provided that you have no history of stroke, thrombosis, etc.
There is good evidence that HRT reduces both osteoporosis and possibly vascular disease in postmenopausal women. The benefits probably outweigh the risks.
I want to try and avoid osteoporosis by taking HRT. As I have diabetes, is this sensible?
Yes. See the question above for our answers on taking HRT generally.
Are the patch forms of HRT as suitable for women with diabetes as the tablets?
Yes.
During the past 5 years I have had trouble with my periods being very heavy and on several occasions I have become very anaemic. I have tried HRT, which interferes with control of my diabetes, and it has been suggested that I have a hysterectomy. I have heard that depression is common after this operation and that HRT is often given to alleviate this feeling but, if this treatment makes my control more difficult, how will I cope?
Many people do have the impression that depression is common following hysterectomy. There is no reason for this. Anyone might get depressed after an operation in the same way that they would after any illness. A few women may feel that, if they have their womb removed, they have lost some of their femininity and therefore will become depressed. However, the womb is merely a muscle and has no effect at all on feminine characteristics apart from its relationship with menstruation. Unless the ovaries are taken out at the same time, there is no reason why you should require HRT. If the ovaries are removed, then HRT should not then upset your diabetes as you will be taking it to replace the hormones that you were producing yourself before the operation. The best person to discuss this with is your doctor.
