Use of hormonal contraceptive methods by women with diabetes.
METHODS
This study sought to establish use of hormonal contraception in UK women aged between 15 and 44 years with type 1 or type 2 diabetes compared with comparison groups with no diabetes. A cross sectional study design was used to compare 947 cases of type 1 diabetes and 365 cases of type 2 diabetes with comparison groups matched for age. Subjects were selected from the General Practice Research Database (GPRD).


RESULTS
Women with diabetes were less likely to use hormonal contraception than women without diabetes--type 1 RR 0.83 (95% CI 0.59-0.93), type 2 RR 0.60 (95% CI 0.42-0.83). Women with type 1 diabetes were more likely to be prescribed a combined pill than a progestogen only pill (POP), but were significantly more likely to be prescribed the POP than were women without diabetes RR 1.65 (95% CI 1.26-2.13). Women with type 2 diabetes were less likely to be prescribed a combined oral contraceptive RR 0.39 (95% CI 0.24-0.62). The injectable contraceptive Depo Provera was significantly more likely to be given to women with diabetes than the comparison group--type 1 RR 1.56 (95% CI 1.12-2.11), type 2 RR 3.57 (95% CI 2.15-5.60).


CONCLUSIONS
The study highlighted significant variation in prescribing of hormonal contraception to women with type 1 and type 2 diabetes in comparison to those without diabetes. It is now recognised that hormonal contraception is a safe and effective option for women with uncomplicated diabetes. Possibly there are significant numbers of young women with poorly controlled diabetes or other risk factors for cardiovascular disease that have influenced clinicians in avoiding the use of hormonal contraception. Paradoxically it is these women who are at most risk from unplanned pregnancy.
Shawe
Jill
J
University of Surrey, Stag Hill, Guildford GU2 7TE, UK. J.shawe@surrey.ac.uk
Mulnier
Henrietta
H
Nicholls
Peter
P
Lawrenson
Ross
R
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D044363:Contraception, Postcoital; D003271:Contraceptive Agents, Female / Q000009:adverse effects / Q000627:therapeutic use*; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D019992:Databases as Topic; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006801:Humans; D016347:Medical Records Systems, Computerized; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D045167:Progesterone Congeners / Q000627:therapeutic use; D006113:United Kingdom; D016387:Women's Health; D055815:Young Adult
D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D045167:Progesterone Congeners; D017258:Medroxyprogesterone Acetate