The various contraceptive methods available today are examined here: natural methods; sterilization; intrauterine devices; oral contraceptives. The analysis of the advantages and disadvantages of each of them indicates that in the diabetic woman low dosages of estrogen-progestins are the most suitable for short-term contraception since they do not seem to influence diabetic control. Once the patient has completed her family, the choice of method for long-term contraception is intrauterine devices or sterilization.
PIP: The menstrual cycle of the diabetic woman is irregular, therefore natural methods are not very reliable. Among male contraceptive methods vasectomy has the advantage of simplicity, requiring only local anesthesia. It does not require surgical intervention in the diabetic woman, but the disadvantage is its irreversibility. There have been numerous attempts with steroids, vaccines, and chemical substances, however, there is no contraceptive yet that is effective and harmless. Once the diabetic woman has achieved the desired family size, sterilization is more often used and it is safe. Sterilization should not be performed during cesarean section, especially not during preterm delivery. The route of choice is laparoscopy or the vaginal route. IUDs are not recommended for nulliparous women because of the possibility of tubal inflammation and hence the effect on fertility. Oral contraceptives (OCs) have shown a diabetogenic effect that has not been fully confirmed. This effect is attributed to the progesterone component. The risk of cardiovascular disease increases in diabetic patients during long-term use according to some studies. A 1991 study indicated that low-dose contraceptives used for 6 months by women with gestational diabetes did not provoke changes in the glucose tolerance test and the lipid profile. Similar findings were obtained in 100 women followed up for 5 years who had been implanted subcutaneously with silicone capsules containing 16 mg of levonorgestrel. The contraceptive vaccine could solve all these metabolic problems, however, research is still at the beginning. In sum, for short-term use in nulliparous women low-dose OCs are suitable, while for the long term the IUD or female or male sterilization is recommended.