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  • Title: [Choice of contraception for the diabetic woman].
    Author: Athea N, Kuttenn F.
    Journal: Journ Annu Diabetol Hotel Dieu; 1983; ():253-61. PubMed ID: 6358615.
    Abstract:
    The absolute need to limit and program pregnancies in diabetic women demands choice of an adequate contraceptive method. Combined oral contraceptives (OCs) do not seem appropriate because of their diabetogenic effects and the added vascular risks they present to already fragile women. The diabetogenic effects of combined OCs are believed to result from a reduced number and affinity of insulin receptors, augmented secretion of STH, vitamin B6 deficiency, or hepatic effects. Some progestagens have been shown to stimulate deleterious effects of estrogens on OCs. The estrogen component of OCs is associated with elevation of triglyceride levels and stimulation of very low density lipoprotein synthesis. To these vascular risks are added an augmented blood pressure which reaches hypertensive levels in 50% of cases. The effects of synthetic estrogens on coagulation factors and vessel walls have been well deomonstrated. Macrodosed progestagen pills taken in 20-day cycles appear to be an interesting alternative, but those with the most constant antigonadotropic activity are derived from nortestosterone and all have to some degree an anabolizing androgenic effect which may result in weight gain. Derivatives of 17-hydroxyprogesterone appear to be without secondary metabolic effects. Cyproterone acetate should be evaluated as a possible OC for diabetic women. Continuous-dose progestagen micropills are highly recommended for diabetic women because of their excellent metabolic tolerance. The action of this type of pills is essentially peripheral. The pill may cause menstrual irregularity, spotting, or amenorrhea, and an increased rate of ectopic pregnancy. The Pearl index is between .8-2/1009 IUDs are a possibility for diabetic women, but because of their increased vulnerability to infection, such women should be carefully screened for prior adnexial or uterine infection, the device should be inserted in completely aseptic conditions, the woman's hygiene should be impeccable, the women should be informed about sexually transmitted diseases and regular follow-up should be arranged. A diaphragm with spermicide is without side effects and is effective if use properly. After age 40, tubal ligation is an ideal method, but it should not be proposed just because a woman has diabetes. Vaginal rings, which avoid most shortcomings of OCs, will surely be of interest to diabetic patients in the future as they become commercially available. Male contraceptive methods also deserve consideration.
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