Becoming A Young Adult: Family Planning, Contraception, And Type 1 Diabetes

Starting a family may be the last thing on your mind as a young adult recently let loose into the world. You may have your hands full navigating living alone for the first time, studying for a university degree, or working your first full-time job. However, unless you’re 1000 per cent sure you don’t want children, never say never. If you’re living with type 1 diabetes, it can help to keep an understanding of family planning and contraception at the back of your mind. This is important if you want to start a family in the imminent future but especially important if you don’t.

Type 1 Diabetes And Fertility

Fertility (and infertility) is typically not something one thinks about until the time comes to try for pregnancy. Infertility is defined as the inability to conceive after 12 months of regular and unprotected sexual intercourse. ¹

If you or your partner are living with type 1 diabetes, there is a higher risk of experiencing infertility in both males and females.¹ However, many other factors can make conception challenging, even for those not living with type 1 diabetes. These factors include:¹

• Obesity.
• Stress.
• Polycystic ovarian syndrome in women.
• Low testosterone levels in men.

There are various treatments to overcome infertility, so speak to your diabetes healthcare team if you’re finding it difficult to fall pregnant. You and your partner may be referred to a specialist clinic for testing, which will help to guide the most appropriate treatments for you. Managing your blood glucose (BG) levels optimally can support your fertility by reducing your risk of diabetes-related complications. If you’re unable to conceive naturally, you may consider in-vitro fertilisation or intrauterine insemination.¹

These Fertile Grounds Are Not Ready For Parenthood

So, you’ve decided you’re not ready for children yet. Realising that changing nappies is not for you at this moment is the first step to thinking about effective contraception.

If you’re sexually active but don’t want children (now or ever), it’s a great idea to use contraception. This is especially true if you’re living with type 1 diabetes, as pregnancy and birth can come with extra risks for women. These pregnancy risks include:²

• Insulin resistance, which can impact your BG management.
• Pre-eclampsia (very high blood pressure that can damage your kidneys or liver).
• A large birth weight baby, which can cause complications during labour and delivery.

Due to pregnancy and birth with type 1 diabetes being potentially a little more complicated, ensuring that you avoid an unplanned pregnancy would be ideal. This is where contraception comes in. There are a variety of contraceptive methods available, and all have their own pros and cons. Work with your diabetes healthcare team about what type of contraception would be the best for you. There can be a few factors you might consider, such as cost, effectiveness, your personal or religious beliefs, or how good you are at remembering to take a pill every day.

Here are just a few options for birth control that you may want to research further:

• Intrauterine devices (IUD). These are inserted into a woman’s uterus by a doctor and can last for up to 10 years. IUDs are easily reversible and don’t impact your ability to have children once they’re removed. This form of contraception is highly effective and rarely has any effect on BG. Different types of IUDs can affect your menstrual bleeding in different ways, so ask your healthcare team which type suits you best.³
• Contraceptive implants. These are small implants containing the progestogen hormone that is inserted under the woman’s skin. Similar to IUDs, these implants are an effective form of contraception that can last for years (typically up to 3 years), and do not affect your fertility once removed. Contraceptive implants are also not known to affect BG levels. However, they may make your menstrual bleeding unpredictable or cause your periods to stop completely.³
• Oral contraceptive pills. There are two types of contraceptive pills – one containing both oestrogen and progesterone hormones (the combined pill) and one with progesterone only (the mini pill). Some research suggests that the combined pill may have some side effects for women living with type 1 diabetes, such as upsetting your BG management.^3,4 If you have diabetes-related complications that affect your eyes or kidneys,^3,4 or if you smoke,⁴ you may be advised to use a different form of contraception. One of the main drawbacks of the pill is that it must be taken regularly to be effective.³ If remembering to take a pill everyday is not one of your strengths, consider a different contraception method.
• Condoms. Condoms worn by the man can be a convenient form of contraception, but are not as effective as IUDs or implants. However, they do have the added advantage of helping to prevent sexually transmitted infections.³

Final Thoughts

If you’re sexually active or intend to be, talk to your diabetes healthcare team about your options for family planning and contraception. Whether or not you’re living with type 1 diabetes, being a young adult already comes with its own challenges. Finding out that you’re about to be a surprise parent doesn’t need to be one of them!

References

1. Diabetes.co.uk. Fertility and Diabetes. https://www.diabetes.co.uk/. 2022. Available at: https://www.diabetes.co.uk/pregnancy-complications/fertility-and-diabetes.html. (Accessed July 2022).
2. CDC. Type 1 Diabetes and Pregnancy. https://www.cdc.gov/. 2021. Available at: https://www.cdc.gov/diabetes/library/features/type-1-and-pregnancy.html. (Accessed July 2022).
3. NDSS. Contraceptive choices, for women with type 1 diabetes. https://www.ndss.com.au/. 2019. Available at: https://www.ndss.com.au/about-diabetes/pregnancy/type-1-diabetes/contraception/contraceptive-choices/. (Accessed July 2022).
4. Diabetes.co.uk. Contraceptive Pill and Diabetes. https://www.diabetes.co.uk/. 2022. Available at: https://www.diabetes.co.uk/diabetes-contraceptive-pill.html. (Accessed July 2022).