People with diabetes can use birth control safely. But different options may affect your blood sugar levels and insulin responses. Your doctor can help you best understand what might work best for you.

Birth control isn’t off limits for those with type 1 diabetes (T1D), but various birth control options may have an impact on blood sugar levels and how insulin responds in their body.

You can discuss the different options with your healthcare team to decide what may be best for your life and how to manage your diabetes when using these products. Each has benefits and drawbacks, so doing your homework is an important part of knowing your options before discussing them with your doctor.

A vaginal ring is a flexible device that is inserted into the vagina for 3 weeks before menstruation occurs.

To work effectively, a new ring must be inserted within 7 days of the prior ring’s removal.

If menstruation lasts longer than 5 days, a new ring can still be inserted, but if you wait more than 5 days to insert a new ring, you will need to use a backup form of birth control as the ring will take up to another 7 days to help prevent pregnancy once inserted.

Pros

  • does not require a healthcare professional for placement or removal
  • potential for periods to become lighter, more regular, and less painful
  • can help with premenstrual symptoms
  • does not interrupt sex

Cons

  • can cause spotting or bleeding during the first few months of use
  • can cause temporary side effects, like increased vaginal discharge and mood changes
  • does not protect against sexually transmitted infections (STIs)
  • is not as long-lasting as other options
  • reversible but may take several months for fertility to return to normal after use

Any special T1D blood sugar or complications concerns?

The hormones in vaginal rings that prevent pregnancy are absorbed directly into the vagina and do not require the body to metabolize the medication.

Without the need to digest the medication, vaginal rings often have little to no impact on blood sugar management.

However, research does indicate that unmanaged diabetes with higher blood sugars may lead to complications by using a vaginal ring.

The makers of NuvaRing, one of the leading creators of vaginal rings, have also advised people who’ve experienced diabetes-related kidney, eye, nerve, or blood vessel damage not touse vaginal rings.

Researchers are still evaluating whether certain diabetes medications, including GLP-1s, may interfere with vaginal rings and make this birth control option less effective.

How much do vaginal rings cost?

Vaginal rings must be prescribed by a healthcare professional, but the user is responsible for placing and removing them.

Vaginal rings vary in price depending on whether you have insurance and which type of plan; they can cost anywhere from $0 to $200.

One NuvaRing can cost between $0 to $200 and lasts up to 4 weeks, while the Annovera ring lasts for 1 year but costs anywhere from $0 to $2,200.

The pill is one of the most widely used forms of birth control and requires users to consistently take a small pill to prevent pregnancy. There are two main types of contraceptive pills:

  1. Combined estrogen-progesterone pill: These are more common and provide good control of a person’s bleeding pattern, especially for people who experience less irregular bleeding. They can also reduce bleeding and help some with menstrual pain. Combination pills are generally effective at preventing pregnancy, but they must be taken every day at the same time. Experts report that 9% of people will become pregnant while using the pill.
  2. Progesterone-only pill: Although less common, it may be more beneficial for certain groups and lifestyles, including such as those who breastfeed, experience heavy periods, have a history of blood clots, or cannot tolerate the estrogen hormone.

Pro

  • can reduce the amount of menstrual bleeding and pain
  • can improve acne
  • non-invasive procedure
  • can be inexpensive

Cons

  • must be taken every day at the same time to be effective
  • potential to increase insulin resistance, thus increasing a person’s insulin intake needs
  • increased risk of worsening kidney disease (nephropathy), eye disease (retinopathy), and nerve damage (neuropathy)
  • can cause irregular bleeding
  • does not protect against STDs
  • may not work properly if you’re vomiting, which means you may need to use an additional form of contraception, like a condom, until your next period
  • may negatively impact people with depression, anxiety, or other mental health issues, as the hormones in birth control can also impact the balance of a person’s brain chemicals

Do birth control pills affect your diabetes?

Birth control pills can produce a variety of results for people with diabetes.

Research shows some people with diabetes experience no side effects, while others may experience increased insulin resistance and other issues, such as headaches and nausea.

Generally, the pill may increase insulin resistance because of the estrogen used in the pill. Birth control pills that use synthetic estrogen and norgestimate (a type of progestin hormone) are often recommended for people with diabetes.

Combination birth control pills that use synthetic estrogen and norgestimate are recommended for people with diabetes due to their decreased likelihood of impacting a person’s blood sugar.

Make sure to consult your doctor about how any birth control, including the pill, may impact your diabetes care and blood sugar management.

What does the pill cost?

In comparison with some of the other birth control options, the Pill can be easy to get, but you will need a prescription.

Prices depend on your insurance and which brand you select. In most cases, one pill pack lasts for 1 month and can cost $0 to $50. With most health insurance plans the Pill is free, and in most states, you can get the Pill prescribed and mailed to you using Planned Parenthood’s Direct app.

Additionally, since the pill requires a prescription, you may need to pay for an appointment with a doctor or nurse. Visits can range from $35 to $250, but most insurance plans through the Affordable Protection and Care Act (ACA) have been required to cover visits that are related to family planning.

Intrauterine contraception, or IUDs, use a small T-shaped device made of flexible plastic with a nylon string attached to the end that is placed inside your uterus.

To have an IUD placed, you must undergo a 15-minute minor procedure in which a healthcare professional inserts the device.

There are two types of IUDs:

  • Copper: This IUD is wrapped in copper wire and can work for up to 10 years.
  • Hormonal: This IUD type slowly releases small amounts of the hormone progestin to stop sperm from reaching the egg. Similar to hormonal birth control pills, hormonal IUDs can also prevent the ovary from releasing an egg (ovulation). The hormones also thicken the cervical mucus to prevent sperm from swimming to the egg and thin the uterine lining to stop a fertilized egg from implanting.

IUDs can be used by people who have not had children and are reversible; once they’re taken out, fertility returns to normal. Depending on which type you use, they can last from 3 to 10 years.

Pros

  • highly effective at preventing pregnancy, at more than 99 percent success
  • “set and place” method, meaning you don’t have to remember to take medication, such as with the Pill
  • reversible; once removed fertility returns to normal
  • can be used by both people who have had children and people who haven’t
  • long-term form of contraception (at least 3 years or more, depending on which device you choose)
  • after the upfront cost for the initial procedure, can save you money otherwise spent on monthly medication refills
  • may stop periods, as reported by 21 percent of users in a 2016 study after 1 year of having a hormonal IUD inserted
  • convenient and private, only you will know you have it; in some cases, possibility of your partner feeling the nylon strings that are attached to the end of the device; if so, call your doctor to arrange for the strings to be cut if bothersome

Cons

  • needs to be placed by a healthcare professional
  • quick procedure but can be painful
  • expensive upfront cost, depending on how much your insurance covers
  • copper IUDs can potentially increase the amount of vaginal bleeding
  • potential increased risk for irregular bleeding at first with use of hormonal IUDS
  • potentially small risk of pelvic infection around the time of insertion for people with uteruses
  • although very uncommon, the possibility of the IUD being incorrectly placed or be pushed out by your uterus; according to the American College of Obstetricians and Gynecologists, just 1.4 out of 1,000 times (or 0.14 percent) for hormonal IUDS being misplaced and 1.1 out of 1,000 (0.11 percent) for copper IUDs being misplaced
  • does not protect against STDs

Any special T1D concerns?

Both hormonal and copper IUDs do not affect blood sugar levels, which can make them an ideal solution for people with T1D.

Hormonal IUDs can reduce or stop menstrual bleeding. This may help those who experience blood sugar fluctuation while on their period. IUDs may be a better contraception option for people who have diabetes complications, specifically those that affect their eyes or kidneys.

What do IUDs cost?

According to Planned Parenthood, IUDs can cost anywhere between $0 to $1,300 depending on your insurance and what kind you choose. The price includes necessary medical exams preoperative and postoperative and IUD insertion. IUDs are often free or low cost with private insurance plans, Medicaid, and some other government programs.

To use an IUD, you must have it placed by a healthcare professional. If you decide an IUD is right for you, talk with your OB-GYN or another trusted doctor about making an appointment to have it placed.

The Nexplanon implantable is a very small rod that is placed underneath the skin of a person’s upper arm and releases hormones that prevent you from getting pregnant.

A gynecologist or other healthcare professional implants and removes the rod, which can last up to 5 years once inserted.

During the procedure, the healthcare professional will give you a shot to numb the area of your upper arm and then use a special inserter tool to place the implant under your skin. The insertion only takes a few minutes, and patients report they only experience a small pinch or stinging sensation.

Your healthcare team can advise you on whether this is a good option for you, and they may perform a physical exam.

Pros

  • very effective at preventing pregnancy, 99 percent
  • long-lasting form of contraceptive (up to 5 years of protection)
  • discrete, only you will know you have it
  • can lighten periods or stop menstruation altogether
  • reversible; once removed, your fertility should return to normal

Cons

  • can cause irregular bleeding
  • may have expensive upfront costs to implant
  • does not protect against STIs

Any special T1D concerns?

Implants are generally considered safe for people with T1D, but as with all things, their effects can vary from person to person.

According to older research, the majority of people who received this implant did not see any change in their A1C, BMI, or insulin resistance.

The implant can be a great option for people with T1D, but it is important to always monitor your blood sugar and ensure that you are not facing any adverse side effects after implantation.

How much does this cost?

Under most commercial insurance plans, Nexplanon is either free or low cost.

Without insurance, the insertion can cost up to $13,000, and the removal expense can be up to $300.

Although the implant may have a high initial cost, it may save you money in the long term because you’ll no longer be paying for monthly birth control prescriptions.

Be sure to talk with your insurance company and healthcare team to understand how much this will cost you.

Hormone injection, also known as the Depo-Provera shot, is an injection you receive every 3 months.

The shot prevents pregnancy by injecting the hormone progestin, which prevents ovulation.

Additionally, progestin prevents eggs from easily moving through the fallopian tube and also makes the cervical mucus thicker, thus preventing sperm from traveling through the uterus.

Pros

  • highly effective at preventing pregnancy
  • longer-term protection than other options; requires 4 shots per year to prevent pregnancy, no medications or other devices needed in between dosages, which can make it an easier option to use
  • convenient and private, only you will know you have it
  • can help protect you from uterine cancer and ectopic pregnancy
  • reversible; once you stop taking the shot, your fertility should return to normal within roughly a year
  • can reduce menstruation bleeding and pain
  • menstruation may stop after one year of using the shot

Cons

  • does not protect against STDs
  • need to get a shot every 3 months
  • must be administered by a healthcare professional (in some cases, you can take the shot home, but this varies by healthcare professional)
  • potential to cause negative side effects (typically only for the first 2–3 months as your body adjusts to the hormones), like irregular bleeding, nausea, headaches, weight gain, sore breasts, or depression
  • can take 9 to 10 months after stopping the shot to become pregnant; pregnancy protection typically wears off after 15 weeks of the last shot, but some people have reported that their fertility did not return to normal until 10 months after their last shot

Any special T1D concerns?

Due to the hormones used in the shot, you face a higher risk of weight gain, which may result in higher insulin resistance.

People with diabetes who use hormone injections for birth control may experience a slight increase in blood sugar levels, which could lead to higher insulin needs.

Your care team may decide to give you a slightly lower dose than others due to your diabetes and will ask you to closely monitor your blood sugar levels following your initial shot.

How much does it cost?

The shot must be administered by a healthcare professional every 12 to 13 weeks, or every 3 months. Some doctors may allow you to do the shot at home, but this varies among healthcare providers. If you’re unable to take the shots at home, you must make regular appointments to ensure you have effective, continual birth control.

Cost depends greatly on your health insurance plan. Some doctors require you to have an exam to ensure you are a good candidate for this option, which can cost up to $250. Every subsequent visit and shot can then cost up to $150.

The morning-after pill is an emergency contraceptive that can work up to 5 days after having sex; emergency contraceptive is meant to be used if other birth control methods were forgotten or failed (such as a broken condom).

There are a couple of different pills that you can use depending on when you had sex without protective methods, your weight, whether you’re breastfeeding, and which type is easiest for you to get. The main types of morning-after pills are a levonorgestrel morning-after pill, like Plan B or My Way, and the ella pill and Plan B.

The most effective morning-after pill is called ella. It’s a prescription pill and it lowers the chance of becoming pregnant by 85% if you take it within 5 days of having sex. The sooner you take it, the more effective it will be. ella works better than Plan B for people who are 155 pounds or have more weight, but it may lose its effectiveness if you weigh more than 195 pounds.

Levonorgestrel morning-after pills must be taken within 3 days of having sex without protective methods but are more effective the sooner you take them. These pills also may not work if you are over 155 pounds. If you have more weight, you may need to use the ella pill or copper IUD as an emergency contraceptive.

Pros

  • convenient, easy to access some options at a pharmacy
  • one dose

Cons

  • can create severe swings in blood sugar levels due to the concentration of hormones
  • effective only for a limited time
  • certain medications may decrease its effectiveness
  • may not be effective if you weigh over 195 pounds

Any special T1D concerns?

While family planning, people with diabetes should plan ahead and try to use other forms of birth control rather than emergency contraceptives.

Due to the morning-after pill’s concentrated, high dosage of hormones, blood sugar swings are common and quite severe in the following days after consumption.

If you need to take emergency contraceptives, closely monitor your blood sugar and keep an eye on insulin dosing to keep yourself safe.

How much does this cost?

Some morning-after pills are available over the counter at your local pharmacy. Depending on the brand, the morning-after pill can range from $20 (from brands like Take Action or Next Choice One Dose) to $50 (Plan B). The average range for most morning-after pills is from $40 to $50.

You will need a doctor’s prescription to use the ella. Most drugstores sell it for $50.

Condoms are a barrier, typically thin and stretchy (made from latex, plastic, or animal skin), that a person wears around their penis while having sex.

Condoms work by preventing sperm from entering the uterus so that it is unable to reach an egg for fertilization.

Pros

  • effective at preventing pregnancy, 85 percent
  • most condoms protect against STDs
  • easily accessible, inexpensive, and available at most drugstores
  • can be used for additional pleasure; can have extra features, such as ribbing, that may increase pleasure during sex
  • can help prevent unplanned pregnancies while using other forms of birth control
  • no side effects

Any special T1D concerns?

Additionally, condoms are a great choice for people with diabetes as they have no effect on blood sugar. Since there is no use of hormones, the condom itself will not cause any blood sugar fluctuations or create an increase in insulin resistance.

How much do condoms cost?

Condoms are a good option for many people, as they’re available at most grocery stores, pharmacies, or even convenience stores.

They’re also relatively unexpensive, typically around $2, and require no prescription.

When selecting a birth control method, it’s important to choose an option that not only works for your lifestyle but also for your diabetes.

When it comes to contraceptives, there is no one solution that fits all. It’s important to advocate for yourself if a certain option is not working for you.

Talk with your healthcare team and monitor your blood sugar to help ensure there are no adverse side effects.