Adolescence

Contraception

• If an unplanned pregnancy in an adolescent girl with diabetes occurs in the setting of poor metabolic control, the risk of congenital malformations, spontaneous abortion, fetal death and macrosomia is greatly increased
• When a diabetic girl becomes sexually active she should do so with knowledge of how to avoid an unplanned pregnancy

A planned pregnancy in a person with diabetes in good metabolic control and in good health carries risks which are not substantially greater than those in the general population

The diabetes care team should be sensitive to the religious and cultural influences affecting an individual’s choice of contraceptive method

Barrier methods

• Worldwide safe sex, STD and HIV campaigns have made adolescents more aware of barrier methods, particularly condoms
• Condoms offer the greatest protection against STDs to the whole genital tract (less against herpes), and substantial protection against pregnancy
• Diaphragms, sometimes worn continuously by women, offer added protection to the condom but on their own provide less effective contraception than the condom and do not protect against vaginal infection
• Spermicidal gels probably increase the effectiveness of barrier methods

Oral contraceptives (OCs)

• In the past, OCs were thought to have an adverse effect on metabolic control and lipid profiles and increase the risks of hypertension, cardiovascular and thromboembolic diseases
• Newer OCs with a lower estrogen dose (<50 µg ethinylestradiol) and alternative progestogens (Table 8) reduce these risks but may be more expensive
• Young people with diabetes on OCs should be monitored regularly, particularly blood pressure, side effects such as headaches, mood changes, breast changes, genital infections
• Starting OCs may slightly increase insulin requirements
• If acne or hirsutism are problems, the use of an OC containing cyproterone acetate may be helpful
• Progesterone-only OCs may provide insufficient contraception for teenagers with erratic lifestyles
• In some circumstances if there is the possibility of an unwanted pregnancy it may be beneficial to advise sexually active young people about the availability of the ‘morning after’ hormone pill

Intra-uterine devices (IUDs)

• IUDs are not suitable for nulliparous girls
• IUDs provide no protection against STDs