Use of the Levonorgestrel Intrauterine Device in Women With Type 2 Diabetes

Abstract

Women with type 2 diabetes are less likely to receive prescriptions for contraceptives despite the fact that diabetes is associated with an increased risk of maternal and fetal complications. In the largest case series to date examining use of the levonorgestrel-releasing intrauterine device (LNG-IUD) in women with type 2 diabetes, we demonstrate that the LNG-IUD is safe and effective and does not affect glycemic control in women with type 2 diabetes. In this study of 115 women under the age of 55 years with type 2 diabetes who had an LNG-IUD placed between 2007 and 2012, we found low rates of pregnancies, expulsions, and other complications in every age category and disease stratification. Thirty-nine patients had A1C data before and up to 2 years after placement, and there was no significant change in A1C (mean A1C decrease of 0.17, 95% CI -0.76 to 0.43). This study will enable evidence-based contraceptive counseling for women with type 2 diabetes.

Long‐acting contraception in adolescents and young women with type 1 and type 2 diabetes

“…Furthermore, the menstrual flow decreases over time with LNG‐IUDs 61 . The rates of LNG‐IUD expulsion and pelvic inflammatory disease reported in this series were 3.7% and 1.7%, respectively, with no cases of unintended pregnancy 44 . These data are similar to what has been reported for non‐diabetic women 67 …”

“…All Cu‐IUDs induce an inflammatory reaction secondary to the release of copper into the uterine cavity, which explains their contraceptive effect. Copper ions, prostaglandins, and macrophages reach high concentrations in intrauterine fluids and throughout the genital tract, creating a medium that is toxic to sperm and oocytes, impairing sperm motility, capacitation, and survival and reducing oocyte fertilization 39‐45 …”

“…Copper ions, prostaglandins, and macrophages reach high concentrations in intrauterine fluids and throughout the genital tract, creating a medium that is toxic to sperm and oocytes, impairing sperm motility, capacitation, and survival and reducing oocyte fertilization. [39][40][41][42][43][44][45] The most common side effects of the T-shaped Cu-IUD are heavy menstrual bleeding and dysmenorrhea, which have been reported in 5% of users and may lead to discontinuation of use. 46 These symptoms have been postulated to be secondary to the inflammatory reaction of the uterus.…”

“…Lang et al evaluated adult women with T2D using LNG-IUDs (n: 112) and showed a mild decrease in HbA1c and no effect on chronic microvascular complications or weight. 44 Rogovskaya evaluated women (N: 62) aged 18 to 45 years with T1D and without evidence of retinopathy or nephropathy who were randomized to receive LNG-IUD or TCU-380A with 12 months of follow-up. Both contraceptive methods had no significant effect on HbA1c levels or daily insulin requirements, and differences between the two groups were not reported.…”

“…61 Similarly, several other studies that have evaluated LNG-IUDs in women with T1D and T2D have shown no effect of LNG-IUDs or non-hormonal IUDs on metabolic control, total daily insulin dose, and lipid profile 42,55,56 . 44,59,[61][62][63][64][65][66] However, no study has reported an in-depth evaluation of the glycemic profile using a continuous glucose monitoring system.…”