Type 1 Diabetes and the IUD
Good news for diabetic reproductive-age women: using the progestin-releasing IUD (Mirena) does not adversely affect blood "sugar" levels in women with type 1 diabetes.
Contraceptive options for women with type 1 DM [diabetes mellitus] are limited because of concerns about the effect of hormones on glucose ["sugar"] metabolism and cardiovascular outcomes. However, good contraception and fertility planning is important because of the risk of fetal anomalies when glucose control is suboptimal. IUDs are an appropriate contraceptive device for diabetic women with no contraindications for use, because of excellent efficacy, minimal metabolic effects, and cost-effectiveness. According to WHO, the copper IUD falls into category 1 (no restrictions on use) for women with type 1 DM, whereas the levonorgestrel IUD falls into category 2 (benefits generally outweigh risks) because of the potential effect of levonorgestrel [the hormone in Mirena] on carbohydrate metabolism. According to the authors of the current study, data are lacking on the effect of the levonorgestrel system when compared with the copper IUD on glucose metabolism in women with type 1 DM. They conducted a randomized controlled trial to examine these effects in women with well-controlled type 1 DM and to examine continuation rates of the two devices at one year.
The study's conclusion:
"The levonorgestrel-releasing device had no adverse effect on glucose metabolism, even at the six-week observation when systemic levels of levonorgestrel would have been higher than at later observations," the authors write. "Concern about a potential adverse effect of this contraceptive on glucose control is unwarranted, and its use in women with diabetes should be liberalized. . . . The WHO [World Health Organization] Category 2 rating for use of the levonorgestrel intrauterine system by women with insulin-dependent diabetes mellitus therefore is overly cautious."
One more noteworthy finding:
In the levonorgestrel group, hemoglobin levels increased from the baseline of 12.85 g/dL to 13.09 g/dL at 12 months, whereas in the copper IUD group, they decreased from 12.67 g/dL to 12.28 g/dL at 12 months.[low hemoglobin-->anemia]
Speaking of Mirena and what it can do for your menstrual management needs, here's a little excerpt from my book:
The Mirena Intrauterine System (IUS) has a plastic, T-shaped frame that contains 52 milligrams of the progestin levonorgestrel in the vertical arm. The IUD gradually releases a very small amount of hormone every day (20 micrograms) and it can be used for five years. LevoNova is Mirena's counterpart in Scandinavian countries. Mirena has been used in Europe for more than ten years, and in December 2000, it was also finally approved for use in the United States.
Mirena is especially useful for women with heavy, prolonged, or painful menstrual periods, because it:
When it comes to menstrual management, the particular disadvantage associated with using Mirena is bleeding and spotting, sometimes heavy, mostly during the first three to six months of use.
Currently being developed is Femilis T
The advantages of this IUD for menstrual management use are that it:
The device is smaller and more flexible in order to allow for an easy insertion even in the small uteri of women who have never had children. Also, because the arms unfold immediately upon insertion of the IUD into the uterine cavity, the risk of perforation is likely to be reduced. The end result is that this model will likely have fewer troublesome side effects such as disturbed bleeding patterns, including amenorrhea, and hormonal side effects.
As with any hormone-releasing IUD in general, the main disadvantage is that, if you're interested in active period control, the hormone-releasing IUD wouldn't be your first choice.
This new type of IUD looks promising for women who suffer from heavy and painful periods, or other period-related medical problems, and who might not be able to tolerate the available IUDs.
And speaking of being unable to tolerate existing IUD brands, more from the book about frameless IUDs:
GyneFix [click on this link for a good review of some of the IUD brands available outside the U.S.]
A frameless IUD, as the name implies, is an IUD that doesn't have the rigid, or semiflexible, plastic frame seen in the framed brands. The frameless IUD currently in use is the GyneFix (and the GyneFix mini), which consists of six (four for the mini) small copper sleeves threaded on a suture strings.
Using a frameless IUD has several advantages over using the regular, framed IUD--better tolerated, less likelihood of expulsion. In addition, when it comes to the menstrual period, this type of IUD doesn't increase period bleeding and reduces cramping. When you use an inert (no copper, no hormone) IUD, like the Lippes Loop, your menstrual blood loss could be about twice (70-80 milliliters) that of a normal period due to the inert frame. With a copper IUD, like one of the copper T series, the amount of excess bleeding is less (50-60 milliliters). In contrast, GyneFix, particularly the GyneFix mini, does not increase your menstrual blood loss (compared to the period prior to IUD use). Of course, a hormone-releasing IUD like Mirena actually decreases the amount of monthly blood loss. But, because Mirena has a frame, that in itself can cause spotting and cramping compared to a frameless IUD like GyneFix.
So developing a frameless, hormone-releasing IUD would be very helpful, because it would combine the best features of GyneFix (no frame, less cramping) and Mirena (hormone-releasing, less bleeding). Enter FibroPlant.
FibroPlant consists of a small rod (about 3 centimeters long), which houses the hormone and the conventional anchoring system used for frameless IUDs. The progestin levonorgestrel is released at a rate of 14 micrograms per day, for a period of three years. A version designed to last a minimum of five years is also under development.
The advantages of this type of IUD for menstrual management are:
The main disadvantage of the frameless hormone-releasing IUD is that you won't be able to use it for active menstrual management.
The frameless hormone-releasing IUD will be particularly useful for women who have tried to use an IUD but were unable to tolerate other types of IUD in the past. It will also help women with heavy or painful periods, and those with uterine fibroids.
[Sorry, I don't know how to reproduce the book's typesetting; I just typed the text in, and I'm all typed out for now. To check the references used, do a "Search inside" at Amazon, starting on page 230.]