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Reproductive and Sexual Health

Estrogen and progesterone are the two hormones that play the most important role in regulating a woman's reproductive cycles. These two hormones can interact with another important hormone, insulin.

This section will explore how the interaction of these hormones can affect the lives of women living with diabetes. We will also discuss how living with diabetes can influence your sexual experiences both physically and emotionally.

Menstruation | Birth Control | Sexuality and Diabetes

Having diabetes can influence some of the major events in a woman's reproductive life. Be sure to check out the sections on Pregnancy and Menopause.


Hormones control the menstrual cycle in a woman. These hormones can also affect your blood glucose. Many women notice fluctuations in blood glucose at certain times in their monthly cycle, such as an increase in blood glucose a few days prior to the beginning of their period and then a decrease once the period begins. This increase usually occurs after ovulation and before menstruation. Changes are due to two hormones, estrogen and progesterone. When these hormones are at their highest level just before your period, they affect another important hormone, insulin, which may, in turn, cause blood glucose to rise. Some women find their blood glucose rises considerably, while others do not notice a difference. In some women, blood glucose levels are lower before and during their periods. Each woman needs to discover her own pattern.

Often it is the fasting blood glucose before breakfast that tends to fluctuate the most in women with type 1 diabetes during the time just before a period begins. Adjusting your insulin often helps. When your period begins and your blood glucose levels go down, readjust your insulin back to its former level.

If you have type 2 diabetes and do not take insulin, remember regular exercise can lower blood glucose, therefore it is important to maintain physical activity during this time of the month. Besides better blood glucose levels, you will likely have more energy and have fewer unpleasant side effects from menstruation if you can be active on a regular basis.

If you notice fluctuations in your blood glucose and are not sure if these are related to your menstrual cycle, it is easy to find out. In your blood glucose record book, indicate when you start your period each month and watch for a relationship between the two.

Some women suffer more from premenstrual syndrome (PMS) than other women. It does not seem to be related to the type of diabetes you have nor is it more common in diabetes. Women commonly experience moodiness, bloating, water retention and food cravings at this time. Food cravings for carbohydrates and fats combined with a reduction in activity may contribute to fluctuations in blood glucose.

Here are a few suggestions that may help to minimize food cravings:

  • Alcohol, caffeine and chocolate may affect your mood, so omitting them from your diet may make you feel less edgy and less inclined to overindulge on high carbohydrate, high-sugar snacks.
  • Eat at regular meal times to try and avoid large swings in blood glucose and to keep you from overeating later.
  • Low fat, low carbohydrate snacks such as vegetable sticks or a cup of unbuttered popcorn may take the edge off your appetite and minimize the rise in blood glucose.

Try to maintain your regular exercise pattern as this helps to decrease blood glucose and will help you to feel better emotionally.

Birth Control

Birth control is an important issue for women with diabetes because there are greater risks for a woman with diabetes and her baby when pregnancy is unplanned.

The contraceptive options for women with diabetes are the same as for any woman and are based on individual preferences. This is a decision that should be made between you, your partner and your doctor. Talk to your partner about safer sex and how the two of you can protect each other. The regular use of condoms can prevent many sexually transmitted infections. The effectiveness of various birth control options is the same for women with or without diabetes.

There is a wide range of birth control options for women with diabetes. It is important to find the method that works best for you. Details about all of these options are offered in our Sexual Health Centre. Here is some information specific to women with diabetes.

The birth control pill is the most popular form of birth control for women, including the woman with diabetes. In the past, women with diabetes were advised to avoid taking the "pill" because of its effect on blood glucose and the risk for heart disease and stroke. These concerns were based on the doses of estrogen and progestin ( the synthetic form of progesterone) used in the "pill". In the last 20-30 years, the doses have decreased greatly, thereby decreasing the risk for these problems. However, the risk of heart disease and strokes remains high for women who also smoke.

Today the "pill" is available in different forms: combination estrogen and progestin, or progestin alone. Some women find the lower dose combination pill can affect their blood glucose. Regular blood glucose monitoring and adjustment of diabetes medication can help resolve blood glucose fluctuations. Your doctor will assess hemoglobin A1C (average blood glucose over a 2-3 month period), total cholesterol, LDL and HDL, triglyceride levels and blood pressure before and after starting the pill. If the results are elevated, an alternative method of birth control may be necessary.

Some doctors may suggest progestin-only pills to avoid the blood glucose fluctuations that may occur with combination pills. These "mini-pills" are effective but some side effects are more common such as break-through bleeding, breast pain, weight gain and irritability. Any concerns should be discussed with your doctor.

The intrauterine device (IUD) is often a preferred option for women with diabetes who are in a stable relationship where neither partner has sexual intercourse with anyone else. In the past, there was concern that IUDs might pose an increased risk for pelvic infection or trauma to the uterine wall and that women with diabetes might be particularly vulnerable to these infections. The newer generation of IUDs appears to be safe in this respect.

The diaphragm is a barrier method that is 95 percent effective in preventing pregnancy when fitted properly and used with spermicidal foam or gel. It does not affect blood glucose but there may be an increased risk for yeast infections for women who have diabetes.

The condom, used with spermicidal foam or gel, is another barrier method that does not affect blood glucose in women with diabetes. It is 85 percent effective against pregnancy when used correctly. Where there is a risk of a sexually transmitted infection, a condom should be used even if other methods of birth control are also used.

Other hormonal contraceptives, such as Norplant or Depo-Provera, are some of the options available to women with diabetes. Norplant comes in the form of a small capsule that is placed under the skin of the arm and slowly releases medication to prevent pregnancy for approximately 5 years. Depo-Provera is given by injection every 3 months. It does not contain estrogen, therefore it is a better form of contraception if you smoke. This is not a preferred method if you find it difficult to see your doctor regularly. Both implantable options may affect blood glucose, therefore regular blood glucose testing and adjustment to diabetes medications may be necessary.

Sterilization or tubal ligation is often the method of choice for the woman who has completed her family or who does not wish to conceive. Women who already have complications of diabetes, such as advanced kidney or eye complications, may want to consider this option.

Sexuality and Diabetes

Having type 1 or type 2 diabetes can affect a woman's sexual experience both physically and emotionally. A woman's level of interest as well as her sexual functioning can be affected. Physical problems related to diabetes can affect a woman's enjoyment of sex. Most of these problems can be resolved. They do not need to have a long-term impact on a woman's sexual activities. They usually resolve with improved control of blood glucose.

The effect of diabetes on women's sexual health is more subtle than the erectile difficulties sometimes experienced by men. Your sexual health is important to your overall health. Discuss these concerns with your doctor. Talking with your partner and physician is the first step towards finding a solution. Here are some of the specific issues affecting the sexual experience of a woman with diabetes.

Vaginal infections or urinary tract infections are more common in women with diabetes, especially when blood glucose is generally high. Vaginal infections, for example yeast infections, can lead to itching, unusual discharge and pain during intercourse, but they are responsive to treatment. A urinary tract infection can lead to cloudy or bloody urine, a burning sensation and/or a constant feeling that you need to urinate. This problem should be addressed immediately to decrease the chance of subsequent kidney infection. Your physician will prescribe an antibiotic. Until the urinary tract infection has cleared, it is best to avoid sexual intercourse.

High Blood Glucose
Persistently high blood glucose can affect a woman's energy level and lead to significant fatigue. This in turn may decrease interest in sex. Achieving an acceptable blood glucose level can improve mood and libido.

Reduced Vaginal Lubrication
A complication of diabetes called neuropathy (nerve damage) can reduce vaginal lubrication in some women.

A decrease or loss of vaginal lubrication can make a woman uncomfortable during sexual intercourse and limit her pleasure. A decrease in, or lack of, lubrication can occur for many other reasons such as menopause, the use of birth control pills and stress. Water-based lubricants are effective in improving dryness and sensitivity to touch. For severe dryness, a vaginal suppository can be used. Learning how to relax the muscles around the vagina using contraction and relaxation exercises, or trying different positions can help decrease pain during intercourse.

During and after menopause, topical hormonal creams or an estrogen ring, which can be inserted into the vagina, may help improve sexual desire, vaginal elasticity and lubrication.

Fear of Pregnancy
Fear of pregnancy can affect responsiveness. A reliable method of contraception can remove this fear.

Heart or Kidney Disease
Heart or kidney disease can affect energy levels and increase anxiety regarding what effect sex may have on health. The intrusion of diabetes on this aspect of a woman's life can be frustrating and upsetting for both the woman and her partner. It becomes very important to communicate these fears or concerns and discuss what works and what does not work for you.

Fear of Hypoglycemia (low blood glucose)
Women who take insulin or pills for diabetes often fear that sexual activity may lead to low blood glucose (hypoglycemia). Your body uses extra energy during sexual activity. Testing your blood glucose prior to intercourse and having some extra carbohydrate either before or just afterwards can help prevent low blood glucose from interfering with your sexual enjoyment.

Weight Issues
Type 2 diabetes is often associated with being overweight. Being overweight for some women can affect how sexually attractive they feel and reduce interest in or enjoyment of sex. This is a body image concern and not necessarily related to diabetes.


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