Diamicron Mr (Gliclazide)
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CONTRACEPTION FOR PEOPLE WITH DIABETES: DIAPHRAGM AND INTRAUTERINE DEVICE
Diaphragm
The diaphragm or Dutch cap is another barrier method used together with spermicides. For this method to be comfortable and effective the vagina has to be measured by a gynecologist so that the cap fits correctly within the vagina and over the cervix. Most women need a little practice before they can insert the cap, covered in spermicidal cream, easily and comfortably. When the diaphragm is in position it can be left there comfortably for some time. It is necessary to insert additional spermicide into the vagina if more than six hours have elapsed since the previous act of intercourse. This method protects the cervix from sperm. The failure rate is three pregnancies per 100 women per year. A similar device called the cervical cap, which is made from a mould of the woman’s cervix and fits exactly, is being studied in several countries. There is little experience of this device being used by women with diabetes, but there is no reason why it should cause particular problems for them.
Intrauterine device (IUD)
The IUD or coil is inserted into the womb and by a combination of chemical and physical effects it prevents the fertilized egg from implanting there properly. Most gynecologists prefer to give this only to women who have already had a pregnancy. The IUD has a failure rate of two pregnancies per hundred women per year. When it has been inserted by the doctor, it can be left in place and no other contraceptive measures need be taken.
There is a small risk of pelvic infection but there is no evidence that this is greater in diabetic women than in the general population. In rare cases, the infection may be so severe the women become permanently infertile. However, a few years ago, a more practical problem was noticed in diabetic users of the coil in Scotland. A large proportion became pregnant with the coil still inside the uterus. It was found that the coils removed from these women had different chemical deposits from those of non-diabetic women. These unusual chemicals had apparently made the coils ineffective. Newer coils are now available and appear to be as effective in women with diabetes as in non-diabetics.
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