Objectives:To review our studies on the clinical and metabolic impact of contraceptive methods in women with insulin dependent cliabete mellitus (IDDM) and women with previousgestation al diabetes meUitus (GDM) in order to provide suggetions for the contraceptive counselling of these women.Methods:The clinical events following first insertions of copper IUDs were studied in 103 women with !DOM and in 119 non- diabetic women. Moreover we studied the effects onglycometabolic control and lipid metabolism in women with well-controlled IDDM using low-dose oral contraceptives (OCs) containing ethinylestradiol combined with norethisterone(n = 10) , levonorgestrel (n = 9) or gestodene (n = 11 ). Hemostatic and endothelial function was also studied in the women using the gestodene-containing preparation. Finally, we studiedthe impact of oral contraceptives on the insulin sensitivity in women with previous GDM.Results:The continuation rates and indications for medical removal of the IUDs were similar in the diabetic and the non-diabetic women. There was no increased pregnancy rate or increasedfrequency of pelvic inflammatory disease in the diabetic women.The glycemic control was not changed by the OCs and none of the treatment regimens were associated with changes in plasma lipids linked to increased risk of atherosclerosis. Indicationsof increased fibrin formation, which seemed to be compensated by increased fibrinolytic activity, were noted with the gestodene-containing preparation . None of the women developedmicroalbuminuria during the study. Compared to normal women, we found reduced insulin sensitivity in the women with previous GDM using the pill.Conclusion:Intrauterine devices and barrier methods can be used by diabetic women with the same reservations as in the general population. Low-dose OCs do not influence the glycemiccontrol and have no adverse impact on plasma lipids. The balance between fibrin formation and resolution was maintained during intake of the gestodene-containing pill. Our findings suggestthat combined oral contraceptives can be used in women with uncomplicated IDDM and in women with previous GDM if clinical and metabolic monitoring can be ensured