Cigarette smokers who use estrogen-containing contraceptives have a higher risk of cardiovascular disease. Are electronic cigarettes (e-cigarettes) a better choice?
E-cigarettes deliver nicotine. Nicotine’s deleterious effects on the cardiovascular system are well established, but its toxicity is lower when not combined with smoke. There have been no published studies of electronic cigarette use among people taking hormonal contraceptives. We don’t know whether or not e-cigarettes compound the cardiovascular risk of estrogen- containing contraceptives.
For people over age 35 who smoke more than 15 cigarettes per day, estrogen-containing contraceptives are contraindicated. Clinicians should encourage all smokers to quit. Although e-cigarettes may help some smokers to quit, FDA-approved smoking cessation medications (such as nicotine patch, gum, inhalers, etc.) are far safer than smoking, and have an established record in helping people quit cigarettes.
Resources
Medical Eligibility Chart
Sources
About Electronic Cigarettes (E-Cigarettes). Centers for Disease Control and Prevention website. Updated 29 Nov 2018. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html.
Benowitz NL, Burbank AD. Cardiovascular toxicity of nicotine: Implications for electronic cigarette use. Trends Cardiovasc Med. 2016 Aug;26(6):515-23. doi: 10.1016/j.tcm.2016.03.001. Epub 2016 Mar 10.
Benowitz NL, Fraiman JB. Cardiovascular effects of electronic cigarettes. Nat Rev Cardiol. 2017 Aug;14(8):447-456. doi: 10.1038/nrcardio.2017.36. Epub 2017 Mar 23.
Benowitz NL, Pipe A, West R, et al. Cardiovascular safety of varenicline, bupropion, and nictonine patch in smokers: A randomized clinical trial. JAMA Intern Med. 2018;178(5):622-631. doi: 10.1001/jamainternmed.2018.0397.
Callahan-Lyon P. Electronic cigarettes: human health effects. Tob Control. 2014 May;23 Suppl 2:ii36-40. doi: 10.1136/tobaccocontrol-2013-051470.
Ford CL, Zlabek JA. Nicotine replacement therapy and cardiovascular disease. Mayo Clinic Proceedings. 2005 May;80(5):652-6. doi: 10.4065/80.5.652.
Riley HE, Berry-Bibee E, England LJ, Jamieson DJ, Marchbanks PA, Curtis KM. Hormonal contraception among electronic cigarette users and cardiovascular risk: a systematic review. Contraception. 2016 Mar;93(3):190-208. doi: 10.1016/j.contraception.2015.11.003. Epub 2015 Nov 3.
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The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.
