About one-quarter of American women smoke cigarettes. Can smokers safely use hormonal contraceptives?

Smokers who use estrogen-containing contraceptives (the pill, patch and vaginal ring) raise their risk for deep vein thrombosis, coronary heart disease, and stroke. This risk increases with age. Risk increases further for women with multiple cardiovascular risk factors (such as hypertension, hyperlipidemia, and diabetes mellitus).

How do we gauge this risk? The World Health Organization has sifted through the data and created guidelines on eligibility for contraception. Because women under age 35 have a low baseline risk for cardiovascular disease, they may take estrogen-containing contraceptives with a mild caution, no matter how much they smoke. Those over age 35 who smoke fewer than 15 cigarettes per day may use estrogen-containing contraceptives with a stronger caution. Women over age 35 who smoke more than 15 cigarettes a day shouldn’t take estrogen.

Women who can’t take estrogen-containing contraceptives should consider an IUD (copper or progestin), progestin implant, progestin injection, and barrier methods.

We appreciate your feedback! Please write us at pearls@reproductiveaccess.org with any questions, comments or additional resources to add to our list.

Helpful Resources

Medical Eligibility for Initiating Contraception

Sources

French DP, Gayton EL, Burton J, Thorogood M, Marteau TM. Measuring perceptions of synergistic circulatory disease risk due to smoking and the oral contraceptive pill. Risk Anal. Dec 2002;22(6):1139-1151.

Vessey M, Painter R, Yeates D. Mortality in relation to oral contraceptive use and cigarette smoking. Lancet.Jul 19 2003;362(9379):185-191.

Pharma-free

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.