Smoking and birth control: what are the risks?
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What's the lowdown?
Women over the age of 35 who smoke, should not use combined hormonal birth control that contain estrogen
Smoking alongside taking the pill, patch or vaginal ring can increase the risk of heart attack and stroke
Other birth control options such as progestogen-only or non-hormonal methods do not have the same risks for smokers
Women under the age of 35 who smoke may be able to use combined hormonal birth control
Smoking risks
Nearly 12% of adults in the US, aged over 18 years, were found to smoke cigarettes in 2021. That makes around 28.3 million adult smokers in the USA1. Smoking might seem like a cool hobby or help you take the edge off after a hard day, but it comes with serious health risks such as lung cancer, and increased cardiovascular risk of heart attacks or strokes. It increases the risk of coronary heart disease by 2-4 times, stroke by 2-4 times and lung cancer by 25 times2. Smoking-related diseases affect more than 16 million adults in the USA2.Â
Smoking and birth control
While smoking is not an absolute contraindication to birth control, alongside your age smoking can affect your suitability for some birth control options. Smoking is mainly a risk factor with combined birth control (estrogen and progestin), especially if you are over the age of 353.
Combined contraceptives contain both man-made (synthetic) estrogen and progesterone. The synthetic estrogen contained in combined birth control prevents the body releasing an egg, thins the womb lining and thickens cervical mucus which prevents pregnancy.
Combined contraceptives include:
Estrogen is safe for most women, but there are some increased risks of using synthetic estrogen. These include a very small increased risk of heart attacks, high blood pressure, strokes and blood clots in the legs and lungs. Smoking also increases the risk of these conditions. Therefore, when someone smokes and uses synthetic estrogen, there is an even greater risk of blood clots, strokes and heart attacks3.Â
Birth control and smoking over 35 years old
If you are over 35 years old and smoke, you should not be prescribed combined contraceptives as birth control. The age 35 is used, as this is the age when researchers start to see excess deaths caused by smoking. So we do not want to add any additional risk by using synthetic estrogen over this age.4
Smoking and birth control under 35 years old
The risk of heart attack and stroke is not increased in women under the age of 35 who smoke. In many cases, women under 35 years old can still be prescribed combined birth control. However, your healthcare provider will still encourage you to stop smoking as it is much better for your overall health.
What contraceptive can I use if I am a smoker?
Progestin-only birth control and non-hormonal options are safe to use.
Smoking has no impact on progestin-only birth control like the:
Smoking also does not affect non-hormonal contraceptive methods like:
Light smoking and birth control
Does the amount you smoke have an impact on the use of combined contraceptives?
Light smoking still introduces nicotine and chemicals into your system, which can affect your cardiovascular system (heart and blood vessels). Your healthcare provider may consider prescribing a combined birth control method if you are smoking less than 15 cigarettes a day, but they will do this with caution, and usually only if you cannot use any other method.
The guideline absolutely prevents contraceptives containing estrogen in women over 35 years of age who smoke 15 or more cigarettes a day5.Â
Smoking on birth control
If you start smoking while on a combined birth control method, please seek medical advice and discuss switching to a different option. We would also recommend discussing tips to stop smoking with your medical provider. They can refer you to services that can offer you support in cutting down.
Cannabis and birth control
There hasn’t been a lot of research into the interaction between cannabis and birth control use. It has been found that the active ingredient in cannabis, tetrahydrocannabinol (THC), increases blood pressure and heart rate6,7. An increased blood pressure is a risk of combined contraception, so using both at the same time may cause even more problems with your blood pressure.
Still curious about the effects of weed on birth control, head on over to our article where we explore it all.
Summary
Quitting smoking can be hard but you can reap major health benefits. Being 1 year smoke-free, reduces the risk of a heart attack by 50%, and 10 years smoke-free halves the risk of dying from lung cancer. Stopping smoking does not only benefit you but also your family and friends. A smoke-free household prevents second-hand smoke inhalation and also provides a positive role model for those who look up to you8.Â
If you are a smoker and looking to start birth control, make sure to let your doctor know this as it can impact the type of birth control you can use. If you want indiviualized recommendations, we have an incredible birth control recommender that can help.
Dr Fatema Dawoodbhoy
Fatema is currently training in London as an Academic doctor, with a special interest in Obstetrics and Gynaecology. She is passionate about championing women to understand their bodies better and prioritise their health. She understands the importance of clinically accurate articles and has been writing engaging and educative medical content for 5 years.
Our medical review process
This article has been medically reviewed for factual and up to date information by a Lowdown doctor.
