What Happens If You Smoke While on Birth Control?

person holding cigarette

Many women are concerned about how smoking and birth control interact. It’s important to know that if you smoke cigarettes, you should not use hormonal birth control methods like the combination pill, patch, or ring.

These methods can increase your risk for serious cardiovascular side effects, including heart attacks and blood clots. Instead, your clinician can recommend progestin-only birth control options.

1. Increased risk of blood clots

The hormones found in combined oral contraceptives like the pill, patch, ring and shots can increase your risk for blood clots if you smoke. Smoking restricts blood flow through the lungs and to your heart, which increases your risk for a serious and life-threatening clot called venous thromboembolism (VTE). A VTE is a clot that forms in a vein in your leg or arm, and can move to your lungs, causing a pulmonary embolism. A pulmonary embolism is usually fatal, but it can be prevented by quitting smoking.

Research shows that women who smoke while using hormonal birth control pills are seven times more likely to develop a clot than non-smokers. This is because nicotine alters how the body metabolizes estrogen, which raises your risk for blood clots. The CDC recommends that smokers over 35 avoid hormonal birth control methods like the combination pill, ring, patch or shot, because they are at higher risk for serious cardiovascular side effects.

If you must use a hormonal birth control method, ask your doctor for a prescription that contains a lower dose of estrogen. Or, you can discuss safer birth control options with your doctor that don’t involve estrogen, such as the copper intrauterine device (IUD), which can prevent pregnancy for up to 10 years. You can also consider the cervical cap, diaphragms or male and female condoms.

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2. Increased risk of stroke

Smoking cigarettes is already known to increase the risk of cardiovascular side effects like heart attack and blood clots. Combining nicotine and increased estrogen levels from birth control pills makes the combination even worse. This is because smoking triggers the body’s stress response and can cause the blood vessels to constrict, leading to a higher heart rate, high blood pressure, and an increased chance of a stroke.

In fact, women who smoke are four times more likely to die from cardiovascular disease than nonsmokers. Adding oral contraceptives to the mix only adds to the risks. According to Modern Fertility, OB-GYNs often advise smokers against using birth control that contains estrogen. If you are over 35 and smoke more than 15 cigarettes per day, it is recommended that you use a different method of birth control, as combined hormonal methods like the pill, patch, or ring carry a much higher risk of serious cardiovascular side effects for smokers.

If you have additional risk factors for blood clots (like high cholesterol, blood sugar, or blood pressure) and want to avoid pregnancy, it is possible that your clinician will still prescribe birth control with estrogen for you, though they may require you to quit smoking/vaping or use a nonhormonal method of birth control instead. Be honest with your clinician and let them know about your lifestyle and habits so they can help you find a safe and effective birth control option for you.

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3. Increased risk of heart attack

The risk of heart disease and blood clots is already high for smokers, but when you combine it with hormonal birth control, it increases the strain on your body’s blood vessels. This can lead to a heart attack or stroke, both of which are deadly. The risk of these cardiovascular conditions also increases with age and heavy smoking (15 or more cigarettes per day).

When clinicians assess whether someone can take combined oral contraceptives that contain estrogen, they make a list of all the things that could increase their chance of getting a blood clot or a heart attack. These include high blood pressure, migraines, being over 35 years of age or older, and a history of blood clots. The most common risk factor is smoking.

Women who smoke can still use non-hormonal birth control methods like the copper IUD, barrier methods, or the shot and minipill. But, it’s important that you share your smoking habits with your clinician to ensure you’re using the right method for you. If you’re over 35 and smoke, your clinician will likely only prescribe birth control that doesn’t contain estrogen if you promise to quit smoking or vaping. Otherwise, you can always consider other safe birth control methods that won’t interact with nicotine or hormones, like the progestin-only pill.

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4. Increased risk of pregnancy

Women who smoke while on birth control are at a greater risk of heart problems, strokes and blood clots. This risk increases if you have additional cardiovascular disease risk factors like high cholesterol or family history of heart disease. This makes it especially important for people who smoke to quit smoking as soon as possible if they want to use birth control. For women who can’t stop smoking, a nonhormonal birth control method may be safer for them than a hormonal pill. For example, the copper intrauterine device (IUD) and barrier methods, like male or female condoms can be a safe alternative to the pill. If you have to use the pill for birth control, a doctor might recommend that you try the progestin-only minipill which doesn’t contain any estrogen.

Many women don’t know that vaping or smoking cannabis (also known as marijuana) can also interfere with their birth control. This is because cannabis contains nicotine, which raises your risk of cardiovascular disease when used with hormonal birth control. This is why most clinicians won’t prescribe you birth control pills containing estrogen if you smoke or vape.

It is important to be honest with your clinician when discussing your smoking habits and birth control options. That way they can help you find a birth control method that’s safe and works for you. If you are younger than 35 and don’t have risk factors for blood clots, your clinician might be willing to prescribe you birth control that contains estrogen. However, if you do have risk factors for blood clots, it’s best to stick with a nonhormonal birth control method, such as the IUD or the copper pill.

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