What you need to know about birth control if you're a smoker

An estimated 11 million women in the U.S. are using the contraceptive pill, making it one of the most prescribed medications in the country. The National Survey of Family Growth among 12,279 women between 2006 and 2010 found that 88% of sexually active women between the ages 15 to 44 had previously used a hormonal contraceptive such as the pill, the patch or the intrauterine device.
 
The hormonal contraceptive pill is popular because it’s highly effective (around 95%) in preventing pregnancies when taken correctly; it’s relatively cost-effective and provides positive side effects such as reducing the severity of premenstrual syndrome and endometriosis. The hormones contained in the birth control pill can also help women with acne and regulate painful or heavy menstrual blood flow.
 
But the birth control pill isn’t suitable for all women. In particular, women who smoke are usually advised not to take the pill. The risk of potentially negative side effects such as blood clots and cardiovascular issues is higher for women who smoke.

The risks of smoking and taking hormonal birth control

Research shows that the use of oral hormonal contraceptives and cigarette smoking severely increases the risk of cardiovascular conditions which could lead to premature death. Smoking also increases the risk of stroke. It’s important to understand the dangers associated with taking hormonal birth control whilst smoking.
 
There is good evidence available that smoking whilst on birth control restricts blood flow to the heart, especially if you are over the age of 35. Estrogen, the hormonal active ingredient in many combined oral contraceptives, has been shown to raise the possibility of blood clots forming. That risk exists whether you smoke or not, but it is relatively low in non-smokers with just one in 3,000 women at risk of blood cots whilst on birth control.
 
An interesting study by the University of Arizona found that women with higher levels of estrogen metabolized nicotine faster. Faster nicotine metabolism is linked to more intense smoking and stronger nicotine cravings. The authors suggest that oral contraceptives may make nicotine users even more dependent.

What about e-cigarettes?

The evidence is a little murky when it comes to the effects of e-cigarettes on health whilst taking birth control. A review in 2016 found that cardiovascular events were rare in e-cigarette smokers who took the pill.
 
Other studies caution that youths experimenting with e-cigarettes are more likely to become cigarette smokers in the long-term. “E-cigarettes seem to move from experimenta­tion to regular tobacco cigarette use among these kids. Kids who use e-cigarettes are also much less likely to have stopped smoking tobacco cigarettes,” said Dr. Stanton Glantz, director at the Center for Tobacco Control Research and Education, University of Cali­fornia. Therefore, it’s too early to call e-cigarettes ‘safe’ when it comes to using oral birth control.

Contraceptive options for smokers

Not all birth control pills are equally bad for smokers. There are some hormonal contraceptives that contain very low doses of estrogen (20 micrograms per pill) and others that contain only progesterone. These are typically better options for female smokers. 

If you’re thinking about going on the pill and are currently smoking it’s best to let your doctor know and discuss your options.
 
There are plenty of other birth control options for women who smoke that do not involve hormonal methods. One of them is the copper intrauterine device (IUD). This small T-shaped copper rod is inserted into the uterus by a doctor. It is 99% effective in preventing pregnancy and lasts between 5 to 10 years. The IUD usually works right away and there are fewer side effects associated with hormones such as headaches or acne. Other options include the cervical cap, diaphragms, and male and female condoms.

References

1. The Johns Hopkins Manual of Gynecology and Obstetrics, 2nd Edition. (2004). Journal of Midwifery & Women's Health, 49/1: 1-1. DOI: https://doi.org/10.1111/j.1542-2011.2004.tb04400.x
2. Daniels, K., Mosher, W.D., and Jones, J. Contraceptive methods women have ever used: United States, 1982–2010. Vital Health Stat. 2013; 62: 1–15
3. Bearak, J., & Jones, R. (2017). Did Contraceptive Use Patterns Change after the Affordable Care Act? A Descriptive Analysis. Women's Health Issues, 27/3: 316-321. DOI: https://doi.org/10.1016/j.whi.2017.01.006
4. Bushnell, C., & McCullough, L. (2014). Stroke prevention in women: synopsis of the 2014 American Heart Association/American Stroke Association guideline. Annals of internal medicine, 160(12), 853–857. doi:https://doi.org/10.7326/M14-0762
5. Allen, A., Weinberger, A., Wetherill, R., Howe, C., & McKee, S. (2017). Oral Contraceptives and Cigarette Smoking: A Review of the Literature and Future Directions. Nicotine & Tobacco Research, 21/5: 592-601. DOI: https://doi.org/10.1093/ntr/ntx258
6. Riley, H., Berry-Bibee, E., England, L., Jamieson, D., Marchbanks, P., & Curtis, K. (2016). Hormonal contraception among electronic cigarette users and cardiovascular risk: a systematic review. Contraception, 93/3: 190-208. DOI: https://doi.org/10.1016/j.contraception.2015.11.003
7.  E-Cigarettes: The Jury Is Out. (2019). Women's Health. Retrieved October 21, 2019, from <https://mavendoctors.io/women/health-conditions/e-cigarettes-the-jury-is-out-D2QmaCmKj0mFD44tNapOrg/>
8. Methods - Copper IUD. (2019). Health.harvard.edu. Retrieved October 21, 2019, from <https://www.health.harvard.edu/birth-control/methods/type/copper-iud>