Understanding the Health Risks of Smoking and Birth Control

It's common knowledge that smoking poses serious health complications to your body. The Centers for Disease Control and Prevention (CDC) notes that it can lead to heart disease, stroke, cancer, diabetes and chronic obstructive pulmonary disease (COPD). It also increases your risk for tuberculosis and may cause problems of the immune system such as rheumatoid arthritis.

While birth control is commonly used around the world (49 percent of women used contraception in 2021), what many women don't know is that some forms of contraception may bring about lethal effects when combined with certain substances, such as nicotine.

Data from 2002 and 2004 surveys published in Women's Health Issues suggested that approximately 1 of 3 premenopausal women who smoke use some form of hormonal contraception, with 27 percent using oral contraceptives specifically.

More recent estimates suggest that the prevalence of hormonal contraceptive use in premenopausal smokers is even higher, 49 percent.

Many of these women may be unaware of the risks and, therefore, may not even share their smoking habits when being prescribed birth control. Continued smoking while using some form of birth control may also be attributed to disregard for the risks.

According to one study, 8 out of 10 women taking the birth control pill continue to smoke despite their doctors warning them of the associated health implications.

But what exactly are the risks and are there safer alternatives?

A lethal combination

While relatively few studies have examined the health outcomes of smoking while on birth control, the limited existing literature reveals that coupling nicotine and combination oral contraceptives make you more susceptible to cardiovascular diseases.

There is also evidence suggesting that this combination increases your body's stress response and nicotine metabolism.

Such risks are usually associated with birth control options that deliver extra estrogen. In addition to combination pills, the vaginal ring (NuvaRing) and the patch also contain estrogen.

"Nicotine combined with estrogen from birth control can create greater risks for blood clots, stroke and heart attack since it increases the stress on your blood vessels," explained Monte Swarup, M.D., a board-certified OB-GYN in Arizona and founder of HPD Rx.

Such risks may increase with age and heavy smoking (15 or more cigarettes per day). For women who are 35 years and older, the risk of heart disease, cardiovascular diseases, heart attack and stroke is elevated, Swarup said.

If you are within this age group and a smoker, you should consult your healthcare provider to discuss the best birth control options.

Birth control and vaping

Also known as e-cigarettes, vapes are increasingly popular, especially among young adults. Since they are a newer form of smoking, there hasn't been a lot of research conducted on vaping as it relates to birth control.

However, Alyssa Dweck, M.D., an OB-GYN in New York and a spokesperson for feminine care brand Intimina, noted that e-cigarettes may not be much safer than nicotine.

"Many e-cigarettes contain nicotine, which increases cardiovascular risk on the pill," Dweck said.

In the United States, the CDC found 99 percent of the e-cigarettes sold in assessed venues contained nicotine. The Food and Drug Administration states, "More research is needed to understand the potential risks and benefits these products may offer adults who use tobacco products."

It's best to avoid vaping altogether if you are taking birth control.

Birth control and marijuana

Just as in the case of vaping, studies on the risks of smoking marijuana on birth control are also few. However, cannabis consumption has been linked to cardiovascular complications such as increased heart rate and dilating blood vessels.

If you are taking hormonal contraceptives with estrogen, such risks are elevated. Therefore, marijuana may not be safe to consume if you are on birth control.

Alternatives for women who smoke

If you smoke and are looking for safe birth control options, the best option is simply to stop smoking while you are on birth control, be it nicotine, vapes or marijuana, advised Sophia Yen, M.D., co-founder and CEO of Pandia Health in California.

However, you can consult a healthcare professional on other safe options that may work for you.

"Progestin-only pills, the implant, intrauterine device [IUD] are options that can work for you if you are a smoker since they don't have the estrogen component," Yen said.

Barrier contraceptive methods such as condoms and diaphragms are also viable options for people who smoke, Dweck added.

In addition, permanent birth control options such as tubal ligation are also a great option if you have no future plans of getting pregnant.

How long after you quit smoking can you start using hormonal contraceptives?

After you quit smoking, Swarup advised that you should wait at least 12 months before you start using birth control.

"This is because after 12 months, the risk to your heart is reduced by 50 percent," Swarup explained. Other safe alternative methods can be used in that interim.

If you are a smoker who is considering your birth control options, scheduling a session with a healthcare professional is the best place to start.