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

Smoking whilst taking the birth control pill is associated with cardiovascular conditions and stroke.


An estimated 11 million women in the U.S. are using an oral contraceptive pill, making it one of the most prescribed medications in the country. The National Survey of Family Growth surveyed 12,279 women between 2006 and 2010, and found that 88% of sexually active women ages 15 to 44 had previously used a hormonal contraceptive, such as the pill, the patch or an 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 may provide other benefits, such as reducing the symptoms of premenstrual syndrome and endometriosis. The hormones contained in the birth control pill can also help control acne and regulate painful or heavy menstruation.

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Oral birth control pills are not suitable for all women, however. In particular, women who smoke are advised not to take an estrogen-containng pill. The risk of negative side effects such as blood clot formation or stroke 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 significantly 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 while smoking.
There is good evidence that smoking while taking birth control restricts blood flow to the heart, especially if you are over the age of 35. Estrogen, the active ingredient in many combined oral contraceptives, has been shown to raise the possibility of blood clot formation. Some risk exists whether you smoke or not, but ithe risk is very low in non-smokers.
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 and 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, accordig to 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. Other options include the cervical cap, diaphragms, and male and female condoms.


  1. The Johns Hopkins Manual of Gynecology and Obstetrics, 2nd Edition. (2004). Journal of Midwifery & Women's Health, 49/1: 1-1. DOI:
  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:
  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:
  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:
  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:
  7.  E-Cigarettes: The Jury Is Out. (2019). Women's Health. Retrieved October 21, 2019, from <>
  8. Methods - Copper IUD. (2019). Retrieved October 21, 2019, from

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