Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 9/18/2020
Tens of millions of women take birth control pills in the United States, making “the pill” one of the most common medications in the country.
The vast majority of these women experience few or no side effects. Some even notice benefits beyond the obvious contraceptive advantages of birth control, such as smoother, softer skin and fewer acne outbreaks.
If you’re a smoker, however, birth control pills can pose a serious risk to your health. From blood clots to heart attack and stroke, many of the potential cardiovascular side effects of birth control pills become much more common and much more severe if you smoke cigarettes. If you are over 35 and a smoker, you should not take birth control pills.
Below, we’ve listed and explained the potential side effects you could face as a cigarette smoker using birth control pills as a form of contraception. If you’re a smoker interested in using birth control as a form of contraception (or, far less likely, a birth control pill user considering taking up smoking), you’ll want to read this before you make any decisions about birth control.
Studies show that smoking cigarettes while using birth control significantly increases your risk of experiencing cardiovascular side effects. Simply put, if you smoke while you use any oral birth control pill, you have an elevated risk of experiencing a stroke, blood clot or heart attack.
All of these cardiovascular events can be deadly, meaning you have a higher risk of premature death if you smoke while you use birth control.
In a 1999 Danish study, researchers found that smoking while using a birth control medication that contains ethinyl estradiol (a common ingredient in combined birth control pills), can have a synergistic effect on your stroke and heart attack risk.
Other studies show that smoking while using birth control can significantly increase your risk of stroke.
Simply put, using birth control while smoking significantly increases your risk of having a severe cardiovascular issue far beyond normal, “unhealthy” activities like smoking on its own.
Because of this, it’s essential that you let your healthcare provider know that you’re a smoker before you start to discuss birth control options. Starting hormonal birth control without informing your healthcare provider that you’re a smoker could put you at a significant risk of damaging your health.
This is particularly important if you’re over 35 years of age. Women aged 35 and up who smoke have the highest risk of experiencing cardiovascular side effects from using birth control. If you are older than 35 and smoke, your healthcare provider will provide alternative options of non-hormonal birth control.
Regardless of your age, if you’re a smoker, let your healthcare provider know. Your health is their priority, and they’ll work with you to find a birth control option that works for you and your risk factors.
Scientific studies have conclusively shown that cigarette smoking is bad for your cardiovascular health. If you smoke, your risk of suffering a heart attack is about two to four times higher than it is for a non-smoker. Smoking is also a significant risk factor for blood clots and stroke.
All three of these medical conditions are potential side effects of common hormonal birth control medications. If you check the packaging for widely used birth control pills like Yaz® or Estrostep®, you’ll notice “stroke” and “blood clots” listed as two of the most serious potential side effects.
Cigarettes and birth control are a dangerous combination for several reasons. The biggest is the combined, synergistic effect that birth control and cigarette smoking can have on your veins and heart.
When you take birth control pills, the combination of estrogens and progestins inside each pill can have a range of effects on your body. The most obvious effect is that your body no longer releases eggs, making it more difficult for you to become pregnant.
The hormones used in combined birth control pills can also have a minor effect on the thickness of your blood. Studies tend to show that some doses of hormones in birth control pills can make your blood thicker than it normally is.
For example, a 1980 study found that women who took oral contraceptives had a higher mean hematocrit (a ratio of red blood cells in the blood to total blood volume) than women who didn’t use any form of hormonal birth control.
This means that your heart has to work harder to pump blood around your body. It also means you have a higher risk of experiencing a blood clot—a gel-like, thicker clump of blood that can cause serious health issues if it travels into your heart, brain or lungs.
On the whole, this effect is fairly minor. The increase in blood thickness from birth control pills isn’t something most women need to worry about—in fact, it’s less than the increase in blood thickness most women will experience while pregnant.
Add smoking into the equation and things become dangerous, fast. Just like birth control pills, smoking can make your blood thicker. In a 2014 study, researchers found that smokers have higher hematocrit and hemoglobin levels than non-smokers.
The difference is that while birth control pills can mildly increase your risk of stroke and other cardiovascular side effects, cigarettes are much more dangerous. Add them together and the risk of you experiencing a serious, life-threatening heart issue gets very high, very quickly.
If you smoke cigarettes and want to start using birth control, it’s important that you talk to your healthcare provider about the potential health risks first.
If you’re below 35 years of age, your healthcare provider might recommend an alternative birth control pill with a lower risk of causing cardiovascular side effects, such as a progestin-only “mini pill.”
These birth control pills don’t contain ethinyl estradiol — the active ingredient in combined birth control pills that’s associated with an increase in blood clots and stroke. Instead, they’re made up of just one progestin hormone.
If you’re above 35 years of age, or your healthcare provider believes that your cigarette smoking is likely to significantly increase your risk of experiencing side effects from hormonal birth control, they’ll likely recommend a safe, suitable alternative form of contraception.
These options include most barrier methods, such as diaphragms and cervical caps, as well as progestin-only IUDs (intrauterine devices). Many smokers aged 35 and up may safely use the Depo-Provera® injection, which only contains a progestin hormone.
It is important to have an honest conversation with your healthcare provider and discuss the risks associated with birth control methods and smoking.
Finally, if you’re a smoker, the best way to avoid side effects from birth control while protecting yourself against pregnancy is to quit smoking. Not only will quitting make birth control pills safe for you to use—it will also provide a huge range of additional benefits for your health.