The birth control pill and smoking

Originally Published: March 11, 2005 - Last Updated / Reviewed On: November 5, 2007
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Dear Alice,

I've been on the pill for nearly 3 months, and although I've been a social smoker for slightly longer than that, the habit's beginning to get heavier. I need to know if smoking stops the pill from working, or if it reduces its efficiency. I want to stop smoking, but for my own ease of mind, I need to know if my smoking is putting me at risk of getting pregnant now by short-circuiting the pill.

— very worried teen

Dear very worried teen,

The answer to your question is maybe. Several health risks go along specifically with smoking while on the birth control pill. There is some evidence that smoking can decrease the effectiveness of hormonal birth control. Smoking causes a breakdown of estrogen, thus lowering the body's estrogen levels, which in turn plays a role in the effectiveness of the pill. Some smokers will experience spotting or breakthrough bleeding on the pill, more so than non-smokers. This could signal that the efficacy of the pill is lowered. More research needs to be conducted to better understand how, to what degree, and in what timetable smoking decreases the pill's effectiveness.

What we know for sure is that women who smoke and take oral contraceptives (OCs) increase their risk of heart disease. This risk is a dose-related situation — meaning, the more you smoke, the older you are, and the higher the levels of estrogen in your pill, the greater the risk. So in regards to heart disease, you need to consider the number of cigarettes you smoke per day, your age, and the type of pill you are taking.

In the meantime, talk with your gynecologist or another women's health care provider about your social smoking. Since you are taking OCs, it's important that s/he know that you smoke in order to consider which birth control pill or another contraceptive is the best option for you. If you are a student at Columbia, you can speak with a health care provider at Primary Care Medical Services (call x4-2284 or log on to Open Communicator to make an appointment).

Best of luck as you consider your options,

Alice