The birth control pill and smoking

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,

Kudos to you for reaching out and trying to put your health before your social life. While this may not put your mind at ease, there’s no conclusive evidence that either proves or disproves that smoking cigarettes makes birth control pills, in general, less effective. However, there’s evidence that combining the two can have greater health risks than pregnancy if your birth control contains estrogen. Keep reading to learn more about how nicotine and estrogen interact.

Scientific studies have been conducted on the effectiveness of the birth control pill in people who smoke. While there’s evidence that smoking can decrease the effectiveness of hormonal birth control, it’s not conclusive and it hasn't been studied again in some time. Additionally, smoking has been shown to lower estrogen levels in the body. Other health care experts don't indicate that smoking may be a cause of reduced effectiveness. However, again, there’s no consensus on this issue. More research needs to be conducted to better understand how, to what degree, and in what timetable smoking decreases the pill's effectiveness, if it does at all.

What may be more risky are the other health effects that smoking can have when combined with birth control containing estrogen. Cigarettes, hookah, and other tobacco products contain nicotine, which causes high blood pressure and increases the heart rate. This places a strain on the blood vessels, and estrogen amplifies this effect. All of this leads to an increased chance of developing heart disease, high cholesterol, high blood pressure, blood clots, or strokes. If you have a family history of any of these conditions and health issues, are above the age of 35, or smoke more than 15 cigarettes a day, the risk is greater.

Very worried teen, since you mentioned the pill, you might want to look into the kind of pill you're taking. If it contains estrogen, it may be worth it to consider the risks of combining smoking tobacco and taking hormonal birth control pills daily. Stopping smoking can provide benefits other than just reducing the risk of interacting with birth control. You may want to check out cessation support as you consider the pros and cons of this potential interaction, as well as how smoking can affect your overall health. Smokefree.gov is a great resource for those looking to quit. If you're a student, you may also want to find out if your campus health center has any tobacco cessation support for students. Another option, if you wish to continue to smoke or find it hard to quit, would be to switch to a non-estrogen-containing birth control method. These include intrauterine devices (IUDs), the birth control implant, the birth control shot, and progestin-only pills (also called minipills). You might consider speaking with your health care provider about your concerns and your social smoking, and they can help you decide the best course of action.

Hopefully your pregnancy worries have gone up in smoke,

Last updated Aug 17, 2018
Originally published Mar 11, 2005

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