Birth Control Pills and Smoking after 35 - Answers to Your Questions

Imagine the situation: you came to the gynecologist for advice on protecting yourself from unplanned pregnancy. The first thing one asks is if you smoke. And this is no coincidence.

Smoking is harmful, especially to the heart and blood vessels. Scientists have found that women who smoke are five times more likely to have a heart attack and two times more likely to have a stroke. And this threat becomes even more real against the background of taking certain contraceptives.

Birth Control Pills and Smoking

'I am 37 years old. I have been taking estrogen-containing contraceptives for the last three years. Everything suits me. But the gynecologist, having learned that I started smoking, persuades me to either quit cigarettes or give up pills. The question is, why?'

Your gynecologist is right. It is better, of course, to quit smoking because smoking is a proven risk factor for cardiovascular and oncological diseases, not to mention aesthetic problems - gray skin, yellow teeth, and tobacco smell from the mouth. Moreover, smoking increases the risk of heavy menstrual bleeding. If you cannot part with a cigarette, consider a suitable method of contraception.

Contraception after 35 y.o.

Estrogen-containing drugs are generally safe for health. But the situation changes if a woman is over 35 years old and smokes. In this case, it increases the likelihood of blood clots, leading to atherosclerosis, heart attack, and stroke.

'I have been smoking since my youth. And I take birth control pills. Nothing bad happens to me! Moreover, I did not prescribe birth control pills for myself but bought them on the advice of a doctor. How many doctors can't be wrong?'

What can I say - you need to look for more competent gynecologists. For some reason, many doctors do not consider smoking a contraindication for taking estrogen-containing hormonal drugs. And they either turn a blind eye to patients' bad habits or are not interested in whether they smoke. Meanwhile, according to the WHO document, if a woman is over 35 years old and smokes more than 15 cigarettes a day, combined methods of contraception containing estrogen are contraindicated for her! These include oral contraceptives, patches, injections, and vaginal rings.

Are Condoms the only Contraceptive for Women Who Smoke?

Not necessary. For women aged 35+ who smoke, progestin oral contraceptives (mini-pill) are suitable. It would be best if you took them every day at the same time. If you are at least 3 hours late, you may need to use additional barrier contraception methods, such as a condom.

Another method of contraception is intrauterine devices, including hormonal. Some women are wary of spirals. They fear heavy menstrual bleeding, inflammation, prolapse, or ingrowth of the intrauterine system. Their fears are only partly justified. For example, metal coils create additional risks for developing iron deficiency anemia due to heavy menstrual bleeding.

Intrauterine systems of a new generation, hormonal IUD systems, are prescribed, among other things, for the relief of copious secretions during menstruation. They do not cause headaches, or high blood pressure, do not affect libido, and can be used during breastfeeding. The only thing is that there are sometimes spotting in the first months after installation. But you should not be afraid of this - the body adapts to the spiral.

'I heard that there are some hormone implants. What are they, and are they suitable for smokers?'

Hormone implants are another tool from the worry-free contraception series. They protect against unwanted pregnancy for up to 3 years and are suitable for women who smoke.

Implants are inserted under the skin of the inner surface of the shoulder (if you are right-handed, then in your left hand, if you are left-handed, then in your right). Initially, there may be side effects: weight gain, headaches, and soreness of the mammary glands. However, they usually disappear afterward.

'How to understand that the gynecologist is qualified and has prescribed a contraceptive according to all the rules?''

You are right in your reasoning - a doctor and only an obstetrician-gynecologist should select hormonal implants, intrauterine systems, and oral contraceptives! You can not buy them on the advice of a friend or a pharmacist in a pharmacy. A qualified specialist will clarify your age and number of pregnancies (childbirth, miscarriages, abortions) and ask questions about the regularity, pain, and duration of menstruation, abundant discharge, and the presence of chronic diseases, lifestyle, and bad habits. It will allow you to choose the right protection method for you and will not harm your fertility until you decide to have kids.