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The Pill and Smoking: Understanding the Risks

Smoking is the leading cause of preventable disease and death in the United States. Although the popularity of cigarettes has dropped in the past decade, the health risks are still very serious for those who do smoke.

Among the major health risks for smokers is cardiovascular disease. For women taking oral contraceptives, this risk can be two to four times higher.

Here’s what you need to know about the risks of stroke and heart attack for women who smoke while on "the pill."

Both Smoking and the Pill Affect Blood Flow

There are risks associated with both smoking and oral contraceptives separately, due to their effects on blood flow, but together they can be a deadly combination.

Studies have shown that blood vessels in smokers often become hard and restricted.

“Blood vessels should be soft and pliable in order to transmit blood to the brain and body. In smokers, the vessels become hard and brittle, increasing the risk for plaque formation and atherosclerotic disease. These plaques block blood flow and can cause stroke and heart attack,” said Hana Choe, MD, assistant director of Neurointerventional Care at the Neuroscience Institute of Abington Hospital – Jefferson Health.

Oral contraceptives also affect blood flow as they alter hormone levels. That change in the body’s hormonal makeup thickens the blood and can cause blood clots in the legs, lungs and veins of the brain. The combination of restricted blood vessels from smoking and thicker blood from birth control increases the risk of cardiovascular issues like strokes or heart attacks.

“Taking oral contraceptives alone only minimally increases a young woman’s risk of stroke and heart disease, while smoking in addition to contraceptives can double, triple or quadruple their chances,” said Dr. Choe.

Other Factors Are at Play

Age, weight and family history are also factors in the potential of having a stroke or heart attack. “Some people are predisposed to heart disease because of genetics. The risk of stroke is increased in patients with hypertension, diabetes and smoking. Those who smoke have even more risk when combined with birth control pills,” said Dr. Choe.

The likelihood of heart disease changes with age. For younger women, the risk of having a stroke or heart attack is low, but as they get older, there is a higher chance of developing cardiovascular disease. The combination of smoking and using birth control, however, increases the risk for stroke and heart disease for women even in their 20s.

Weight can also be associated with heart disease and strokes, especially with a diagnosis of metabolic syndrome, which is an increased inflammation in the body that can cause a predisposition to cardiovascular disease.

Smokers affected by these factors put themselves at a higher risk by taking oral contraceptives, which exacerbate the strain on blood vessels in the body.

What Options Do You Have?

"Not smoking is the best choice for your overall health but if you do smoke there are birth control options available to you," said Amy M. Mackey, MD, vice chair, Department of Obstetrics & Gynecology, Abington - Jefferson Health. "Please speak with your OB/GYN provider to determine the right contraceptive method for you."

Consider with your doctor a non-hormonal method of contraception such as condoms or a copper IUD. The more effective option, however, is to quit smoking altogether.

If you have been considering quitting, but don’t know how to begin, here are four options to help you get started.

  • Make an appointment with your healthcare provider to discuss quitting.
  • Contact Anne Marie Kinsey, nurse practitioner with Abington – Jefferson Health, who provides individual counseling and medications, if needed. Most insurance plans cover this service. Call 215-481-6070.
  • Enroll in the Abington – Jefferson Health Smoking Cessation Program, 7 week session, $25. For more information or to register, call 215-481-2204.
  • Call the State of Pennsylvania’s Smoking Quitline: 1-800-QUIT-NOW

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