Smoking and the pill

Q: What is the effect of smoking while you’re on the pill? I’ve heard that it’s dangerous but I don’t know why. Does smoking lessen the pill’s effectiveness?

A: Smoking is bad for you, no matter what. It actually does not interfere with the pill’s effectiveness. However, what it does do is increase the risk of cardiovascular complications – things like heart attacks and phlebitis – while you are on the pill. The increased risks are truly minimal before age 35, and start increasing significantly at that point. I will prescribe oral contraceptives for women under 35 who smoke, but encourage them to stop smoking.

I think we always need to keep the risks of smoking in mind. For example, many women are terrified of breast cancer. Yet lung cancer, which occurs almost exclusively in smokers, is the number one cancer killer of American women. And let me tell you, lung cancer is a really awful way to die.

Another less lethal but also scary issue is that smokers experience significantly earlier menopause than non-smokers – by as much as two years – it’s as if cigarettes destroy your ovaries. So let’s say you want to delay having a baby. If you are smoking, you are prematurely destroying ovarian function, and you may be destroying your fertility at the same time.

So rather than worrying just about the how smoking affects the pill, focus your energy on quitting smoking in order to eliminate a range of health risks.

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