Smoking and the Pill

WebMD Feature

June 5, 2000 -- As a rebellious teenager growing up in Berkeley, Calif., Sandra Thompson (not her real name) didn't think twice about lying to her doctor about a pack-a-day smoking habit to get her hands on birth control pills. Now a doctor herself, Thompson, 30, is much more careful about mixing cigarettes and oral contraceptives. "At one point, it was a real driving force for me," she says. "I knew I had to either quit the pill or quit smoking." She quit taking the pill.

Thompson's dilemma is familiar to many female smokers. Oral contraceptives are the most popular reversible form of birth control in America, yet smokers must decide if the protection is worth the risk. The pill works by providing a steady dose of synthetic hormones that prevent ovulation. For nonsmokers, problems associated with the pill are minimal. For women who smoke, however, the dangers include potentially fatal blood clots, heart attack, and stroke -- especially for women 35 and over.

This year, as the pill celebrates its 40th birthday, smokers may finally have reason to celebrate. According to a study published in the January 1999 issue of the journal Obstetrics & Gynecology, newer low-dose versions of the pill may be safer for smokers than older versions of the contraceptive. The study looked specifically at progesterones, which have been problematic for smokers' hearts in the past. "What we found is that a lot of medical literature was based on old formulations of oral contraceptives," says Patricia Straneva, lead author of the study. "There was a need to reconsider the pill for women who smoke."

Researchers at the University of North Carolina at Chapel Hill recruited both smoking and nonsmoking oral contraceptive users for the study. The women fell into two categories: those taking the older pill formula and those on the newer version. As expected, results showed that simple stress tests taxed the hearts of smokers more than nonsmokers. More important, however, the smokers taking the older version of the pill saw the greatest heart threats, in the form of high blood pressure and blood vessel tension. Researchers concluded that new low-dose formulas appear more heart-healthy for women smokers.

However, female smokers should still be cautious before they choose to take the pill, says Mary C. Davis, PhD, an associate professor of psychology at Arizona State University who specializes in women and smoking. "Even smokers who take the low-dose pill are putting unnecessary stress on their hearts." Many doctors prescribe oral contraceptives to young women smokers because they figure it's better to be smoking and on the pill than smoking and pregnant, she says.

Ultimately, women smokers who use oral contraceptives should be honest with their doctors when they discuss what formula (if any) is right for them, Straneva says. And they should keep in mind that, in the end, "the best thing a woman smoker can do for her health is to quit smoking."

Catherine Guthrie is a freelance writer based in San Francisco. Her work has appeared in Health magazine.

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