Using hormonal birth control and smoking cigarettes can both increase your risk of heart disease. Significant improvements in overall heart health typically begin to take effect 12 months after cessation.

Smoking cigarettes can damage your heart and blood vessels.

Ethinyl estradiol, a synthetic form of estrogen found in combined hormonal contraceptives, can increase blood pressure, cholesterol and fat levels, and the risk of blood clots.

Smoking cigarettes and taking certain hormonal contraceptives may further increase the risk of heart conditions, including high blood pressure, blood clots, and stroke.

That’s why healthcare professionals typically advise against using hormonal contraception containing estrogen, particularly if you use tobacco products or are over 35 years old.

According to research from 2020, third-generation oral contraceptives might increase the risk of blood clots in your arteries. This can prevent blood from reaching important organs and increase the likelihood of heart attack.

The chemicals you inhale when you smoke can damage your heart and blood vessels, making it more likely that plaque will build up in your arteries. Plaque buildup can increase the risk of heart disease, which can cause heart attack.

The most common third-generation oral contraceptives include:

  • desogestrel (Gedarel, Marvelon, Mercilon)
  • drospirenone (Eloine, Lucette, Yasmin, Yacella, Yiznell)
  • etonogestrel (NuvaRing)
  • gestodene (Femodene)
  • norelgestromin (Evra)

It’s unclear whether other hormonal contraceptives with estrogen, like the patch, the shot, and the vaginal ring, carry the same level of blood clot risk.

Hormonal contraceptives without estrogen, also known as progestin-only contraceptives, typically do not increase the risk of blood clots.

If you have high blood pressure before beginning hormonal birth control, talk with a clinician about what methods they recommend.

The shot (Depo-Provera) could increase the level of lipoproteins in your blood, increasing your risk of stroke.

There’s not as much research on products like vapes and e-cigarettes as there is on cigarettes.

Some research indicates that e-cigarettes might cause inflammation and oxidative stress, possibly in the lungs and the cardiovascular system.

However, there’s a lack of research concerning e-cigarettes and hormonal contraceptives directly.

There’s also limited research on smokeless tobacco, and it mostly comes from Sweden, where “snus,” usually placed under the upper lip, is popular.

Smokeless tobacco may be associated with an increased risk of conditions like myocardial infarction, but more research is needed.

As with vaping, there’s not a lot of research on the effects of cannabis alongside hormonal birth control.

However, the American Heart Association did release a statement in 2020 stating that if you use cannabis weekly or more frequently, you might have an increased risk of transient ischemic attack or stroke.

And, in the same statement, tentative links were made between some of the chemicals in cannabis and an increased risk of certain heart conditions, including heart attack and heart failure.

THC, one of the main psychoactive compounds in cannabis, increases heart rate and blood pressure.

It’s thought that THC affects estrogen, too, per a 2013 study. Hormonal contraceptives containing estrogen could make you more sensitive to THC, so the effects you feel when using cannabis could be amplified.

What birth control methods are safe for people who smoke?

Clinicians typically recommend progestin-only contraceptives for people who smoke.

What’s the best birth control method for people over age 35 who smoke?

People who smoke are typically advised to consider a progestin-only or nonhormonal contraceptive.

If you smoke, are over age 35, and don’t plan to become pregnant, clinicians may recommend getting an IUD or an implant for long-term pregnancy prevention.

How long do you need to wait after you quit smoking to become pregnant?

The positive effects of quitting smoking can be seen in your eggs after 3 months, so while it’s not a necessity, you may decide to wait for at least 3 months after quitting before becoming pregnant.

However, the longer you wait to become pregnant after stopping smoking, the lower the risk of smoking-related complications during pregnancy.

Hormonal contraceptives containing estrogen and smoking are both risk factors for cardiovascular disease, so it’s advisable to look for different types of birth control — particularly if you’re over 35 years old.

Alternatives include progestin-only contraceptives, like the pill or the IUD, or barrier methods, like condoms.

If you have questions about which contraceptive might be best for you, or you’re thinking of cutting down on or quitting smoking, consult with a healthcare professional for help.

Adam England lives in the United Kingdom, and his work has appeared in a number of national and international publications. When he’s not working, he’s probably listening to live music.