Smoking while using the combined pill

The decision is shaped by age, how much you smoke, blood pressure, migraine history and other risks for clots, heart attack or stroke. Do not hide occasional smoking or vaping with nicotine during a contraceptive review.

Tobacco smoke damages blood vessels and promotes clotting. Oestrogen-containing contraception also changes clotting activity. Together, these effects can make the combined pill unsuitable, particularly for older smokers or anyone with additional vascular risk factors.

Nicotine vaping avoids smoke but is not automatically harmless for cardiovascular health. Tell the prescriber about cigarettes, shisha, heated tobacco, vaping and nicotine replacement so the assessment reflects your actual exposure.

Keep using contraception until a clinician advises how to switch; stopping without another method can leave a pregnancy risk. Progestogen-only pills, implants, injections, intrauterine methods and condoms do not contain oestrogen, although each has its own benefits and cautions.

If you want to stop smoking, ask for practical support such as a quit plan, medication review and strategies for triggers. Quitting improves health, but past smoking and other risk factors still belong in the contraceptive conversation.

Call emergency services for chest pressure or pain, sudden breathlessness, coughing blood, fainting, sudden facial droop, arm weakness, speech difficulty or sudden loss of vision. Seek urgent assessment for new one-sided calf or thigh swelling, warmth and pain.

A new migraine with aura, a marked change in usual headaches or repeatedly high blood-pressure readings also warrants prompt medical advice and a review of the pill.

Ask which part of your health history changes the recommendation, which oestrogen-free choices match your priorities, and how to change methods without a gap in protection. Bring the name of your pill and an honest account of tobacco or nicotine use.