Is It Safe To Smoke Tobacco While Taking Birth Control?

By Kendall McKenzie
Someone asked us: Can you smoke hookah while on birth control? I smoke it every now and then, but not frequently.
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Okay, so setting aside the “smoking, including hookah, is bad for you” lesson — which we all know, right? — here’s the deal with smoking tobacco and birth control:
If your method of birth control does not contain estrogen, smoking tobacco (like hookah and cigarettes) won’t increase your risk of birth control-related complications. Estrogen-free birth control methods include: IUDs (Skyla, Mirena, and ParaGard), the implant (Implanon or Nexplanon), the shot (Depo Provera), and progestin-only pills (a.k.a. mini-pills).
However, smoking while using hormonal birth control that DOES have estrogen can increase the chance of blood clots or stroke, especially if you’re over 35 or have certain health conditions (like high blood pressure or heart problems). Methods with estrogen — like most birth control pills, the ring, and the patch — are very safe for most people, but you should definitely let your doctor know about any health problems you may have and whether or not you ever smoke.
There’s not enough research to know how hookah specifically affects birth control safety, as opposed to other tobacco products, because studies typically focus on cigarettes. But, we do know that hookah tobacco (a.k.a. shisha) usually contains nicotine — the chemical in cigarettes that makes them addictive — so it has the same health risks and may have the same birth control complications as regular cigarettes. We simply can’t say for sure that smoking hookah is any safer than cigarettes when it comes to choosing a birth control method. (This goes for e-cigs too, which also contain nicotine.)
So, what should you do if you’re a smoker on birth control? For starters, be totally clear with your doctor about what you smoke and how often you smoke it. This will help them prescribe a method that’s safe for you. If you’re over 35 and you smoke at all, you should not use a method that contains estrogen. If you’re under 35 and you smoke — even occasionally — double-check with your doctor about what kind of birth control is best for you. They may say that your age and smoking habits don’t make using methods with estrogen dangerous, or they may recommend you go estrogen-free. Luckily, there are lots of birth control methods to choose from, so almost everyone can find something that works with their lifestyle.
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