Contraception in people who smoke tobacco or use nicotine vaping products
Tobacco smoking is a risk factor for cardiovascular disease, and increases cancer risk, including that of breast and cervical cancer. In the absence of long-term evidence, vaping with nicotine is currently considered to confer the same risks as tobacco smoking in relation to contraceptive choice.
Combined hormonal contraception is contraindicated (UKMEC 4) in individuals 35 years or older who smoke 15 or more cigarettes per day; see also Contraindications and precautions for combined hormonal contraception. Because it is not possible to determine equivalence of exposure between vaping and tobacco smoking, any nicotine vaping in a person aged 35 years or older is a contraindication to the use of combined hormonal contraception according to Australian consensus.
Use of depot medroxyprogesterone requires expert judgment or referral (UKMEC 3) in people who smoke tobacco and have additional risk factors for cardiovascular disease (eg obesity, diabetes, age older than 45 years); all other contraceptives except for combined hormonal methods are considered safe. Australian consensus indicates the same considerations apply to people who vape nicotine.
People who smoke tobacco or vape nicotine and do not have additional risk factors for cardiovascular disease can use any method of contraception, with the exception of combined hormonal contraception in those 35 years or older.