Birth Control Options for Older Smoker

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Birth Control Options for Older Smoker

Question:

I am a 43-year-old female in need of birth control. I smoke one or two cigarettes per day. What types of birth control can you suggest?

Answer:

Smoking increases the risk of heart attack and stroke in women using birth control pills. The risk is so small in younger women (under 35 years of age) that smokers may use the pill, though a wiser choice would be to stop smoking. After age 35, the risks are so high that estrogen-containing contraceptive pills, patches, and rings should not be used.

Safer forms of birth control for older smokers include barrier methods (the condom or diaphragm), intrauterine device (IUD), and sterilization by tubal ligation (for the woman) or vasectomy (for the man). Progesterone-only hormone contraceptives may be used, but are usually recommended only if other options are unacceptable. These are available as an injection or skin implant.

All birth control methods have advantages and disadvantages that you should consider when comparing options. Barrier methods are very safe. However, higher pregnancy rates due to failure and improper use are significant drawbacks for many women.

The IUD is very convenient and failures occur in only about 1% of users. However, women with more than one sexual partner are at increased risk of pelvic infection with an IUD, so it is a poor choice for them. Some women do not tolerate the copper-containing IUD because it causes cramps and heavy periods. A progesterone-containing IUD is available. It may diminish these symptoms.

Sterilization is permanent, so it is only appropriate for couples that have completed their family. Blocking the fallopian tubes is one method that has traditionally been done in the operating room using a small fiber optic telescope inserted into the women's pelvis. General anesthesia is usually required. A newer technique performed in the office uses a scope inserted into the uterus through the vagina. A coil is inserted into the tubes to close them. Local anesthesia is used.

Joan Bengtson, M.D., is assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology & Reproduction at Brigham and Women's Hospital.

Last updated:	July 20, 2009