Contraception options for smokers ≥35 years of age

OB/GYN

“Cigarette smoking, increasing age, and exogenous estrogen, particularly at the supraphysiologic doses used in contraceptives, all increase risk for vascular events such as venous thromboembolism and stroke. The use of estrogen-containing contraception in smokers ≥35 years is contraindicated because of this risk.”ABFM Critique

Progestin-only contraceptives are good options for this patient.  These include:

  • Etonogestrel implant (Nexplanon);
  • Levonorgestrel-releasing IUD;
  • Depot medroxyprogesterone acetate;
  • Progestin-only oral contraceptive pills (POPs).
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