Pill and tobacco: risks, side effects, alternatives

According to the French Cardiology Federation, smokers, whether regular or very occasional (even one cigarette per day!), Have almost twice as much risk of undergoing cardiovascular accidents than non-smokers : +48% in men and +57% in women, these risks are all the higher in the event of excess cholesterol, diabetes, high blood pressure … but What is the risk when tobacco and associated with taking a pill in women? What contraception to choose if we smoke? Explanations from Professor Nicolas Meneveau, cardiologist in Besançon.

The risk of infarction is multiplied by 26!

Smoking includes risks inherent in women using an estro -rogestative pill (called “combined”) which is formally contraindicated in smokers. “”Smoking (whatever its consumption mode: cigarettes, cigarettes, hookahs …) When you take a contraceptive pill is dangerous because this association has an increased risk of cardiovascular complicationss,, such as: THE thrombosis, heart or cerebral accidents (stroke)“, confirms Professor Meneveau. The expert explains:”In the absence of risk factors such as diabetes, high blood pressure, the existence of cardiovascular personal history, obesity, smoking or hypercholesterolemia, serious accidents remain rare in women of child procure. On the other hand, in the presence of associated risk factors, the probability of presenting a cardiovascular event will grow very significantly. As an example, a smoking woman under estro -rogestative pill has a risk of myocardial infarction multiplied by 26“. He adds that”Even if this risk remains relatively low in absolute value, the severity of the vascular complications relating to the millions of women who receive an estro -rogestative contraception in France, constitutes a potential public health problem which should be taken into account!“”

→ To remember: Take an estrogen -rogestative pill if you are a smoker leads to an increased risk of:

“”In patients taking an estro -rogestative pill, the venous risk is multiplied by four, regardless of smoking. Each year, this risk affects 0.5 women in 1000 – a rate that increases with The so -called 3 pillse and 4^e generation. The venous risk is mainly high during the first year of the drug taking ” indicates our interlocutor. It is favored by other factors:

• age (risk is greater after 40 years),
• Personal history of vascular events,
• certain genetic factors,
• pregnancy,
• Cancers
• obesity,
• surgery,
• the post-delivery period,
• prolonged immobilization.

In this context, an isolated smoking influences relatively little on venous vascular risk, in the absence of estro-progestogen contraception.

“The tobacco and hormones association is deleterious car It induces biological changes that promote Caillots training and generate lesions of the wall of blood vessels“The estrogen dose constitutes an important part of the vascular risk inherent in the pill.”There is a linear relationship between the dose of estrogen and the vascular risk. The higher the dose of estrogen making up the estro -rogestative pill, the greater the risk of thrombotic vascular complications is important“”explains the cardiologist. The first pills strongly dosed in estrogens have succeeded mini-dosed formulations in order to reduce the risk of strokes or myocardial infarction. The nature of the progestin also impacts the risk of venous vascular complications, in particular those used in the pills of 3^e and 4^e generation.

Smokers must avoid pills containing estrogens. Here is the list of estrogen-professional pills marketed in France: Adepal, Belara, Cilest, Effiprev, Harmonet, Jasmine, Jasminelle, Meliane, Melodia, Mercilon, Minesse, Minidril, Minulet, Moneva, Optidril, Optilova, Phaeva, Seasonique, Stedir, Triafemi, Tricilet, Triela Trinordiol, Varnoline, Yaz, Zoely and their generics.

Estro -rogestative contraception is formally contraindicated for a woman over 35 years old

“”When prescribing a contraceptive, the doctor will learn, during the interrogation, the possible presence of cardiovascular risk factors. In France, we consider that an estro -rogestative contraception is formally contraindicated for a woman over 35 years old And which smokes more than 15 cigarettes per day. A woman under 35 can consider taking a combined pill if she has no other cardiovascular risk factors“, Continues Prof. Meneveau. But even if the ideal is to reduce or even stop its tobacco consumption, in case of intense smoking, it is preferable to use more suitable progestogy contraception ::

• Micro-dosed progestogen pill (without estrogens): Cerazette® (and its generics Antigone®, Clareal Ge®, Desopiop®, Diamilla®), Microval® and Slinda®.
• DIU to progestins,
• Progestin implant
• Copper diu (without hormones)
• Diaphragm or cervical cape (without hormones)

These methods do not contain estrogen and are possible regardless of the age or level of severity of smoking. Finally, vaginal patches or rings contain estrogens which, associated with tobacco, have the same effects on the venous and arterial risks as the combined pills. In any case, ask your doctor or gynecologist for advice.

Thank you to Professor Nicolas Meneveau, cardiologist in Besançon.