From the Research
Combined oral contraceptives (COCs) can be started immediately after smoking cessation, with no waiting period required. This is based on the most recent evidence, which suggests that the risks associated with smoking and COC use decrease rapidly after smoking cessation 1. The study found that longer duration between smoking cessation and surgery was associated with lower odds of major complication or mortality, and that quitting at least 3 weeks before surgery had similar odds of death or major complication as nonsmokers. Although this study was focused on surgical patients, the principle of reduced risk after smoking cessation can be applied to COC use as well.
When considering the use of COCs after smoking cessation, it is essential to weigh the benefits and risks. The benefits of COCs include effective contraception, regulation of menstrual cycles, and reduction of menstrual cramps and other symptoms associated with menstruation. The risks, on the other hand, include an increased risk of blood clots, stroke, and heart attack, particularly in women over 35 years old who smoke. However, as mentioned earlier, these risks decrease rapidly after smoking cessation.
For former smokers who want to start COCs, standard dosing regimens apply: take one pill daily at approximately the same time, typically in 21-day active pill cycles followed by 7-day breaks (or 7 placebo pills, depending on the formulation) 2. If starting COCs for the first time after quitting smoking, begin on the first day of menstruation for immediate contraceptive protection. It is crucial to note that COCs are not suitable for all women, particularly those with a history of blood clots, stroke, or heart attack, and those who are over 35 years old and smoke.
In terms of the effectiveness of COCs, studies have shown that they are highly effective in preventing pregnancy, with a failure rate of less than 1% per year when used perfectly 3. However, typical use failure rates are higher, ranging from 4% to 7% per year.
Some studies have suggested that quitting smoking shortly before surgery may not be detrimental to postoperative outcomes, and that patients should be advised to stop smoking as early as possible 4. This principle can be applied to COC use as well, emphasizing the importance of quitting smoking before starting COCs.
Overall, the evidence suggests that COCs can be started immediately after smoking cessation, with no waiting period required. However, it is essential to weigh the benefits and risks and to consider individual factors, such as age, medical history, and smoking status, before starting COCs.