From the Guidelines
For a 27-year-old female smoker, a progestin-only pill (POP) is the recommended contraceptive option over Alesse. This recommendation is based on the fact that POPs do not contain estrogen, which increases the risk of blood clots, heart attacks, and strokes when combined with smoking 1. Alesse, on the other hand, contains ethinyl estradiol (an estrogen) along with levonorgestrel, making it a combined hormonal contraceptive that poses higher cardiovascular risks for smokers.
The typical POP regimen involves taking one pill daily at the same time, with a narrower window for effectiveness (3 hours for traditional POPs, 12 hours for drospirenone) compared to combined pills. POPs work primarily by thickening cervical mucus and thinning the endometrial lining, with some formulations also suppressing ovulation. Side effects may include irregular bleeding, which typically improves after several months of use.
It's essential to note that the risk of venous thromboembolism (VTE) in healthy women taking combined estrogen-progestin contraceptives is significantly higher than the baseline annual risk, and this risk is further increased in smokers 1. In contrast, progestin-only methods are widely accepted as a lower-risk option in patients for whom estrogens are contraindicated but who still need effective contraception.
The patient should be advised that POPs are highly effective when taken correctly but require consistent daily timing for maximum protection. Additionally, the patient should be informed about the potential side effects and the importance of regular follow-up visits to monitor their health and adjust the contraceptive method if necessary.
Overall, the benefits of using a POP in a 27-year-old female smoker outweigh the risks, making it the preferred contraceptive option over Alesse.
From the Research
Contraceptive Options for a 27-Year-Old Female Smoker
- The user is considering two contraceptive options: a progestin-only pill (POP) and Alesse (ethinyl estradiol and levonorgestrel).
- According to 2, progestin-only pills are a valuable option for women who prefer to take an oral hormonal contraceptive but are ineligible for, or choose not to use, combined oral contraceptives (COCs).
- 3 suggests that POPs are a recommended method for women who are at risk of coronary heart disease due to the presence of risk factors like hypertension.
Smoking and Contraceptive Use
- Smoking is a significant risk factor for cardiovascular disease, and its interaction with contraceptive use is crucial 4.
- 5 found no significant increase in cardiovascular disease risk associated with progestogen-only pill use, although the association between cardiovascular disease and established risk factors (smoking and hypertension) was confirmed.
Comparison of Progestin-Only Pill and Alesse
- Alesse, being a combined oral contraceptive, contains estrogen, which may increase the risk of cardiovascular events, especially in smokers 4, 6.
- In contrast, progestin-only pills do not contain estrogen and may be a safer option for smokers, as they do not increase the risk of cardiovascular disease 3, 5.
Key Considerations
- The user's smoking status and potential cardiovascular risks should be taken into account when selecting a contraceptive method.
- Counseling women interested in using POPs about the variable bleeding patterns associated with this method may improve compliance and acceptance 2.
- Optimal contraceptive selection requires patient and clinician discussion of the patient's tolerance for risk of pregnancy, menstrual bleeding changes, other risks, and personal values and preferences 6.