Women older than 40 years who smoke should not use birth control pills.Tobacco is contraindicated for any patient age 40 years or older who uses hormonal contraceptives. The combination of tobacco and hormonal contraceptives increases risk for vascular problems (e.g., deep vein thrombosis, pulmonary emboli) as well as risk for cardiovascular incident. Even light or "social" smoking doubles a female patient's risk of cardiovascular mortality.
