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Women over the age of 35 who smoke, should not use combined hormonal birth control that contain estrogen Smoking alongside taking the pill, patch or vaginal ring can increase the risk of heart attack and stroke Other birth control options such as progestogen-only or non-hormonal methods do not have the same risks for smokers Women under the age of 35 who smoke may be able to use combined hormonal birth control Smoking risks Nearly 12% of adults in the US, aged over 18 years, were found to smoke cigarettes in 2021