• Women less than 35 years of age and are currently smoking, or are 35 years of age or older and stopped smoking 12 or more months ago
• Methods that can be used without restriction: progestogen-only pill, progestogen-only injectables and implants, copper intrauterine devices (IUDs), the levonorgestrel-releasing intrauterine system (IUS), barrier methods, natural family planning, and sterilization.
• Methods that can generally be used (advantages generally outweigh the risks): combined oral contraceptives (COCs), combined contraceptive patch, and combined contraceptive vaginal ring.
• There are no methods that should not be used (because of unacceptable risk).
• Women 35 years of age or older who smoke less than 15 cigarettes daily, or have stopped smoking in the past 12 months
• Methods that can be used without restriction: progestogen-only pill, progestogen-only injectables and implants, copper IUDs, the levonorgestrel-releasing IUS, barrier methods, natural family planning, and sterilization.
• Methods that are not usually recommended (risks usually outweigh the advantages): COCs, combined contraceptive patch, and combined contraceptive vaginal ring.
• Women 35 years of age or older who smoke 15 or more cigarettes daily
• Methods that can be used without restriction: progestogen-only pill, progestogen-only injectables and implants, copper IUDs, the levonorgestrel-releasing IUS, barrier methods, natural family planning, and sterilization.
• Methods that should not be used (because of unacceptable risk): COCs, combined contraceptive patch, and combined contraceptive vaginal ring.

• Women who use combined oral contraceptives (COCs) and smoke are at increased risk of cardiovascular disease, especially myocardial infarction, compared with women who use COCs and do not smoke.
• The risk of myocardial infarction increases with the number of cigarettes smoked daily.
• Excess mortality from cigarette smoking is apparent from 35 years of age.
• Women who stop smoking reduce their risk of cardiovascular disease:
• After 1 year, the risk can be reduced by as much as 50%.
• It may take up to 10 years to reach the risk level of people who have never smoked.

[FFPRHC, 2006a]

• These recommendations are based on guidelines published by the Faculty of Sexual and Reproductive Health Care (FSRHC), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FSRH, 2009b].
• The guidance on the combined contraceptive vaginal ring is based on epidemiological data from combined oral contraceptives (COCs), as no specific data are currently available on the vaginal route of hormone administration. The warnings for COCs are considered applicable to the use of the combined contraceptive vaginal ring [ABPI Medicines Compendium, 2009b].