Contraception for Smokers Over 40

Introduction to Depo-Provera

The American College of Obstetricians and Gynecologists recommends progestin-only methods, including Depo-Provera, as the most appropriate contraceptive options for women over 40 due to their favorable safety profiles 1

Combined oral contraceptives (COC) with estrogen are contraindicated in smokers over 35, with a category 3 risk (risks generally outweigh benefits) for those smoking less than 15 cigarettes per day and a category 4 risk (unacceptable risk - absolute contraindication) for those smoking 15 or more cigarettes per day 3, 4
The reason for this contraindication is the significantly increased risk of myocardial infarction and stroke with combined estrogen and smoking 3, 4

Depo-Provera has a favorable safety profile in this population, classified as category 1 or 2 for women over 40, regardless of smoking status 1, 2
The absence of estrogen in Depo-Provera makes it safe for smokers over 35 2
Depo-Provera has an efficacy rate with a failure rate of less than 0.05%, making it one of the most effective methods available 2

The American College of Obstetricians and Gynecologists specifically recommends progestin-only methods, including Depo-Provera, for women over 40 due to their favorable safety profiles 1

The only absolute contraindications (category 4) to Depo-Provera are current breast cancer and known or suspected pregnancy 2

Depo-Provera has the advantage of no negative interaction with smoking and can reduce menstrual cramps 2
Contraception with Depo-Provera should be continued until confirmed menopause (12 months without menstruation) or until age 50-55 1