Oral contraceptives and smoking, current considerations: Recommendations of a consensus panel

In a closed meeting, members of the consensus panel evaluated the presentat ions of the scientific panel and developed a series of recommendations. The y outlined clinical imperatives related to the identification and education of patients who smoke, the physician's role in smoking cessation, and the prescription of oral contraceptives for patients who smoke. They also outli ned research objectives for the future. The most important suggestions incl ude the following: All patients should be asked about their smoking status at every visit, and all smokers should be encouraged and helped to quit. Th e decision to prescribe an oral contraceptive requires a detailed personal and family history of thrombotic disease. Measurement of lipid profile shou ld be considered, along with exercise and dietary intervention, for smokers >35 years old who use or request oral contraceptives. Patients >35 years o ld who smoke heavily (>15 cigarettes/d) should be denied the use of oral co ntraceptives. Preliminary data suggest that an oral contraceptive with the very low dose of 20 mu g ethinyl estradiol may be safer for oral contracept ive users who smoke, even for those >35 years old who have an occasional ci garette, but these laboratory findings require clinical corroboration.