New UK guidance says alternatives to the combined contraceptive pill should be prioritised for people who vape, because there is not enough evidence to establish the risks of doing both at once.
Nicotine in vapes can speed up liver enzymes that break down many medications, reducing how well they work, according to health website detronic. These include antidepressants, blood thinners and, perhaps lesser-known, the combined contraceptive pill.
What the updated UKMEC guidance says
The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC), which is used by doctors, nurses and pharmacists across the UK, sets out who can safely use each type of contraception. Its latest edition, published by the College of Sexual and Reproductive Healthcare in December 2025, now says alternatives to the combined pill “should be prioritised” for people who vape.
The guidance states: “UKMEC does not include use of e-cigarettes as there is insufficient evidence to establish associated risks. However, given the unknown long term cardiovascular risks with e-cigarettes alternatives to CHC should be prioritised.”
CHC stands for combined hormonal contraception, which covers the combined pill, the contraceptive patch and the vaginal ring. The previous edition, last updated in 2019, said only that the risks linked to e-cigarettes were “not yet established”.
Who the guidance applies to
The guidance only applies to the combined methods, which contain oestrogen. It does not cover the progestogen-only 'mini pill', the implant, the injection or the coil.
Vaping retail experts at Ecigone have highlighted the advice ahead of World Contraception Day on Saturday, September 26. Anyone who vapes and takes this contraception should make sure to highlight it at their next pill check, as official health guidance recommends looking into alternatives.
Writing for GP magazine Pulse in January, GP Dr Toni Hazell pointed out that vaping is often not recorded on patient notes, so in practice any review of pill users who vape “may have to be opportunistic”.
Stricter warnings for smokers
The guidance is much firmer on smoking. For smokers aged 35 and over, the risks of combined contraception are judged to usually outweigh the benefits, and for those smoking 15 or more cigarettes a day it is classed as an “unacceptable health risk”.
The same higher-risk rating applies to anyone aged 35 or over who stopped smoking less than a year ago, including people who have swapped cigarettes for a vape.
Shane Margereson, owner of Ecigone, said: “Stopping the pill overnight is the one thing nobody should do off the back of this, because that’s how people end up with no protection at all. The guidance is about which option a doctor or nurse reaches for first. It isn’t a ban.”
He added: “Plenty of vapers never bring it up at a pill check because they don’t think of vaping as smoking, so it’s worth mentioning now. Going back to cigarettes would be the worst reaction of all, because the warnings on smoking and the pill are far stronger than anything said about vaping.”
The NHS says evidence shows vaping is less harmful than smoking, but that it is “not risk-free”. Around 5.5 million adults in Great Britain now vape, according to the charity Action on Smoking and Health (ASH). Anyone unsure about their contraception can speak to their GP, a practice nurse, a pharmacist or a sexual health clinic.
