I am 35 years old with a 17-year history of smoking. My GYN wanted to put me on oral contraceptives for a brief time to suppress ovulatory function. I quit smoking and started using nicotine gum the day before I started taking the pills. Is the nicotine gum the equivalent of smoking when it comes to risk factors associated with taking the pill? What exactly is the causal relationship between smoking and smoking-related risks when on oral contraceptives, particularly in the 35-and-over age group?

D.F.

Smoking, in and of itself, increases the odds of high blood pressure, heart attacks and stroke. These conditions also become more common as we age. Components of oral contraceptives, in higher doses than are used today, may also increase these risks. In women under the age of 35, even if they smoke, the risks of having a blood clot, stroke or heart attack are extremely low and are outweighed by other benefits of the pill. In women over 35 who smoke, however, the risk of a serious, or even fatal, complication is too high to justify continued use of the pill.

As far as nicotine gum -- or the nicotine patch, for that matter -- is concerned, the risks do not seem to be as great as with smoking cigarettes. In properly selected women it may be appropriate to use a low-dose oral contraceptive along with nicotine gum or patches. If the woman has high blood pressure, is significantly overweight or has diabetes, however, the pill probably should not be used along with the gum or patch. This is a decision that can be made only by your own personal physician.