Are the potential complications of birth control pills while smoking in women over 40 the same for those using nicotine replacement while on the pill?

Excellent question: Very good question. Nicotene causes increased heart rate and blood pressure which are not healthy in general. Nicotene plus estrogen is still damaging in the event of brain hippocampal ischemia. There do not, however, seem to be as many significant atheroslerotic events as with smoking and contraceptives. Try Zyban (bupropion). http://www.ncbi.nlm.nih.gov/pubmed/19442878