Which of the following is a contraindication to estrogen-containing contraception methods?

• A. Hypertension
• B. Smokers >35 years of age and in patients with migraine with aura
• C. Breastfeeding
• D. History of deep venous thrombosis

Answer: (B)

Estrogen-containing contraception increases the risk of thrombotic and cerebrovascular events, so certain groups cannot safely use it. The strongest and most classic absolute contraindications are being over 35 and smoking, and having migraine with aura. In these situations, estrogen markedly raises the risk of heart attack, stroke, or clots, making estrogen-containing methods inappropriate. This combination of two well-established risk factors is why that option is the best answer. Other scenarios, like a history of deep venous thrombosis, are also important contraindications, but the two cardiovascular/stroke risk factors listed are the most definitive and commonly tested.