Which of the following is a commonly tested contraindication for the use of combined oral contraceptives (COCs)?

The use of combined oral contraceptives (COCs) is contraindicated for women who smoke and are 35 years of age or older because smoking significantly increases the risk of cardiovascular complications associated with estrogen-containing contraceptives. The risk of thromboembolic events—such as deep vein thrombosis and pulmonary embolism—escalates in this population, leading to serious health concerns. Therefore, guidelines for prescribing COCs recommend careful assessment and often advise against their use in these individuals.

Age greater than 40, history of dysmenorrhea, and having a family history of hypertension do not carry the same level of contraindication related to COC use. Women over 40 can often safely use COCs if they are otherwise healthy and do not have additional risk factors. Dysmenorrhea is not a contraindication and could actually be treated effectively with COCs. While a family history of hypertension may indicate a need for closer monitoring, it does not automatically contraindicate the use of COCs unless the woman has developed hypertension herself or has additional risk factors.