Which group should avoid using estrogen-containing pills, rings, or patches due to a risk of serious cardiovascular events?

• A. Women over 35 who smoke
• B. Women under 18
• C. Women with a BMI over 25
• D. Women with a history of migraines with aura

Answer: (A)

Estrogen-containing contraception raises the risk of serious cardiovascular events by increasing the blood's tendency to clot. This risk climbs sharply when estrogen exposure combines with other high-risk factors, especially tobacco use in older age. Women who are over 35 and who smoke have a substantially higher baseline risk for thromboembolic events, heart attack, and stroke when using estrogen-containing pills, rings, or patches, making these methods inappropriate for that group. In younger individuals, or those without significant smoking, the relative risk is much lower, though other factors like migraines with aura can still pose a concern for stroke risk with estrogen. For this reason, the group described as over 35 and smoking is the clearest match for avoiding estrogen-containing contraception due to cardiovascular risk, and alternative methods such as progestin-only or non-hormonal options are preferred.