Which of the following is NOT an indication for combined oral contraceptives?

• A. Dysmenorrhea
• B. Acne
• C. Endometriosis
• D. Pregnancy

Answer: (D)

The key idea is that combined oral contraceptives have both contraceptive and non-contraceptive benefits, but they are not used to treat or indicate pregnancy. Dysmenorrhea, acne, and endometriosis are common non-contraceptive indications for COCs because the hormones suppress ovulation and stabilize the endometrium, which reduces cramps, lowers androgen-driven acne, and decreases disease activity in endometriosis. Pregnancy, on the other hand, is a state in which starting or continuing an estrogen-containing contraceptive is not indicated; COCs are contraindicated during pregnancy because there is no reproductive need to prevent pregnancy and exposure to hormones is not desired for a developing fetus. So the option that isn’t an indication for combined oral contraceptives is pregnancy.