A 23-year old woman desires a combined oral contraceptive for pregnancy protection. A factor that would lead a health professional to recommend an alternative form of contraception is that the woman:
**Core Concept**
The underlying principle in selecting a suitable contraceptive for a woman involves considering various factors such as age, medical history, and potential health risks associated with certain contraceptive methods. In this case, the health professional needs to identify a contraindication or a condition that would make a combined oral contraceptive (COC) unsuitable for the woman.
**Why the Correct Answer is Right**
A contraindication for using combined oral contraceptives is a history of venous thromboembolism (VTE). VTE includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). The risk of VTE is increased with the use of COCs due to the estrogen component, which affects blood clotting. Women with a history of VTE are at a higher risk of developing another clot while using COCs. Therefore, a health professional would recommend an alternative form of contraception to avoid exacerbating this condition.
**Why Each Wrong Option is Incorrect**
**Option A:** Smoking is a risk factor for cardiovascular disease and can increase the risk of VTE, but it is not a direct contraindication for using COCs. Women who smoke may be advised to stop smoking or use alternative forms of contraception, but smoking itself is not a reason to exclude COCs entirely.
**Option B:** A history of hypertension is a concern when using COCs, but it is not an absolute contraindication. Women with hypertension may still be prescribed COCs, especially if their blood pressure is well-controlled. However, they would require closer monitoring.
**Option C:** Breastfeeding is not a contraindication for using COCs, but it may affect the type and dose of the contraceptive used. Some COCs may contain higher doses of estrogen, which could potentially affect milk production or the baby's health. A health professional may recommend a lower-dose COC or an alternative form of contraception.
**Clinical Pearl / High-Yield Fact**
When considering a contraceptive method for a woman with a history of VTE, it's essential to remember that other options like progestin-only pills, intrauterine devices (IUDs), or barrier methods like condoms can be suitable alternatives.
**Correct Answer:** C.