Which of the following is a contraindication to combined oral contraceptives (COCs)?

• A. Amenorrhea not due to pregnancy
• B. Vitamin deficiency
• C. Age under 17
• D. Pregnancy

Answer: (D)

A key idea here is that any condition that makes using estrogen-containing contraception unsafe or unnecessary is a contraindication. Pregnancy is an absolute contraindication because giving hormonal pills to someone who is already pregnant offers no contraceptive benefit and could pose risks to the developing fetus. When pregnancy is present, contraception should not be started or continued.

The other scenarios don’t automatically rule out combined oral contraceptives. Amenorrhea not due to pregnancy doesn’t by itself ban COCs; many people with irregular or absent menses use COCs to regulate cycles once pregnancy is excluded and the underlying cause is considered. A vitamin deficiency isn’t a direct safety issue with COCs, so it isn’t a contraindication. Age under 17 isn’t an automatic restriction either; adolescents can use COCs with appropriate medical evaluation and choice of formulation.