What is a contraindication for prescribing oral hormonal contraceptives?

The contraindication for prescribing oral hormonal contraceptives in a patient who is older than 35 years and has a history of smoking is rooted in the increased risk of thromboembolic events. Smoking significantly raises the risk of cardiovascular complications, particularly when combined with estrogen-based hormonal contraceptives.

In patients over 35, the combination of age and smoking leads to a substantially higher risk of conditions such as deep vein thrombosis (DVT) and pulmonary embolism (PE). This is why healthcare providers generally advise against the use of combined oral contraceptives in this demographic to ensure patient safety.

The other options listed generally do not preclude the use of oral contraceptives. For example, a history of iron deficiency anemia or dysmenorrhea does not pose a direct contraindication and may even lead to the use of hormonal contraceptives to manage symptoms. Additionally, a positive family history of ovarian cancer may raise concern about hereditary cancer syndromes, but it does not inherently contraindicate the use of hormonal birth control.