Who should avoid combined hormonal contraceptives according to contraindications?

Combined hormonal contraceptives (CHCs) are generally safe for many women; however, certain contraindications must be taken into account to ensure both efficacy and safety. Women who have a history of smoking and hypertension should avoid combined hormonal contraceptives due to the elevated risk for serious complications, including thrombosis and cardiovascular events. The presence of hypertension, particularly if it is poorly controlled, significantly increases the risk of these complications when using estrogen-containing contraceptives.

For women younger than 30 without risk factors, combined hormonal contraceptives are typically considered safe as they do not have the same level of risk associated with older age or pre-existing health conditions that could complicate their use. Pregnant women should avoid these methods as they are designed to prevent pregnancy, creating a paradox if used during an existing pregnancy, though they do not pose a risk to the pregnancy itself. Women who are not sexually active may not need contraception at all, as the primary purpose of these methods is to prevent unintended pregnancies in sexually active individuals.

In summary, the combination of smoking and hypertension provides a clear contraindication for the use of combined hormonal contraceptives due to the associated health risks, making it critical to evaluate medical history before prescribing these forms of contraception.