AKT-2840

A 35-year-old woman who smokes 10 cigarettes per day presents for a consultation regarding contraception. She has previously used an intra-uterine system but had it removed before getting pregnant with her child. She is now nine months postpartum and still breastfeeding. She has no significant medical history but was recently diagnosed with biliary colic and is awaiting review for a possible cholecystectomy. Her blood pressure is normal, and her BMI is 27 kg/m2.

What is the primary factor that would discourage you from prescribing the combined oral contraceptive pill?