Pulmonary embolism (PE) is a common and sometimes fatal disease. It is due to obstruction of a pulmonary artery or one of its branches by material (e.g., thrombus, tumor, air, or fat) that originated elsewhere in the body. Objective: To review and evaluate the potentially serious adverse effects of prolonged use of combined oral contraceptive pills in a 50-year-old woman. Case Presentation: A 50-year-old Saudi female admitted to our hospital,(King Fahad hospital Alhfuof) with an eight-day

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... y of right leg swelling associated with pain, she is not known diabetic or hypertensive. She is para8 with no history of abortion and she was using oral contraceptive pills for the past fourteen years. Diagnosis of deep Vein thrombosis was made by color duplex ultrasonography. She was started on enoxaparin sodium 70 mg twice per day and warfarin 5 mg daily. She improved and the INR was in the therapeutic range in Day 5 of admission it was 2.2; but she developed dyspnoea, chest pain and had tachycardia. CT pulmonary angiography and showed an acute pulmonary embolism in the right pulmonary artery. The patient was transferred to the intensive care unit and managed with high flow oxygen and low molecular weight heparin was continued and the warfarin dose was increased; she became well without significant sequelae and was discharged from hospital in good condition. Conclusion: This case illustrates the development of a life-threatening condition such as pulmonary embolism as a result of prolonged use of combined oral contraceptive pills in a 5o-year-old woman. Keywords: Deep Vein thrombosis; pulmonary embolism; oral contraceptive pills.