What birth control options are available for a woman of reproductive age with a history of leg abscess, who wants to stop her periods?

Birth Control Options That Stop Periods for Women with History of Leg Abscess

For a woman with a history of leg abscess seeking to stop her periods, the levonorgestrel-releasing intrauterine system (LNG-IUS/Mirena) is the optimal first-line choice, as combined hormonal contraceptives containing estrogen are contraindicated due to significantly elevated venous thromboembolism risk. 1, 2

Why Combined Oral Contraceptives Are NOT Appropriate

The history of leg abscess raises critical concern for potential venous thromboembolism (VTE) risk:

• Combined oral contraceptives (estrogen-containing pills, patches, rings) increase VTE risk three to fourfold and are absolutely contraindicated in women with history of blood clots in arms, legs, lungs, or eyes 3, 2
• If the leg abscess was associated with any thrombotic event or represents a VTE risk factor, estrogen-containing methods should be avoided entirely 3, 2

Recommended Option: Levonorgestrel Intrauterine System (LNG-IUS/Mirena)

The LNG-IUS is the ideal choice for period suppression in this clinical scenario:

Effectiveness for Stopping Periods

• Reduces menstrual blood loss by 90% from baseline during the first year of use 4
• Achieves amenorrhea (complete absence of periods) in 35% of women after 2 years 5
• Marked reduction in menstrual bleeding and irregular bleeding patterns 5
• Eliminates dysmenorrhea (menstrual pain) 4

Safety Profile

• No increased VTE risk - safe for women with thrombotic concerns 5
• Pregnancy rate of only 0.0-0.2 per 100 woman-years, making it one of the most effective contraceptive methods 4
• Provides 5 years of continuous protection 1, 6

Insertion and Timing

• Can be inserted at any time if reasonably certain the woman is not pregnant 1
• No examinations or tests required before insertion in healthy women 1
• Immediate contraceptive protection when inserted during first 5 days of menstrual bleeding 1

Important Counseling Points

• Expect irregular spotting and breakthrough bleeding during the first 2-3 months of use - this is the most common reason for discontinuation but typically resolves 5, 7
• Detailed counseling about anticipated bleeding patterns is crucial to prevent unnecessary discontinuation 7
• Does not protect against sexually transmitted infections; condom use recommended if at risk 1

Side Effects

• Progestogenic effects: headache, acne, breast tension, functional ovarian cysts 5
• These are generally mild and well-tolerated 5

Alternative Option: Etonogestrel Implant (Nexplanon)

If the LNG-IUS is declined or contraindicated, the etonogestrel implant is an excellent alternative:

• Highly effective with fewer than 1 pregnancy per 100 women in first year of typical use 1
• Can be inserted immediately during menstruation with immediate contraceptive protection 1
• Failure rate less than 0.05% 8
• Does cause amenorrhea in some women, though bleeding patterns are less predictable than with LNG-IUS 1
• No VTE risk 1

Options to AVOID

Combined Hormonal Contraceptives (Pills, Patch, Ring)

• Absolutely contraindicated if leg abscess was thrombotic in nature 2
• Increase VTE risk significantly 3, 2
• Should not be used in women over 35 who smoke 2

Depot Medroxyprogesterone Acetate (Depo-Provera)

• While it can suppress periods and has no VTE risk, it has significant bone mineral density concerns with long-term use 1
• Less preferable than LNG-IUS or implant for this indication 1

Clinical Pitfalls to Avoid

• Failing to clarify the nature of the "leg abscess" - determine if this was actually a deep vein thrombosis, superficial thrombophlebitis, or true infectious abscess, as this dramatically changes contraceptive eligibility 3, 2
• Not counseling adequately about initial irregular bleeding with LNG-IUS - this leads to premature discontinuation of an otherwise excellent method 7
• Assuming all birth control that stops periods contains estrogen - progestin-only methods are highly effective for menstrual suppression without VTE risk 5, 4