Seasonique Use in Women with History of Leg Abscess
A history of leg abscess alone does not contraindicate Seasonique (ethinyl estradiol/levonorgestrel) use, but you must first determine if the abscess was associated with deep vein thrombosis or represents a thrombotic risk factor before prescribing this combined hormonal contraceptive.
Critical Risk Assessment Required
The key clinical question is whether the leg abscess was:
- Associated with deep vein thrombosis (DVT): If the abscess was complicated by or caused DVT, Seasonique is absolutely contraindicated 1
- An isolated superficial infection: If confirmed to be purely infectious without thrombotic involvement, combined oral contraceptives may be appropriate 1
Thrombotic History Evaluation
If there is ANY history of venous thromboembolism:
- Combined estrogen-progestin contraceptives like Seasonique carry a 36-fold increased risk of VTE compared to baseline 1
- Even with lower thrombotic risk factors, the hazard ratio remains elevated (HR 1.40,95% CI 0.90-2.19 for extended-cycle formulations) 2
- Absolute contraindication exists if DVT/PE occurred 1
Recommended Alternatives if Thrombotic Risk Present
First-line alternatives for women with thrombotic history:
- Levonorgestrel IUD: No increased VTE risk (RR 0.61,95% CI 0.24-1.53), highly effective with <1% pregnancy rate 1, 3
- Copper IUD: Equally effective, no hormonal thrombotic concerns 1, 3
- Progestin-only pill: Lower efficacy but acceptable safety profile (RR 0.90,95% CI 0.57-1.45 for VTE) 1
Avoid depot medroxyprogesterone acetate (DMPA) if any thrombotic concerns exist, as it carries similar VTE risk to combined contraceptives (RR 2.67,95% CI 1.29-5.53) 1
If No Thrombotic History Confirmed
Seasonique can be used safely in women without thrombotic complications 2, 4:
- Extended-cycle formulation (84 active pills with 20 μg ethinyl estradiol/100 μg levonorgestrel) shows comparable safety to traditional 28-day formulations 2
- Pearl index of 0.13-0.88 demonstrates excellent contraceptive efficacy 5, 6
- Lower estrogen dose may reduce thrombotic risk compared to higher-dose formulations 4
Dosing Instructions for Seasonique
Standard regimen 1:
- Take one active pill daily for 84 consecutive days
- Follow with 7 days of low-dose estrogen pills (not placebo)
- Results in 4 menstrual periods per year
- Can be taken at same time daily, with or without food
Additional Screening Considerations
Before prescribing Seasonique, evaluate for:
- Antiphospholipid antibodies if any autoimmune features present—positive aPL is an absolute contraindication to estrogen-containing contraceptives 1
- Other thrombophilic conditions (Factor V Leiden, prothrombin mutation) 1
- Smoking status, hypertension, migraine with aura—all increase thrombotic risk with combined contraceptives 1
Common pitfall: Assuming all leg infections are benign without investigating potential thrombotic complications. Always obtain imaging history and review whether anticoagulation was required during the abscess treatment.