McKesson Clinical Reference Systems: Women's Health Advisor 2002.2

Birth Control Patch (Ortho Evra)

What is the birth control patch?

The birth control patch is a way to prevent pregnancy. The patch, which is put on your skin, contains forms of the 2 female hormones estrogen and progesterone. These hormones are also in birth control pills, monthly shots, and vaginal rings. The hormones are on the adhesive side of the patch. The brand name of the patch is Ortho Evra.

The patch is a weekly form of birth control. When a patch is on your skin, the hormones are absorbed through the skin. The hormones move into your bloodstream and stop ovulation (release of eggs from the ovaries). The hormones also help prevent pregnancy in 2 other ways. They cause a thickening of the mucus on the cervix and they change the lining of the uterus. The thickened mucus on the cervix makes it hard for sperm to enter the uterus. The change in the lining of the uterus helps prevent a fertilized egg from attaching to the uterus.

How is it used?

Each patch is worn on your skin for a week. Place a patch on a clean, dry, healthy area of skin on your buttock, abdomen, upper outer arm, or upper torso. Put it in an area where it will not be rubbed by tight clothing. Do not put the patch on skin that is red, irritated, or cut. Do not put it on your breasts. Also, do not apply the patch over makeup, creams, lotions, powder, or other skin products because the patch may not stick well. These products may also affect the absorption of the hormones into the skin. You can wear a patch in a different place each week to avoid irritation.

When you use birth control patches for the first time, you may start by putting a patch on your skin the first day of your menstrual period. Leave the patch on for 7 days and then take it off and replace it with a new patch every 7 days for a total of 3 weeks. On the first day of the fourth week, remove the third patch and do not wear a patch for 1 week. You should have a menstrual period at this time. After 7 days without a patch, start a new patch. Repeat this cycle every 4 weeks, regardless of when you have your menstrual periods. Apply the patch on the same day of the week each week. This is your "patch change day."

Another way to start using patches is to start a patch on the first Sunday after your menstrual period starts. You will then put a new patch on each Sunday for 3 weeks. On the fourth Sunday you will take off the third patch and not put on another patch until the next Sunday. If the first time you use a patch is the first Sunday after your menstrual period, rather than the first day of your menstrual period, you should use some other form of birth control during the first week, such as condoms, a diaphragm, or a spermicide.

If you have recently been pregnant or are breast-feeding, discuss with your health care provider the best time for you to start using the patch.

Most women can get pregnant soon after they stop using the patch unless they had irregular menstrual periods before using the patch.

What should I do if the patch falls off?

If a patch becomes loose or is off your skin, try to put it back on the same place or put a new patch on right away. If you do this within 24 hours, no backup birth control is necessary. Your patch change day will stay the same.

If a patch is loose or is off your skin for more than 24 hours, or you are not sure how long the patch has been off, start a new cycle with a new patch. In this case, your patch change day will change and you should use some form of backup birth control for the next 7 days. If you have any questions when this happens, call your health care provider for advice.

Do not use tape, bandages, or wraps to hold a patch in place. Always use only 1 patch at a time.

What are the benefits?

  • The birth control patch is 99% effective in preventing pregnancy.
  • You don't have to insert any birth control devices, and there is no interruption of sex.
  • You don't have to remember to take a pill for birth control every day.
  • You do not have to go to an office to get a shot every month.

What are the disadvantages?

Side effects you might have while you are using the patch are:

  • changes in your menstrual periods and cycle, such as spotting, irregular bleeding, or no periods at all
  • nausea or vomiting
  • swelling of your hands, ankles, or abdomen
  • breast swelling or tenderness
  • weight gain or loss
  • headaches
  • rash (caused by an allergic reaction)
  • jaundice (yellowing of the skin or whites of the eyes)
  • yeast infection of the vagina
  • contact lens problems
  • depression.

You might increase your risk of the following problems:

  • blood clots in the arteries, veins, lungs, or brain
  • heart attack
  • brain hemorrhage (stroke)
  • gallbladder disease
  • tumors in the liver or breast cancer
  • eye problems (such as double vision or blood clots).

Smoking increases the risks especially if you are 35 years or older and smoke 15 or more cigarettes a day.

The patch may not keep protecting you against pregnancy if you are taking antibiotics or medicines for seizures or fungal infections. If you weigh 198 pounds or more, the patch may not prevent pregnancy.

The patch does not protect you from getting AIDS or sexually transmitted disease.

Who should not use the birth control patch?

You should not use the patch if you have the following medical history or conditions:

  • an allergy to any hormones
  • blood clots in your legs, lungs, or eyes
  • diabetes
  • disease of the heart valves
  • gallbladder, kidney, or liver disease
  • headaches along with symptoms such as vomiting, double vision, unsteadiness, weakness, or personality changes
  • heart attack or stroke
  • high blood pressure or high cholesterol
  • breast cancer or cancer of the lining of the uterus, cervix, or vagina
  • unexplained vaginal bleeding
  • yellowing of the eyes or skin (jaundice) during pregnancy or during past use of birth control pills.

When should I call my health care provider?

Call your health care provider if:

  • You need help or advice from your provider for side effects or problems with the patch.
  • You have chest pain.
  • You have redness, swelling, or pain in your legs.
  • You have abnormal or irregular vaginal bleeding.
  • You become jaundiced (your skin looks yellow).
  • You think you might be pregnant.

Written by Anthony Angello, MD.
Published by McKesson Clinical Reference Systems.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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