Contraceptive Patch

What is the contraceptive patch?

The contraceptive patch is a combined hormone form of contraception, containing oestrogen and progestogen hormones. It is essentially the same type of contraception as the combined oral contraceptive pill but it is used in a patch form instead of taking pills by mouth. The contraceptive patch is stuck onto the skin so that the two hormones are continuously delivered to the body. This gives contraceptive cover. See the separate leaflet on the Combined Oral Contraceptive Pill.

There is one combined contraceptive patch available in the UK called Evra®. The contraceptive patch is available from your GP, family planning clinic or sexual health clinic. You should remember that the contraceptive patch will not protect you from sexually transmitted infections. You should use condoms to protect against these.

How does the contraceptive patch work?

The contraceptive patch works mainly by changing the body's hormone balance so that you do not ovulate. That is, you do not release an egg (ovum) each month from an ovary. In addition, it causes the mucus made by the cervix to thicken and form a 'mucus plug' in the cervix. This makes it difficult for sperm to get through to the uterus (womb) to fertilise an egg. The contraceptive patch also makes the lining of the uterus thinner. This makes it unlikely that a fertilised egg will be able to attach to the uterus.

How effective is the contraceptive patch?

It is over 99% effective if used correctly. This means that less than 1 woman in 100 using the contraceptive patch correctly will become pregnant each year. Compare this to when no contraception is used: more than 80 in 100 sexually active women who do not use contraception become pregnant within one year.

What are the advantages of the contraceptive patch?

It is very effective and easy to use. It does not interfere with sex. You do not have to remember to take a pill every day but just have to remember to change the patch once a week. The patch is small and discreet so people won't easily notice that you are wearing it. It is skin coloured and is about 5cm x 5cm in size. The patch sticks well to your skin. It can be worn continuously, even while you are bathing, showering, exercising and swimming.

Your periods are often lighter, less painful, and more regular when you are using the contraceptive patch. If you have vomiting or diarrhoea, the contraceptive patch is still effective (unlike when you are taking the pill). This is because the hormones are absorbed into your bloodstream through your skin, rather than through your gastrointestinal tract (stomach and gut).

The other advantages of the contraceptive patch are thought to be similar to those of the combined contraceptive pill. However, because it is a newer form of contraception, there have not been as many research studies with the contraceptive patch as there have been with the pill. For example, the contraceptive patch may relieve pre-menstrual tension. It may also reduce the risk of pelvic infection (as the 'mucus plug' may prevent bacteria, as well as sperm, from getting into the uterus). It may help to protect against some benign (non-cancerous) breast disease. It may reduce the risk of developing certain types of cyst in the ovary. It may reduce the risk of developing cancers of the ovary, colon and uterus (womb).

What are the disadvantages of the contraceptive patch?

Some women have skin irritation when they use the contraceptive patch. This is usually itching, redness or soreness. About 2 in 100 women have to stop using the patch because of skin irritation. Even though the patch sticks well most of the time, there is a possibility that it can become detached from the skin, either totally or partially. This is not common but can mean that its effectiveness as contraception can be lost. Despite its discreet design, some women still feel that the contraceptive patch can be seen.

Are there any side effects of the contraceptive patch?

Some women get some mild side effects when they first start using the contraceptive patch. If side effects do occur, they tend to settle down within the first few months. Possible side effects can include:

• Breast discomfort and tenderness.
• Slight changes in body weight (these are small and are similar to those that can occur with the pill).
• Headaches.
• Nausea (feeling sick).
• Mood changes.
• Breakthrough bleeding (bleeding between your periods) and spotting (light, irregular bleeding).

Who cannot use the contraceptive patch?

Most women can use the contraceptive patch. Your doctor or family planning nurse will discuss any current and past diseases that you have had. They may also ask about any health problems in your family. Some diseases cause an increased risk, or other problems, when using the contraceptive patch. Therefore, the contraceptive patch will not be prescribed to some women with a history of certain diseases or who are at increased risk of developing certain diseases. For example, some women with an increased risk of having a blood clot (thrombosis) may be advised not to use the contraceptive patch (see below).

If you are breastfeeding you should not use the contraceptive patch as it can reduce the amount of milk that you produce. Other forms of contraception are available if you are breastfeeding. You should not use the contraceptive patch if you are, or you think you may be, pregnant.

The contraceptive patch is less effective in women who weigh over 90kg and it is generally advised that it should not be used for these women. Women with liver or gall bladder problems or women who have unexplained vaginal bleeding (for example after sex or between their periods) may also not be able to use the contraceptive patch.

Are there any risks in using the contraceptive patch?

The risks in using the contraceptive patch are thought to be similar to those when using the combined oral contraceptive pill because it contains similar hormones. For most women, the benefits far outweigh the risks as the risks are small. However, a small number of women who use the contraceptive patch may develop serious problems. Because you are asked about any current or past diseases that you have had and any family history of health problems, women who are at a greater risk of developing serious side effects are usually prevented from using the contraceptive patch. The serious side effects that can occur in some women include the following:

Thrombosis. This means a blood clot in a blood vessel. This can be very serious. A blood clot in an artery can cause a stroke or a heart attack. A blood clot in a vein can cause a deep vein thrombosis which can travel to the lung and cause a pulmonary embolus. The following situations increase the risk of thrombosis if you use the contraceptive patch. The contraceptive patch may not be advised in these circumstances:

• If you have had a previous deep vein thrombosis or pulmonary embolism.
• Severe obesity.
• Immobility (for example, wheelchair bound).
• Severe varicose veins.
• Poorly controlled diabetes.
• High blood pressure that is not adequately controlled.
• If you have a close family member who has had a thrombosis, heart attack, or stroke before the age of 45.
• Severe migraine.
• If you have any complications from diabetes or have had diabetes for more than 20 years.
• Smoking - particularly if you are over 35.
• If you have had a heart attack, stroke, mini-stroke or suffer with angina.
• Some other rare conditions.

See a doctor straight away if you have any of the following: severe headache, bad pains in the chest or leg, leg swelling, breathing difficulty, if you cough up blood, sudden problems with sight or speech, vision problems, weakness or numbness in an arm or leg, collapse.

Cancer. There is a small increased risk of developing breast cancer in women who use combined hormone contraception such as the contraceptive patch. You should not use the contraceptive patch if you currently have breast cancer or have had breast cancer within the last five years. If you have a strong family history of breast cancer or have had breast cancer treated more than five years ago, you should discuss the pros and cons of starting the contraceptive patch with your doctor.

How do I use the contraceptive patch?

When to start the patch

You should ideally start using the patch on the first day of your period. This means that the patch will start working straight away as a contraceptive. You can have sex straight away and you will be protected. If you start the patch on any other day in your menstrual cycle, you should first be sure that you are not pregnant. You should then also use an additional method of contraception (such as condoms) for the first seven days.

Applying the patch

The contraceptive patch should be applied to clean, dry, non-hairy skin. Do not use any lotions, make-up, creams, powders or anything else on the area of skin before you apply the patch. Do not use on areas of skin that are irritated or broken. Suitable places to apply the patch are the upper outer arm, the chest/upper back area (do not apply the patch on the breasts), the buttocks or the lower abdomen. You should use a different site when you change your patch as this will help to avoid skin irritation. You should check each day to make sure that the patch has not fallen off.

You should follow the manufacturer's instructions on the packet when discarding the patch after use as they still contain some active hormones.

When to change the patch

You wear a patch every day for three weeks. The patch needs to be removed and changed every week. During the fourth week, when you are not wearing a patch, you should have your period.

Imagine your menstrual cycle as being 28 days long. Day 1 of your cycle is the first day of your period. Use the following instructions:

1. Apply the patch for the first time on the first day of your period (day 1).
2. Wear the patch for seven days (week 1).
3. On day 8, remove the used patch and apply a new patch immediately. You are now in week 2.
4. Wear the new patch for seven days again. On day 15, remove the used patch and apply another new patch immediately. You are now in week 3.
5. Wear the new patch for seven days again. On day 22, remove the patch.
6. Do not wear a patch between day 22 and day 28 (week 4). You should have a bleed like your period during this time. You are still protected from getting pregnant, provided that you apply your next patch on time.
7. Start your next 4 week cycle the day after day 28. Apply a new patch on this day. You should apply this patch no matter when your period begins or ends.

You will change your patch on the same day every week, your 'patch change day'.

What if my contraceptive patch falls off?

It is unlikely that your contraceptive patch will fall off as it has been carefully designed to minimise this.

If the patch has been off for less than 48 hours:

• Reapply it as quickly as possible (if it is still sticky).
• If it is not still sticky, replace it with a new patch, do not use anything such as tape to try to hold a patch in place that is no longer sticky.
• You are still protected and do not need to use any additional contraceptive methods.
• Continue to use your patch as normal and change it on your normal day.

• Start a whole new patch cycle by applying a new patch as soon as possible. This is now week 1 of the patch cycle. It may also mean that you have a new day of the week for changing your patches and starting new cycles.
• If you have sex within the next 7 days, you need to use additional contraception such as condoms.
• You may need to take additional emergency contraception if you have had sex within the past 5 days. If this is the case, you should discuss this with your GP, practice nurse, family planning or sexual health clinic.

What if I forget to change my contraceptive patch?

If you forget to take your patch off at the end of week 1 or week 2

If the delay in changing the patch is less than 48 hours:

• Replace the old patch with a new patch as soon as possible.
• Continue using the patch as normal, changing it on the usual day.
• You do not need to use any extra contraceptive precautions.

If the delay in changing the patch is more than 48 hours:

• Replace the old patch with a new patch as soon as possible.
• This is now week 1 of the patch cycle. It may also mean that you have a new day of the week for changing your patches and starting new cycles.
• If you have sex within the next 7 days, you need to use additional contraception such as condoms.
• You may need to take additional emergency contraception if you have had sex within the past 5 days. If this is the case, you should discuss this with your GP, practice nurse, family planning or sexual health clinic.

If you forget to take the patch off at the end of week 3

• Take the patch off as soon as possible.
• Apply the next patch on the usual start day of the next patch cycle. This may mean that you do not have a 7 day patch-free break.

If you forget to put on a new patch as the end of the patch-free week

If the delay in changing the patch is less than 48 hours:

• Put a new patch on as soon as possible.
• This is now week 1 of the new patch cycle. It may also mean that you have a new day of the week for changing your patches and starting new cycles.
• You do not need to use any extra contraceptive precautions.

If the delay in changing the patch is more than 48 hours:

• Apply a new patch as soon as possible.
• This is now week 1 of the new patch cycle. It may also mean that you have a new day of the week for changing your patches and starting new cycles.
• If you have sex within the next 7 days, you need to use additional contraception such as condoms.
• You may need to take additional emergency contraception if you have had sex within the past 5 days. If this is the case, you should discuss this with your GP, practice nurse, family planning or sexual health clinic.

Do other medicines interfere with the contraceptive patch?

Some medicines can interfere with the contraceptive patch and make it less effective in providing contraception. You should always make sure that you discuss all other medication that you are taking with the person prescribing the patch. This includes over the counter medications such as St. John's Wort which may also interfere with the contraceptive patch. If you are starting a new medication, make sure that you tell the person prescribing it that you are using the contraceptive patch. You may need to use extra contraceptive precautions (such as condoms) while you are taking the other medication and for a period of time after it is finished.

Some commonly encountered drugs that can interfere with the contraceptive patch include certain antibiotics, some anticonvulsants (drugs used to treat epilepsy), some medicines used for HIV infection, some drugs used to treat fungal infections and St. John's Wort (a herbal remedy used to treat low mood).

What if I vomit or have diarrhoea?

If you have vomiting or diarrhoea, the contraceptive patch is still effective (unlike when you are taking the pill). This is because the hormones are absorbed into your bloodstream through your skin, rather than through your gastrointestinal tract (stomach and gut). You do not need to use extra contraceptive precautions.

What happens if I don't have a withdrawal bleed (like a period) between patches?

Sometimes not all women have a bleed during their patch free week. If you have used your contraceptive patch properly, if it has not fallen off and if you have not taken any medication that may interfere with the patch, you are unlikely to be pregnant. If you are worried, you can do a pregnancy test or you can visit your GP, practice nurse, family planning or sexual health clinic for advice. If you miss two periods, you should seek medical advice.

Bleeding whilst using the contraceptive patch (breakthrough bleeding)

During the first few months while your body is adjusting to the contraceptive patch, you may have some vaginal bleeding in addition to the usual bleeding during your patch free week. This is not serious but more of a nuisance. It may vary from 'spotting' to a heavier loss like a light period. Do not stop using your patch. This usually settles after the first 2-3 months. If it persists, see your doctor or nurse.