Contraceptive patch

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart, or by stopping egg production. One method of contraception is the patch.

The contraceptive patch is a sticky patch, a bit like a nicotine patch, measuring 5cm by 5cm. It delivers hormones into your body through your skin. In the UK, the patch’s brand name is Evra.

It contains the same hormones as the combined pill, and it works in the same way. This means that it:

• prevents ovulation (the release of an egg)
• thickens cervical mucus, which makes it more difficult for sperm to travel through the cervix
• thins the womb lining, making it less likely that a fertilised egg will implant there

At a glance: facts about the patch

When used correctly, the patch is more than 99% effective at preventing pregnancy.

In real world use, at least 8 women in 100 a year become pregnant because they forget to change the patch (92% effective).

Each patch lasts for 1 week. You change the patch every week for 3 weeks, then have a week off without a patch. You’ll still be protected against pregnancy during this week.

You don’t need to think about it every day, and it’s still effective if you vomit or have diarrhoea.

You can wear the patch in the bath, in the swimming pool and while playing sports.

The patch can increase blood pressure, and some women get side effects such as headaches, which may be temporary.

Some women develop a blood clot when using the patch, but this is rare.

The patch may protect against ovarian cancer, womb cancer and colon cancer.

The patch may not be suitable for women who smoke and who are 35 or over, or who weigh 90kg (14 stone) or more.

The patch does not protect against sexually transmitted infections (STIs). Using a condom as well will help to protect you against STIs.

How the patch works

You can use the contraceptive patch on most areas of your body, as long as the skin is clean, dry and not very hairy. For example, your leg, arm or back.

You apply a new patch once a week (every 7 days) for 3 weeks, and then stop using the patch for 7 days. This is known as your patch-free week. During your patch-free week you will get a withdrawal bleed, like a period. This may not always happen.

After 7 patch-free days, you apply a new patch and start the 4-week cycle again. Start your new cycle even if you’re still bleeding.

You should not stick the patch on:

• sore or irritated skin
• anywhere it may get rubbed off by tight clothing
• your breasts

When you first start using the patch, you can vary the position every time you use a new patch to reduce your risk of irritation.

When the patch starts to work

If you start using the patch on the first day of your period, it starts working straight away. This means you can have sex without getting pregnant.

If you start using it on any other day, you need to use an extra form of contraception, such as condoms, for the first 7 days.

You can talk to your doctor or nurse for more information about when the patch will start to work, and whether you need to use extra contraception.

What to do if the patch falls off

The contraceptive patch is very sticky and should stay on. It should not come off after a shower, bath, hot tub, sauna or swim, or after exercise.

If the patch does fall off, what you need to do depends on how long it has been off, and how many days you had a patch on before it came off.

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

• stick your patch back on as soon as possible (if it’s still sticky)
• if it’s not sticky, replace it with a new patch (do not try to hold the old patch in place with a plaster or bandage)
• continue to use your patch as normal and change your patch on your normal change day

If the patch has been off for less than 48 hours before you replace it, you’ll still be protected against pregnancy as long as the patch was on properly for 7 days before the patch came off. If this is the case, you do not need to use extra contraception.

If you have had a patch on for 6 days or less before it falls off, you may not be protected against pregnancy. You should use extra contraception, such as condoms, for 7 days.

If the patch has been off for 48 hours or more, or you’re not sure how long it has been off:

• apply a new patch as soon as possible and start a new patch cycle (this will now be day 1 of your new cycle)
• use another form of contraception, such as condoms, for the next 7 days

If you had unprotected sex in the previous few days, you may need emergency contraception. Speak to your GP, nurse, local sexual health (GUM) clinic or pharmacist if you’re concerned.

What to do if you forget to take the patch off

If you forget to take the patch off after week 1 or 2, what you need to do depends on how long you have forgotten it.

If it has been on for less than 48 hours longer than it should have been (8 or 9 days in total) – take off the old patch and put on a new one. Continue to use your patch as normal, changing it on your normal change day. You don’t need to use any extra contraception and you are protected against pregnancy.

If it has been on for 48 hours or more longer than it should have been (10 days or more in total), start a whole new patch cycle by applying a new patch as soon as possible. This is now week 1 of the patch cycle and you’ll have a new day of the week as your start day and change day. Use another method of contraception, such as condoms, for the next 7 days. Ask your doctor or nurse for advice if you have had sex in the previous few days and were not using a condom, as you may need emergency contraception.

If you forget to take the patch off after week 3, take the patch off as soon as possible and start your patch-free break. Start a new patch on your usual start day, even if you are bleeding. This means that you will not have a full week of patch-free days. You’ll be protected against pregnancy and do not need to use any extra contraception. You may or may not bleed on the patch-free days.

What to do if you forget to put a patch on after the patch-free week

If you forget to put on a patch at the end of the patch-free week, put a new one on as soon as you remember.

If you put the patch on 48 hours late or less (so the patch-free interval has been 9 days or less), you’ll still be protected against pregnancy, as long as you wore the patch correctly before the patch-free interval.

If you put the patch on more than 48 hours late, so the interval has been 10 days or more, you may not be protected against pregnancy. You should use extra contraception, such as condoms, for 7 days. Ask your doctor or nurse for advice if you have had sex in the patch-free interval, as you may need emergency contraception.

Bleeding in the patch-free week

Some women don’t always have a bleed in their patch-free week. This is nothing to worry about if you have used the patch properly and have not taken any medication that could affect it.

See your GP or nurse for advice if you are worried, or do a pregnancy test to check if you are pregnant. If you miss more than 2 bleeds, get medical advice.

Who can use the patch?

The contraceptive patch is not suitable for everyone. Your doctor or nurse will ask you about your health and your family’s medical history to make sure the patch is right for you. It’s very important to tell them about any illnesses or operations you have had, or medications you are currently taking.

You should not use the patch if you:

• are pregnant or think you may be pregnant
• are breastfeeding
• smoke and are 35 or over
• are 35 or over and stopped smoking less than a year ago
• are very overweight
• take certain medicines, such as some antibiotics, St John’s Wort or medicines used to treat epilepsy, tuberculosis (TB) or HIV

You will also not be able to use the patch if you have (or have had):

• thrombosis (blood clots) in a vein or artery
• a heart problem or a disease affecting your blood circulatory system (including high blood pressure)
• migraine with aura (warning signs)
• breast cancer
• disease of the liver or gallbladder
• diabetes with complications, or diabetes for more than 20 years

Advantages and disadvantages of the patch

If it’s used properly, the contraceptive patch is more than 99% effective in stopping you from getting pregnant. This means that if 100 women use the patch according to the instructions, fewer than 1 will get pregnant in a year. Other advantages of the patch are:

• it’s very easy to use
• it does not interrupt sex
• unlike the combined oral contraceptive pill, you do not have to think about it every day – you only have to remember to change the patch once a week
• the hormones from the contraceptive patch do not need to be absorbed by the stomach, so it’s just as effective even if you vomit or have diarrhoea
• like the pill, it tends to make your periods more regular, lighter and less painful
• it can help with premenstrual symptoms
• it may reduce the risk of ovarian, womb and bowel cancer
• it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease

Some potential disadvantages of the patch are that:

• it may be visible
• it can cause skin irritation, itching and soreness
• it does not protect you against STIs, so you may need to use condoms as well if you have a high risk of getting an STI – for example, if you have multiple sexual partners or are unsure of your partners sexual health
• some women get mild temporary side effects when they first start using the patch, such as headaches, nausea (sickness), breast tenderness and mood changes; these side effects usually settle down after a few months
• bleeding between periods (breakthrough bleeding) and spotting (very light, irregular bleeding) is common in the first few cycles of using the patch; this is nothing to worry about if you are using the patch properly, and you’ll still be protected against pregnancy

Some medicines can make the patch less effective. If you are prescribed new medicine or are buying an over-the-counter medicine, ask the doctor or pharmacist for advice. You may need to use an extra form of contraception while you are taking the medicine, and for 28 days afterwards.

Risks of using the patch

There is a very small risk of some serious side effects when you use a hormonal contraceptive, such as the contraceptive patch or combined pill.

Blood clots

The patch slightly increases your chance of developing a blood clot. A blood clot can block a vein (venous thrombosis) or an artery (arterial thrombosis, which may lead to a heart attack or stroke). If you have had a blood clot before, do not use the patch.

Your risk of blood clots is higher during the first year of using the patch. Your risk is also higher if:

• you smoke
• you’re very overweight
• you’re immobile (unable to move) or use a wheelchair
• you have severe varicose veins
• a close family member had a venous thrombosis before they were 45 years old

The risk of arterial thrombosis is greatest if:

• you smoke
• you’re diabetic
• you have high blood pressure (hypertension)
• you’re very overweight
• you regularly have migraines with aura (warning signs)
• a close family member had a heart attack or stroke before they were 45

Cancer

Current research suggests that people who use oestrogen and progestogen contraception, such as the contraceptive patch, are at a slightly increased risk of breast cancer compared with people who do not use hormonal contraception. Further research is needed to provide more definitive evidence.

Research also suggests there is a small increase in your risk of developing cervical cancer with the long-term use of oestrogen and progestogen hormonal contraception.

For most women, the benefits of the patch outweigh the risks. Talk about all risks and benefits with your doctor or nurse before starting to use the patch. You will not be allowed to use the patch if you are considered to be at a higher risk of serious side effects.

Where you can get the contraceptive patch?

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. When you first get the contraceptive patch you’ll be given a 3 month supply to see how you get on with it. If there are no problems, you can be prescribed the patch for 6 months to a year.

Places where you can get contraception include:

• most GP practices – talk to your GP or practice nurse
• community sexual health clinics
• some young people’s services

Contraception services are free and confidential, including for people under the age of 16.

If you’re under 16 and want contraception, the doctor, nurse or pharmacists won’t tell your parents (or carer). They’ll provide you with contraception as long as they believe you fully understand the information you’re given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They’ll encourage you to consider telling your parents (or carer), but they won’t make you. The only time that a professional will not be able to keep confidentiality is if they believe you’re at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.