The Patch

The EVRA Birth Control Patchmural-88

How does the EVRA Patch work?
The EVRA patch is a flexible square sticker that sticks to the skin for a week at a time. It releases the hormones estrogen and progesterone (the same hormones as the birth control pill) and prevents the release of an egg from the ovary (ovulation). When used perfectly the patch can be up to 99% effective in preventing pregnancy. In actual use it is 92%, or in other words, an average of 8 women out of 100 get pregnant in a year when using the patch as their only form of birth control.

Please note: The Patch is considered less effective for women who weigh 198 lbs (90 kg) or more. It does not protect against sexually transmitted infections (STIs). Using condoms with the Patch will protect you against both pregnancy and STIs. It is also recommended to get tested regularly for STIs.

How do you start the EVRA Patch?
You can start using the Evra Patch at any time. You do not have to wait for your period to come. Use condoms or do not have intercourse until you have had the first Patch on for seven full days. If you have had a medical abortion, you can start using the Evra Patch once you have had a checkup and the doctor says the abortion is complete. You can also start using the Patch on the day following a surgical abortion. If you start the Patch the day after a surgical abortion or on the first day of your period you do not need to use a backup method of birth control for the first week.

How do you use an EVRA Patch?
Each Evra Patch works for one week (seven days) at a time. Gently remove the patch from the foil pouch being careful not to accidentally remove the clear protective liner on the back. Peel away half of the clear liner (avoid touching the sticky surface) and position the patch on the skin. Then remove the other half of the liner. Press firmly on the patch for at least 10 seconds to make sure that all of it sticks well.

You can wear patches on your buttock (bum), abdomen (lower belly), shoulder or outside of your upper arm. You can put it on a different place every week (for example, if it irritates your skin), but wherever you put it, it has to stay there for the full seven days. Always apply the Patch to clean, dry skin. Do not use creams, oils, powder or makeup on the skin where a patch will be applied. Avoid putting it onto skin that is red, cut, or irritated. Check the patch at least once every day to make sure it is still stuck on properly and has not gotten caught on clothing or peeled up at the edges. Patches should be kept at room temperature until they are used.

How do you take off/change an EVRA Patch?
The seventh day after you put on your patch is called your “Patch Change Day.” You can change your patch at any time on this day. To remove your patch, grasp it by an edge and pull it off. Fold it so that the sticky side is stuck together to seal in any remaining medication. Put it in the garbage. Do not flush it down the toilet. If any stickiness remains on your skin, remove it using baby oil or lotion.

Should you take breaks on the EVRA Patch for your period?
You can decide whether or not you want to have your period when you are using the Patch. It is okay to skip your period when you are using hormonal birth control because the lining of the uterus does not grow as much and does not need to shed every month. You can use the Patch in the following ways:

  • 7 Day Patch Free Break: Some doctors and the instructions that come with the Evra Patch may recommend that you use three patches in a row (for a total of three weeks or 21 days) and then take a seven day break, which will cause your period to come. This will mean that your Patch Change Day remains on the same day of the week. Never take a break longer than seven days, even if your period has not come or is not finished.
  • 3-4 Day Patch Free Break: Research has shown that it is safe and may be more effective to only take a three or four day break. You can use three patches in a row (for a total of 21 days) and then take a three or four day break before putting on the next one. If you do this, your period may start in the three or four days that you are not wearing a Patch. It will likely be shorter and lighter than your regular period. You don’t need to wait until your period starts or finishes to put your next Patch on – you can just start your new Patch after three or four days whether you are bleeding or not. This means that your Patch Change Day will be on a different day of the week each cycle.
  • Continuous Use: You can also continue using patches, changing them once a week without taking a break. This may also make the Patch more effective in preventing pregnancy. For most people this will mean that their period will not come. Some will have spotting after a few months – this is normal. If you do not like having irregular spotting, you may want to take a three-seven day break every second or third month, which will make it more like having a period. Otherwise, just continue to change your Patch every seven days and the spotting will eventually stop. This will mean that your Patch Change Day remains on the same day of the week.
  • Note: Do not skip patches, even if you do not have sex often.

What do you do if the edges of your EVRA Patch lift up?
Press down firmly on the patch with the palm of your hand for at least 10 seconds and then run your finger around the edge of the patch. If it will not completely stick, apply a new patch immediately (see below). Do not try to re-attach the same patch if it is no longer sticky, has become stuck to itself or something else, has other materials stuck to it or has become loose or fallen off before. Do not use anything else, such as tape, glue or fabric, to try to keep the patch on your skin.

What do you do if it falls off or you forget to change your Evra Patch?
If it has been less than 24 hours:
Apply a new patch immediately. Change it on your normal Patch Change Day (even if this is less than a week away). No backup contraception (birth control) is needed.
If you are taking breaks for your period (3-4 or 7 day patch free break):

  • More than 24 hours off/late with first patch of cycle or more than 2 days off/late with second or third patch: Apply the a new patch as soon as you remember and start a new 4-week cycle. This becomes your new Patch Change Day. Use condoms or do not have sex until you have had a new patch on for seven days in a row. If you have had sex in the last 7 days with nothing but the Patch for protection consider taking Plan B or having an emergency Copper IUD inserted.
  • Less than 2 days off/late in second or third patch of cycle: Apply a new patch immediately. Change it on your normal Patch Change Day (even if this is less than a week away). No backup contraception is needed.
  • Forgot to take your patch off for your break: take off as soon as you remember and put your new patch on the same day you would have if you had not forgotten, even if this makes the break shorter or means you do not take a break this month. No back up is needed.

If you are doing Continuous Use (not taking a patch-free break):

  • Less than 2 days off/late: Apply a new patch immediately. Change it on your normal Patch Change Day (even if this is less than a week away). No backup contraception is needed.
  • More than two days off/late: Apply a new patch as soon as you remember. This becomes your new Patch Change Day. Use condoms or do not have intercourse until you have had a new patch on for seven days in a row. If you have had sex in the last 7 days with nothing but the Patch for protection consider taking Plan B or having an emergency Copper IUD inserted.

What side effects can the EVRA Patch have?
The Patch will not make it harder to get pregnant or to have children in the future. When you stop using it your fertility will return very quickly. It can also have good side effects. Many women find their periods get lighter and less painful, and this can be helpful with iron levels. Some women also find that their skin gets clearer. Women who use the patch may have a significantly smaller risk of certain kinds of cancer. They may also have a much lower risk of having a serious pelvic infection that can affect future fertility.
The most significant negative effect is a slightly increased risk of blood clots (deep venous thrombosis, DVT). There is a lower risk of blood clots when on the patch than there is during pregnancy. It is highest in the first 6-12 months of use. Other side effects are mild headaches, skin reactions, nausea, and breast tenderness. Often these go away after the first three months. If you want to stop using the Patch, talk to someone first to lessen the chance of pregnancy.

If you have any of the following symptoms see a doctor immediately: sharp chest pain, coughing blood, sudden shortness of breath; severe pain in calf (lower leg); sudden severe headache or vomiting, dizziness or fainting, problems with vision or speech, numbness in arm or leg; severe pain, swelling, or tenderness in abdomen (belly); breast lumps; swelling of fingers or ankles.

Who should not use the EVRA Patch?
You should not use the patch if you are over age 35 and smoke more than 15 cigarettes a day; are breastfeeding a baby less than six months old; have a history of blood clots, stroke, heart attack, certain cancers, severe high blood pressure, migraine headaches with neurological symptoms (“aura”), liver disease, jaundice, or diabetes with complications of the eyes, kidneys, nerves, or blood vessels.