The patch side effects

Contents

Xulane Side Effects

Generic Name: ethinyl estradiol / norelgestromin

Medically reviewed by Drugs.com. Last updated on Dec 1, 2018.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Interactions
  • More

Note: This document contains side effect information about ethinyl estradiol / norelgestromin. Some of the dosage forms listed on this page may not apply to the brand name Xulane.

For the Consumer

Applies to ethinyl estradiol / norelgestromin: transdermal patch extended release

Warning

Transdermal route (Patch, Extended Release)

Cigarette smoking increases the risk of serious cardiovascular side effects from hormonal contraceptive use. This risk increases with age and with the number of cigarettes smoked and is marked in women over 35 years of age. Women who are over 35 years of age and smoke should not use ethinyl estradiol / norelgestromin. A significantly increased risk of venous thromboembolism was found among women aged 15 to 44 years who used ethinyl estradiol / norelgestromin patch compared with oral contraceptives containing 30 to 35 mcg of ethinyl estradiol (EE) and either levonorgestrel or norgestimate. Increased estrogen exposure from the patch may increase the risk of adverse events, including venous thromboembolism, compared with oral contraceptives.

Along with its needed effects, ethinyl estradiol / norelgestromin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking ethinyl estradiol / norelgestromin:

More common

  • Body aches or pain
  • chills
  • cough
  • difficulty with breathing
  • ear congestion
  • fever
  • headache
  • loss of voice
  • nasal congestion
  • runny nose
  • sneezing
  • sore throat
  • unusual tiredness or weakness

Incidence not known

  • Anxiety
  • changes in skin color
  • chest pain or discomfort
  • confusion
  • dark urine
  • diarrhea
  • dizziness
  • eye pain
  • fainting
  • inability to speak
  • itching
  • lack or loss of appetite
  • light-colored stools
  • lightheadedness
  • nausea
  • numbness in the hands
  • pain in the stomach
  • pain in the chest, groin, or legs, especially the calves
  • pain or discomfort in the arms, jaw, back, or neck
  • pain, tenderness, or swelling of the foot or leg
  • pounding in the ears
  • rash
  • seizures
  • slow or fast heartbeat
  • slurred speech
  • sudden headache
  • sudden loss of coordination
  • sudden, severe weakness or numbness in the arm or leg on one side of the body
  • sweating
  • swelling, pain, or tenderness in the upper abdominal or stomach area
  • temporary blindness
  • unpleasant breath odor
  • vision changes
  • vomiting of blood
  • yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur while taking ethinyl estradiol / norelgestromin:

Symptoms of overdose

  • Unusual vaginal bleeding in women
  • vomiting

Some side effects of ethinyl estradiol / norelgestromin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Burning, itching, or redness of the skin
  • menstrual cramps
  • pain, soreness, swelling, or discharge from the breast or breasts
  • swelling or soreness at the patch site

Incidence not known

  • Absent, missed, or irregular menstrual periods
  • bloody vaginal discharge
  • brown, blotchy spots on exposed skin
  • change in amount of vaginal discharge
  • change in menstrual flow
  • decreased amount of breast milk
  • discouragement
  • dry mouth
  • feeling sad or empty
  • increase or decrease in weight
  • increased hunger or thirst
  • increased urination
  • irritability
  • itching of the vagina or outside of the genitals
  • light vaginal bleeding between periods and after sexual intercourse
  • loss of interest or pleasure
  • pain during sexual intercourse
  • stomach cramps or bloating
  • stopping of menstrual bleeding
  • swelling
  • thick, white curd-like vaginal discharge without odor or with mild odor
  • trouble concentrating
  • trouble sleeping

For Healthcare Professionals

Applies to ethinyl estradiol / norelgestromin: transdermal film extended release

General

The most frequently reported side effects were breast symptoms, nausea/vomiting, headache, application site disorder, abdominal pain, dysmenorrhea, vaginal bleeding and menstrual disorders, and mood affect and anxiety disorders.

Gastrointestinal

Very common (10% or more): Nausea (16.6%)

Common (1% to 10%): Abdominal pain, vomiting, diarrhea, abdominal distention

Postmarketing reports: Colitis

Nervous system

Very common (10% or more): Headache (21%)

Common (1% to 10%): Dizziness, migraine

Rare (less than 0.1%): Cerebrovascular accident

Frequency not reported: Stroke

Postmarketing reports: Dysgeusia, migraine with aura, hemorrhage intracranial, cerebral hemorrhage, abnormal taste

Respiratory

Rare (less than 0.1%): Pulmonary embolism

Postmarketing reports: Pulmonary artery thrombosis

Genitourinary

Very common (10% or more): Breast symptoms (22.4%), breast tenderness

Common (1% to 10%): Dysmenorrhea, vaginal bleeding/menstrual disorder, vaginal yeast infection/candidiasis, vulvovaginal infection, uterine spasm, vaginal discharge

Uncommon (0.1% to 1%): Galactorrhea, premenstrual syndrome, vulvovaginal dryness

Rare (less than 0.1%): Genital discharge

Frequency not reported: Uterine bleeding irregular

Postmarketing reports: Lactation suppressed, menstrual disorder

Local

Very common (10% or more): Application site disorder (17.1%)

Common (1% to 10%): Application site reaction

Rare (less than 0.1%): Application site pustule

Postmarketing reports: Erosion, abscess

Cardiovascular

Uncommon (0.1% to 1%): Hypertension, blood pressure increased

Rare (less than 0.1%): Arterial thromboembolism

Postmarketing reports: Myocardial infarction, arterial thrombosis, cerebrovascular accident, deep vein thrombosis, hypertension, hypertensive crisis, thrombosis, venous thromboembolism

Psychiatric

Common (1% to 10%): Mood disorder, affect disorder, anxiety

Uncommon (0.1% to 1%): Insomnia, libido decreased

Rare (less than 0.1%): Libido increased

Postmarketing reports: Anger, emotional disorder, frustration, irritability

Metabolic

Uncommon (0.1% to 1%): Hypercholesterolemia, fluid retention, appetite increase, lipid disorder

Postmarketing reports: Hyperglycemia, insulin resistance, blood glucose decreased, blood glucose increased, blood cholesterol abnormal, low density lipoprotein increased, blood glucose abnormal

Dermatologic

Common (1% to 10%): Acne, pruritus, rash, skin reaction, skin irritation

Uncommon (0.1% to 1%): Alopecia, allergic dermatitis, eczema, urticaria, photosensitivity, contact dermatitis, erythema

Frequency not reported: Chloasma

Postmarketing reports: Erythema multiforme, erythema nodosum, seborrheic dermatitis, pustular rash, angioedema, exfoliative rash

Hepatic

Rare (less than 0.1%): Cholecystitis, cholelithiasis

Postmarketing reports: Cholestasis, hepatic lesion, cholestatic jaundice

Other

Common (1% to 10%): Fatigue, weight increased, malaise

Uncommon (0.1% to 1%): Edema, peripheral edema

Rare (less than 0.1%): Swelling

Postmarketing reports: Face edema, pitting edema, localized edema

Musculoskeletal

Common (1% to 10%): Muscle spasm

Oncologic

Rare (less than 0.1%): Fibroadenoma of breast, uterine leiomyoma

Postmarketing reports: Breast cancer, cervix carcinoma, hepatic adenoma, hepatic neoplasm, breast mass, cervical dysplasia

Ocular

Postmarketing reports: Contact lens intolerance/complication

Immunologic

Uncommon (0.1% to 1%): Hypersensitivity

Postmarketing reports: Allergic reaction

1. “Product Information. Ortho Evra (ethinyl estradiol-norelgestromin).” Janssen Pharmaceuticals, Titusville, NJ.

2. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Medical Disclaimer

More about Xulane (ethinyl estradiol / norelgestromin)

  • During Pregnancy
  • Dosage Information
  • Drug Interactions
  • Compare Alternatives
  • Support Group
  • Pricing & Coupons
  • En Español
  • 396 Reviews
  • FDA Approval History

Consumer resources

  • Xulane transdermal
  • Xulane
  • Xulane (Advanced Reading)

Other brands: Ortho Evra

Professional resources

  • Xulane (FDA)

Related treatment guides

  • Birth Control

In This Section

  • Birth Control Patch
  • How effective is the patch?
  • How safe is the patch?
  • How do I use the patch?
  • How do I get the patch?
  • What are the benefits of the patch?
  • What are the disadvantages of the patch?

Remembering to change your patch on time can be hard. And some people get side effects that bother them (but they usually go away in a few months).

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Want the patch?

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You have to change the patch on time.

It’s really important to always change your patch on time, or you might not be protected from pregnancy. Using Spot On (our birth control app), setting a reminder, or marking your calendar can help you stay on schedule.

If you have a really busy life and think you won’t stay on top of your patch schedule, check out other birth control methods like IUDs or the implant that are super low-maintenance and almost impossible to mess up.
Take our quiz to help you find the birth control method that’s best for you.

There can be negative side effects.

Like all medicines, there can be birth control patch side effects. But they usually go away after 2 or 3 months. Many people use the patch with no problems at all. You can keep track of any side effects with our Spot On app.

The most common side effects are spotting or bleeding between periods, sore breasts, nausea, or headaches. You may also notice a change in your level of sexual desire. These side effects usually go away after 2 or 3 months, and they don’t happen to everyone who uses the patch.

Birth control shouldn’t make you feel sick or uncomfortable. Luckily, there are many different types of birth control, so you’ve got options. If you keep having side effects that bother you, talk with your nurse or doctor about trying another birth control method. But don’t stop using the patch without starting a new method if you can, or you won’t be protected from pregnancy.

Some side effects of the patch are serious.

Serious problems from using the birth control patch are very rare. People using birth control that has the hormone estrogen, like the patch, have a slightly higher chance of having a few rare but dangerous problems than people who don’t use birth control with estrogen.

For more information about side effects, talk with your nurse or doctor or read the package insert that came with your patches.

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On the other hand, women on the patch can experience tender boobs, nausea, headaches, bloating, and abnormal bleeding, just like with the pill and vaginal ring. These symptoms are “usually transient and happen the first few months…as your body adjusts,” Suzanne Fenske, M.D., assistant professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai, tells SELF. “Most women do not feel that this is significant enough to warrant stopping the patch.” If you start the patch, symptoms persist for many months, and they’re bothersome enough to interfere with your quality of life, talk to your doctor.

9. The adhesive can be annoying, though.

One of the biggest complaints Dr. Ruiz hears about the patch is that a line of dirt, lint, or whatever can get stuck around the edge, which may feel kind of gross. “When you pull the patch off, you have to wash or scrape that stuff away—that annoys some people,” Dr. Ruiz says.

Some people may even have an allergic reaction to the adhesive and experience symptoms like itchiness, he says.

10. You may be at a greater risk of developing blood clots on the patch.

When you use the patch, you’re exposed to about 60 percent more estrogen than when you take other forms of combined hormonal birth control with 35 micrograms of estrogen, according to the prescribing information for the birth control patch. Estrogen can increase the clotting factors in your blood, so the patch may come with a higher risk of blood clots than if you opted for a different BC.

Estimates vary for how much the patch raises your risk of blood clots compared with other combined hormonal contraceptives like the pill, but it seems to be around twice as high, per a 2017 review published in the International Journal of Women’s Health. Still, the absolute risk of a blood clot while on birth control is very low—much lower than your risk of a blood clot during and just after pregnancy, according to a 2015 study in BMJ that looked at over 50,000 women. That study put the odds of getting a blood clot while not on hormonal birth control at about 0.04 percent, while on the pill it goes up to 0.06 to 0.18 percent, depending on the type you choose.

That said, if you have a history of blood clots, high blood pressure, smoke and are over 35, or have any other blood clot risk factors, talk to your doctor—it’s probably best to play it safe and skip this birth control method. The patch is also not suggested for anyone who has breast cancer, liver tumors, or liver disease.

11. The patch may be less effective if you weigh more than 198 pounds.

The theory is that higher levels of body fat may make it harder for your body to absorb the hormones as effectively, Dr. Quinlan says. If you weigh more than 198 pounds, your doctor may recommend a different form of birth control, like a hormonal IUD (which works by thickening cervical mucus, thinning the uterine lining, and partially suppressing ovulation) or the non-hormonal copper IUD (which creates an inflammatory reaction that’s toxic to sperm). Since they’re placed directly in the uterus, they act locally and are an effective birth control option regardless of weight, Dr. Minkin explains.

If you’re interested in the patch, talk to your doctor about what you need from birth control. They can walk you through the pros and cons to help you figure out the best reinforcements in your goal to avoid an unintended pregnancy.

Related:

  • What to Expect After IUD Removal: Ob/Gyn Experts Explain
  • What to Do If Birth Control Makes Your Period Worse
  • The Birth Control Method That’s Even More Effective Than an IUD

What is Xulane?
Xulane® is a prescription contraceptive patch used for the prevention of pregnancy in women who choose to use a transdermal patch.

Limitation of Use:

Xulane may not be as effective in women weighing more than 198 lbs (90 kg).

If you weigh more than 198 lbs. (90 kg), talk to your healthcare professional about which method of birth control is right for you.

Hormonal birth control methods help to lower the chances of becoming pregnant. They do not protect against HIV infection (AIDS) and other sexually transmitted infections.

IMPORTANT SAFETY INFORMATION

Who should not use Xulane?

Do not use Xulane if you:

  • Smoke and are over 35 years old
  • Have or have had blood clots in your arms, legs, eyes or lungs
  • Have an inherited problem that makes your blood clot more than normal
  • Have had a stroke
  • Have had a heart attack
  • Have certain heart valve problems or heart rhythm problems that can cause blood clots to form in the heart
  • Have high blood pressure that medicine cannot control
  • Have diabetes with kidney, eye, nerve, or blood vessel damage
  • Have had certain kinds of severe migraine headaches with aura, numbness, weakness or changes in vision, or have any migraine headaches if you are over age 35
  • Have liver disease, including liver tumors (benign or cancerous)
  • Take any Hepatitis C drug combination containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir. This may increase levels of the liver enzyme “alanine aminotransferase” (ALT) in the blood.
  • Have unexplained vaginal bleeding
  • Are pregnant or think you may be pregnant. However, Xulane is not known to cause birth defects when used by accident during pregnancy.
  • Have had breast cancer or any cancer that is sensitive to female hormones

Hormonal birth control methods may not be a good choice for you if you have ever had jaundice (yellowing of the skin or eyes) caused by pregnancy or related to previous use of hormonal birth control.

Tell your healthcare professional if you have ever had any of the above conditions. Your healthcare professional may recommend another method of birth control.

Before you use Xulane tell your healthcare professional:

  • About all your medical conditions.
  • If you are pregnant or think you are pregnant.
  • If you are scheduled for surgery. Xulane may increase your risk of blood clots after surgery. You should stop using your Xulane patch at least 4 weeks before you have surgery and not restart it until at least 2 weeks after your surgery.
  • If you are or will be inactive or immobilized for a long period of time.
  • If you are scheduled for any laboratory tests. Certain blood tests may be affected by hormonal birth control methods.
  • Are breastfeeding or plan to breastfeed. Hormonal birth control methods that contain estrogen, like Xulane, may decrease the amount of milk you make. A small amount of hormones from the Xulane patch may pass into your breast milk. Consider another method of birth control until you are ready to stop breastfeeding.

Tell your healthcare professional about all medicines and herbal products that you take.

Some medicines and herbal products may make hormonal birth control less effective, including, but not limited to:

  • certain seizure medicines (carbamazepine, felbamate, oxcarbazepine, phenytoin, rufinamide, and topiramate)
  • aprepitant
  • barbiturates
  • bosentan
  • griseofulvin
  • certain combinations of HIV medicines (nelfinavir, ritonavir, ritonavir-boosted protease inhibitors)
  • certain non-nucleoside reverse transcriptase inhibitors (nevirapine)
  • rifampin and rifabutin
  • St. John’s wort

Use another birth control method (such as a condom and spermicide or diaphragm and spermicide) when you take medicines that may make the Xulane patch less effective.

Some medicines and grapefruit juice may increase your level of the hormone ethinyl estradiol if used together, including:

  • acetaminophen
  • ascorbic acid
  • medicines that affect how your liver breaks down other medicines (itraconazole, ketoconazole, voriconazole, and fluconazole)
  • certain HIV medicines (atazanavir, indinavir)
  • atorvastatin
  • rosuvastatin
  • etravirine

Hormonal birth control methods may interact with lamotrigine, an anti-seizure medicine used for epilepsy. This may increase the risk of seizures, so your healthcare professional may need to adjust the dose of lamotrigine.

Women on thyroid replacement therapy may need increased doses of thyroid hormone.

Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.

What are the possible side effects of Xulane?

Xulane may cause serious side effects, including:

  • Blood clots. Like pregnancy, hormonal birth control methods increase the risk of serious blood clots, especially in women who have other risk factors, such as smoking, obesity, or age greater than 35. This increased risk is highest when you first start using hormonal birth control and when you restart the same or different hormonal birth control after not using it for a month or more. Some studies have reported that women who use norelgestromin and ethinyl estradiol transdermal system have a higher risk of getting a blood clot. Talk with your healthcare professional about your risk of getting a blood clot before using Xulane or deciding which type of birth control is right for you.

It is possible to die or be permanently disabled from a problem caused by a blood clot, such as a heart attack or a stroke. Some examples of serious blood clots are blood clots in the:

  • legs (deep vein thrombosis)
  • lungs (pulmonary embolus)
  • eyes (loss of eyesight)
  • heart (heart attack)
  • brain (stroke)

Call your healthcare professional right away if you have:

  • leg pain that will not go away
  • sudden shortness of breath
  • sudden blindness, partial or complete
  • severe pain or pressure in your chest
  • sudden, severe headache unlike your usual headaches
  • weakness or numbness in an arm or leg, or trouble speaking
  • yellowing of the skin or eyeballs

Other serious risks include:

  • liver problems including liver tumors
  • gallbladder disease
  • high blood pressure

The most common side effects of Xulane are:

  • breast symptoms (discomfort, swelling, or pain)
  • nausea
  • headache
  • skin irritation, redness, pain, swelling, itching or rash at the patch application site
  • stomach pain
  • pain during menstruation
  • vaginal bleeding and menstrual disorders, such as spotting or bleeding between periods
  • mood, affect and anxiety disorders

Some women have spotting or light bleeding, breast tenderness, or feel sick to their stomach during norelgestromin and ethinyl estradiol transdermal system use. If these symptoms occur, do not stop using the Xulane patch. The problem will usually go away. If it doesn’t go away, check with your healthcare professional.

Less common side effects are:

  • acne
  • less sexual desire
  • bloating or fluid retention
  • blotchy darkening of your skin, especially your face
  • high blood sugar, especially in women with diabetes
  • high fat (cholesterol, triglycerides) levels in the blood
  • depression, especially if you have had depression in the past. Call your healthcare professional immediately if you have any thoughts of harming yourself.
  • problems tolerating contact lenses
  • weight gain

Tell your healthcare professional about any side effect that bothers you or that does not go away. These are not all the possible side effects of Xulane. For more information, ask your healthcare professional or pharmacist.

What should I know about my period when using Xulane?

  • When you use Xulane, you may have bleeding and spotting between periods called unplanned bleeding. Such bleeding may be temporary and usually does not indicate any serious problems. It is important to continue using the patch on schedule. If the unplanned bleeding or spotting is heavy or lasts for more than a few days, you should discuss this with your healthcare professional.

What if I miss my scheduled period when using Xulane?

  • Some women miss periods on hormonal birth control, even when they are not pregnant. However, if you go 2 or more months in a row without a period, or you miss your period after a month where you did not use all of your patches correctly, or you have symptoms associated with pregnancy, such as morning sickness or unusual breast tenderness, call your healthcare professional because you may be pregnant. Stop taking Xulane if you are pregnant.

How do I use Xulane after childbirth?

  • If you are not breastfeeding, wait 4 weeks before using Xulane and use a non-hormonal contraceptive method of birth control, such as a condom and spermicide or diaphragm and spermicide, for the first 7 days of your first cycle only. If you have had sex since your baby was born, wait for your first period, or see your healthcare provider to make sure you are not pregnant before starting Xulane.

How do I use Xulane after childbirth?

  • If you are not breastfeeding, wait 4 weeks before using Xulane and use a non-hormonal contraceptive method of birth control, such as a condom and spermicide or diaphragm and spermicide, for the first 7 days of your first cycle only. If you have had sex since your baby was born, wait for your first period, or see your healthcare provider to make sure you are not pregnant before starting Xulane.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This is not all of the information you should read prior to using Xulane. Please to see Patient Information and full Prescribing Information.

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The contraceptive patch is a form of contraception which contains oestrogen and progestogen hormones, similar to the combined oral contraceptive (COC) pill. The patch sticks to the skin. If used correctly, it is a very effective form of contraception.

What is the contraceptive patch?

The patch is essentially the same type of contraception as the COC pill (often referred to as ‘the pill’) but as a patch instead of taking pills. The contraceptive patch is stuck on to the skin so that the two hormones are continuously delivered to the body, giving contraceptive cover. You can read about the COC pill in more depth.

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.

How does the contraceptive patch work?

The contraceptive patch works mainly by changing the body’s hormonal balance so that you do not produce an egg every month (ovulate). It also makes the cervical mucus thicker, forming a plug in the neck of the womb (cervix). This makes it difficult for sperm to get through to the womb (uterus) to fertilise an egg. The hormones in the contraceptive patch also make the lining of the womb thinner, so it is less likely that a fertilised egg will be able to attach to the womb.

How effective is the contraceptive patch?

Between 3-90 women in 1,000 using the contraceptive patch will become pregnant each year. It is about as effective as the COC pill. When no contraception is used, more than 800 in 1,000 sexually active women become pregnant within one year.

How effective is the birth control patch?

Dr Rosemary Leonard MBE

Why would I choose the contraceptive patch?

  • It is very effective and easy to use.
  • It does not interfere with sex.
  • Your periods are often lighter, less painful and more regular when you are using the contraceptive patch.
  • You do not have to remember to take your 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 5 cm x 5 cm in size.
  • The patch sticks well to your skin and can be worn continuously, even while you are bathing, showering, exercising and swimming.

The other advantages of the contraceptive patch are thought to be similar to those of the COC 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 COC pill. For example, the contraceptive patch may relieve premenstrual tension. It may also reduce the risk of pelvic infection, as the mucous plug may prevent germs (bacteria), as well as sperm, from getting into the womb (uterus). It may help to protect against some non-cancerous (benign) 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 womb.

Are there any side-effects of the contraceptive patch?

What are the side effects of the birth control patch?

Dr Rosemary Leonard MBE

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.

Some women have some other 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 weight changes are small and are similar to those that can occur with the COC pill. Studies have shown the patch does not cause significant weight gain.
  • Headaches.
  • Feeling sick (nausea).
  • Mood changes.
  • 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. It will not be prescribed to some women with a history of certain diseases or who are at increased risk of developing certain diseases. In particular, some women with an increased risk of having a blood clot (thrombosis) may be advised not to use the contraceptive patch (see below). For example, if you smoke and are over the age of 35 years, it is thought your risk of thrombosis is too high for the patch to be safe for you.

If you are breastfeeding you should not use the contraceptive patch until your baby is 6 weeks old. If you have had a baby and are not breastfeeding, you may be able to use the patch from 3-6 weeks after your baby is born. Your doctor, midwife or nurse will be able to advise. 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 90 kg and it is generally advised that it should not be used for these women. Women with liver or gallbladder 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. Other conditions which may mean the patch is not suitable for you include very high blood pressure, heart problems, migraine and, in some cases, diabetes. The doctor prescribing the patch for you will need to know all your medical history in order to make the decision that it is safe for you personally.

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 COC pill because the patch 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. When the patch is prescribed, you are asked about any current or past diseases that you have had and any family history of health problems. This means 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 clot in a blood vessel and it can be very serious. A blood clot in an artery can cause a stroke or a heart attack. A blood clot in a vein, called a deep vein thrombosis (DVT), can travel through the veins and cause a blood clot in the lung. This is called a pulmonary embolism.

The following situations increase the risk of thrombosis and you may be advised not to use the contraceptive patch in these circumstances:

  • If you have had a previous DVT or pulmonary embolism.
  • If you are very overweight.
  • Immobility (for example, wheelchair-bound, or after a major operation).
  • Poorly controlled diabetes which has led to problems with your eyes, feet or kidneys.
  • High blood pressure that is not adequately controlled.
  • If you have a close family member who has had a thrombosis before the age of 45 years.
  • Severe migraine. Specifically, migraine with “aura”. This means other symptoms that occur before the headache, such as changes in your vision, numbness or not being able to talk properly.
  • If you smoke – particularly if you are aged over 35 years.
  • If you have had a heart attack, stroke, “mini-stroke” (transient ischaemic attack) or have angina.
  • Some other rare conditions. These include having heart abnormalities, or diseases which affect your blood clotting system.

See a doctor straightaway if you have any of the following whilst using the patch:

  • Severe headache.
  • Bad pains in the chest or leg.
  • Leg swelling.
  • Breathing difficulty.
  • Coughing up blood.
  • Sudden problems with sight or speech.
  • Vision problems.
  • Weakness or numbness in an arm or a leg.
  • Collapse.

Cancer

There is a small increased risk of developing breast cancer in women who use combined hormonal contraception such as the contraceptive patch. You should not use the contraceptive patch if you currently have breast cancer or have had breast cancer in the past. If you have a strong family history of breast cancer, you should discuss with your doctor the pros and cons of starting the contraceptive patch.

There may also be a small increased risk of developing cancer of the neck of the womb (cervix) for women using combined hormonal contraception such as the contraceptive patch. However, it seems to protect slightly from cancers of the ovary, the womb (uterus) and bowel.

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 straightaway as a contraceptive. You will be protected from becoming pregnant from the first day you use the patch if you start on the first day. If you start the patch on day 2 to day 5 of your cycle (the first day of your period is day 1) you should also be protected straightaway. If you start the patch on any other day in your menstrual cycle, you should be sure that you are not pregnant. If you then start on the patch, you cannot rely on it for contraception for the first seven days. So, you should then use an additional method of contraception (such as condoms) for the first seven days. Alternatively, after starting the patch, you could wait for seven days before having sex.

Where is the best place to put the birth control patch?

Dr Rosemary Leonard MBE

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. These can interfere with the stickiness of the patch and make it more likely to fall off. Do not use on areas of skin that are irritated or broken. Suitable places to apply the patch are the upper outer arm, upper back area, the buttocks or the lower part of the tummy (abdomen). Do not apply the patch to the breasts. You should use a different place each time you change your patch. 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 it still contains 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. After three weeks (and three patches) you will have a patch-free break for one 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. Follow these instructions:

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

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

Editor’s note

Dr Sarah Jarvis, 22nd January 2019.

New options for patch timings
New guidelines from the Faculty of Sexual and Reproductive Healthcare (FSRH) have concluded that there are no health benefits to taking a hormone-free week (when you do not wear a patch) and having a bleed every month. They recommend that while some women will want to use the patch in this ‘standard’ way, all women should be given the choice to tailor the timing of their patches. This includes:

  • Changing your patch at the same time every week without ever taking a week off.
  • Changing your patch every week for three weeks, and starting the next three-week. cycle of patches 4 (rather than 7) days later. This may cut your risk of unplanned pregnancy.
  • Wearing a patch for nine weeks running, followed by a 4- or 7-day break.
  • Changing your patch every week until you bleed for 3-4 days in a row – at this stage you take a break of 4 or 7 days before you put a new patch on.

Although using the patch in this way means you may have fewer, or no, periods, you are more likely to have irregular bleeding. However, if you continue to apply your patches in the same way, this may settle down.

What do I do when I want to stop using the patch?

This depends on your plan for contraception after the patch. If you do not need contraception any more, either because you plan to have a baby or because you are not in a relationship, you can just stop it any time. Ideally stop it at the end of week 3 when you would normally come to the end of the cycle. If you do this, it will cause less disruption to your monthly bleeding cycle. However, if you wish to take the patch off before the end of the cycle, you may do so any time as long as you have not had unprotected sex in the previous five days.

If you still need contraception then speak with your doctor or nurse about how to swap to a different type of contraception in a way which will provide continuous protection as you swap over.

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.

If the patch has been off for 48 hours or longer, or if the time that it has been detached is uncertain:

  • 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 following seven 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 previous five days. If this is the case, you should discuss this with your GP, practice nurse, family planning clinic 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 following seven 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 previous five days. If this is the case, you should discuss this with your GP, practice nurse, family planning clinic 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 seven-day patch-free break.

If you forget to put on a new patch at 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 following seven 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 previous five days. If this is the case, you should discuss this with your GP, practice nurse, family planning clinic or sexual health clinic.

Do other medicines interfere with the contraceptive patch?

Some medicines can interfere with it and make it less effective. You should always 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 medicines that can interfere with the contraceptive patch include certain antibiotics (for example, rifampicin or rifabutin), some medicines used to treat epilepsy (anticonvulsants), some medicines used for HIV infection, and, as mentioned above, St John’s wort (a herbal remedy used to treat low mood).

Note: antibiotics which are commonly used (for example, to treat a chest infection or urine infection) do not interfere with the effectiveness of the contraceptive patch.

What if I am vomiting or have diarrhoea?

If you are being sick (vomiting) or have 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 stomach and gut (gastrointestinal tract). 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 clinic 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 can be 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.

Can I avoid the withdrawal bleed?

Occasionally, for special occasions such as holidays or exams, you can choose to miss your monthly withdrawal bleed (period). To do this, do not have a patch-free week. When you get to the end of week 3, simply put on another patch and start the cycle as if it is week 1. This will not always work, and you may have some breakthrough bleeding. If you have used the patch correctly every seven days, you are unlikely to be pregnant. If you prefer not to have a period or withdrawal bleed at all, you could consider other methods of contraception instead of the contraceptive patch. There are some contraceptive options where periods are extremely light or do not occur at all. These include the contraceptive implant, the intrauterine system, and contraceptive injections.

What are the long-term side effects of birth control?

For most people, using contraceptives for a long time does not cause significant problems.

Many people use hormonal birth control for contraception. But, others take hormonal birth control to manage long-term medical conditions. Conditions include heavy or painful periods, endometriosis, and menopause symptoms. Doctors approve the use of the pills for these conditions, so they should be okay to take.

A doctor can advise individuals about the safety and risks of using long-term birth control according to their medical history.

There are several factors and possible side effects to consider when taking long-term birth control:

Birth control and cancer

According to the National Cancer Institute, there is mixed evidence that hormonal contraceptives may increase the risk of breast and cervical cancer but reduce the risk of endometrial, ovarian, and colorectal cancers.

The hormones in birth control, including progesterone and estrogen, may stimulate the growth of some types of cancer cells and reduce the risk of others developing.

The American Cancer Society (ACS) says that people who have taken birth control pills are slightly more likely to develop breast cancer than those who have never used them. However, this risk goes away when people have been off the pill for 10 or more years.

The ACS also report that taking birth control for more than 5 years may increase the risk of cervical cancer. The longer people take the pill, the higher their risk. However, the risk should go back down gradually when someone stops taking the pill.

A large-scale study published in 2018 looked at the cancer prevalence in over 100,000 women aged 50 to 71 who were currently taking birth control pills. The study indicated that long-term use of birth control decreased the risk of both ovarian and endometrial cancer.

Researchers are not sure why birth control pills may lower the risk of certain cancers. It may be because the pill decreases the number of ovulations a person has in their lifetime, which exposes them to less naturally occurring hormones.

Birth control and blood clots

A 2013 meta-analysis of 26 studies indicated that the use of oral contraceptives containing both progesterone and estrogen increased people’s risk of developing a blood clot.

Blood clots increase a person’s risk of a stroke and heart attack. People who smoke may be especially at risk for developing blood clots when using birth control pills.

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What Is the Birth Control Patch?

The birth control patch is a thin, beige, 1¾-inch (4½-centimeter) square patch that sticks to the skin. It releases hormones through the skin into the bloodstream to prevent pregnancy. Hormones are chemical substances that control the functioning of the body’s organs.

How Does the Birth Control Patch Work?

The combination of the hormones progesterone and estrogen in the patch prevents ovulation (the release of an egg from the ovaries during a girl’s monthly cycle). If an egg isn’t released, a girl can’t get pregnant because there’s nothing for a guy’s sperm to fertilize.

The hormones in the patch also thicken the mucus produced in the cervix, making it difficult for sperm to enter and reach any eggs that may have been released. The hormones can also sometimes affect the lining of the uterus so that if the egg is fertilized it will have a hard time attaching to the wall of the uterus.

Like other birth control methods that use hormones, such as the birth control pill or birth control ring, a girl uses the birth control patch based on her monthly menstrual cycle. She puts on the patch on the first day of her menstrual cycle or the first Sunday after her menstrual cycle begins. She will change the patch on her skin once a week for 3 weeks in a row. (The patch should be applied to one of these four areas: the abdomen, buttocks, upper outer arm, or upper torso — except for the breasts.) On the fourth week, no patch is worn, and a girl’s period should start during this time.

Using the Patch

It’s important to apply a new patch on the same day every week to make sure that it keeps working effectively. For example, a girl who applies her first patch on a Monday should always apply her patches on a Monday.

When it’s time to change the patch, pull the old one off first, before applying a new patch. Place the new patch on a different area from the old patch (but still on one of the four recommended areas) to avoid skin irritation. Don’t apply the patch to skin that is red, irritated, or cut.

For the first 7 days on the patch, use an additional form of contraception as well to prevent pregnancy.

If you forget to apply a new patch on the right day, or if the patch becomes loose and falls off, read the instructions that come in the package or call your doctor. If this happens, you might need to use a backup method of birth control (such as condoms) or stop having sex for a while to protect against pregnancy. Also, if you stop using the patch for any reason, you will need to begin using another birth control method, usually after 24 hours of removing your last patch.

It’s OK to participate in regular activities like swimming and exercise while wearing the patch. It can also get wet in the shower or in the bath. Do not remove the patch until the week is over (pulling the patch off to reposition or move it may cause it to lose some of its stickiness and it might fall off easily). If the patch does not stick well, apply a replacement patch. Don’t try to decorate the patch, change the size of a patch by trimming it, or try to attach it with tape. Talk to your doctor if the patch falls off.

The patch should not be applied over makeup, creams, lotions, powder, or other skin products as these may prevent it from sticking well. (Skin products may also affect how hormones are absorbed by the skin.)

When you remove the patch, fold it in half with the sticky sides facing each other (to prevent the chemicals from getting into other items in the trash and going to the soil) and throw it away (don’t flush it down the toilet).

How Well Does the Birth Control Patch Work?

Ongoing studies suggest the birth control patch is as effective as the birth control pill. That means that about 9 out of 100 couples will have an unintended pregnancy during the first year of use. Of course, the chance of getting pregnant depends on whether you use the patch correctly. Delaying or missing a weekly application or removing a patch too early lowers its effectiveness and increases the chance a girl will become pregnant.

For girls who weigh more than 198 pounds (90 kilograms), the contraceptive patch may be less effective in preventing pregnancy.

In general, how well each type of birth control method works depends on a lot of things. These include whether a person has any health conditions or is taking any medicines that might interfere with the patch. How effective the patch is at preventing pregnancy also depends on whether the method chosen is convenient — and whether the person remembers to use it correctly all the time.

Does the Birth Control Patch Help Prevent STDs?

The birth control patch does not protect against sexually transmitted diseases (STDs). Couples having sex must always use condoms along with the birth control patch to protect against STDs.

Abstinence (the decision to not have sex or any genital intimacy) is the only method that always prevents pregnancy and STDs.

Are There Any Problems With the Birth Control Patch?

The birth control patch is a safe and effective method of birth control. Most young women who use the patch have no side effects. Smoking cigarettes while using the patch can increase a girl’s risk of certain side effects, which is why health professionals advise women who use the patch not to smoke.

The side effects that some women have while using the patch are similar to those experienced with the birth control pill. These may include:

  • irregular menstrual bleeding
  • nausea, headaches, dizziness, and breast tenderness
  • mood changes
  • blood clots (these are rare in women under 35 who do not smoke, but there may be a higher risk with the patch than with the Pill)

Other possible side effects seen in patch users include:

  • skin reactions at the site of application of the patch
  • problems with contact lens use — a change in vision or inability to wear the lenses
  • menstrual cramps

Many of these side effects are mild and tend to disappear after 2 or 3 months.

Who Is the Birth Control Patch Right for?

The birth control patch may be a good choice for sexually active young women who weigh less than 198 pounds (90 kilograms) and find it difficult to remember to take a pill every day or who have difficulty swallowing pills.

Not all women can — or should — use the birth control patch. In some cases, medical or other conditions make the use of the patch less effective or more risky. For example, it’s not recommended for women who have had blood clots, severe high blood pressure, some cancers, certain types of migraine headaches, or diabetes with certain problems. Girls who have had unexplained vaginal bleeding (bleeding that’s not during their periods) or who think they may be pregnant should talk to their doctors, discontinue using the patch, and use another form of birth control in the meantime.

Girls who are interested in learning more about the possible health benefits and risks of different types of birth control, including the patch, should talk to a doctor or other health professional.

Where Is the Birth Control Patch Available?

A doctor or a nurse practitioner must prescribe the patch. He or she will ask questions about health and family medical history, and may also do a complete physical exam, including a blood pressure measurement and a pelvic exam. If recommending the patch, the doctor or nurse practitioner will write a prescription and give you instructions on how to use it.

Those who start using the patch may be asked to return within a few months for a blood pressure measurement and to make sure that there are no problems. After that, a doctor may recommend routine exams once or twice a year or as needed.

The cost of the patch can range from free to around $85 a month. Check your health insurance plan and what programs are available (such as Planned Parenthood) to get the best price.

Reviewed by: Lonna P. Gordon, MD Date reviewed: January 2017

Ethinyl estradiol and norelgestromin contains a combination of female hormones that prevent ovulation (the release of an egg from an ovary). This medicine also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Ethinyl estradiol and norelgestromin transdermal (skin patch) is used as contraception to prevent pregnancy.

Ethinyl estradiol and norelgestromin may also be used for purposes not listed in this medication guide.

Do not use this medicine if you are pregnant or if you have recently had a baby.

You should not use hormonal birth control if you have: uncontrolled high blood pressure, heart disease, coronary artery disease, circulation problems (especially with diabetes), undiagnosed vaginal bleeding, liver disease or liver cancer, severe migraine headaches, if you also take certain hepatitis C medication, if you will have major surgery, if you smoke and are over 35, or if you have ever had a heart attack, a stroke, a blood clot, jaundice caused by pregnancy or birth control pills, or cancer of the breast, uterus/cervix, or vagina.

Using hormonal birth control can increase your risk of blood clots, stroke, or heart attack. Your risk of serious blood clot may be higher with the use of birth control skin patches than with pills.

Smoking can greatly increase your risk of blood clots, stroke, or heart attack. You should not use this medicine if you smoke and are older than 35 years of age.

Using hormonal birth control can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, or if you are overweight. Your risk of stroke or blood clot is highest during your first year of using birth control. Your risk is also high when you restart this medicine after not using for 4 weeks or longer.

Smoking can greatly increase your risk of blood clots, stroke, or heart attack. Your risk increases the older you are and the more you smoke. You should not use this medicine if you smoke and are over 35 years old.

Your risk of serious blood clot may be higher with the use of birth control skin patches than with the use of birth control pills.

Do not use if you are pregnant. Stop using the medicine and tell your doctor right away if you become pregnant, or if you miss 2 menstrual periods in a row. If you have recently had a baby, wait at least 4 weeks before using this medicine.

You should not use hormonal birth control if you have:

  • untreated or uncontrolled high blood pressure;
  • heart disease (chest pain, coronary artery disease, history of heart attack, stroke, or blood clot);
  • an increased risk of having blood clots due to a heart problem or a hereditary blood disorder;
  • circulation problems (especially if caused by diabetes);
  • a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina;
  • unusual vaginal bleeding that has not been checked by a doctor;
  • liver disease or cancer;
  • severe migraine headaches (aura, numbness, vision changes), especially if you are older than 35;
  • if you smoke and are over 35 years old; or
  • if you take any hepatitis C medication containing ombitasvir/paritaprevir/ritonavir (Technivie).

Tell your doctor if you have ever had:

  • heart problems, high blood pressure, or if you are prone to having blood clots;
  • high cholesterol or triglycerides, or if you are overweight;
  • depression;
  • a seizure or migraine headache;
  • liver or kidney disease;
  • jaundice caused by pregnancy or birth control pills;
  • irregular menstrual cycles; or
  • diabetes, gallbladder disease, underactive thyroid.

This medicine can slow breast milk production. Do not use if you are breast-feeding a baby.

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