The contraceptive patch

Originally Published: September 20, 2002 - Last Updated / Reviewed On: September 22, 2011
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Dear Alice,

I saw this commercial on TV last night about the birth control patch. Is it as good as the pill? Do you keep the same patch on for a week or do you have to remember to put one on every day just like having to remember to take the pill? I was just wondering, because I forget a lot to take my pill and just wanted to know if that was easier. Are the side effects worse than the pill?


Dear Reader,

As effective as the birth control pill, the contraceptive, Ortho Evra, is the first birth control patch to be approved by the U.S. Food and Drug Administration (FDA). The contraceptive patch is 99 percent effective in preventing pregnancy when it's used correctly. Similar to the pill, the patch prevents pregnancy by suppressing ovulation, meaning that the ovaries do not release an egg, and it also causes the cervical mucus to thicken, making it difficult for sperm to enter the uterus. Ortho Evra is available by prescription, and the cost of a four-week supply of the patch is comparable to that of a birth control pill pack. It's important to remember that neither the pill nor the patch protect against sexually transmitted infections (STIs).

You mentioned that you sometimes forget to take your birth control pill, which happens with pill users every now and then. Women who frequently find themselves in this situation may want to consider another birth control option, including the contraceptive patch. Unlike the daily regimen of the pill, a woman using the patch has to remember just three times a month to adhere it to her skin.

There are some differences between the patch and the pill. Perhaps the most notable is that the patch exposes the wearer to 60% more estrogen than the birth control pill. This extra estrogen can increase the risk of blood clots, strokes, and heart attacks. The patch is also recommended for use only for women who weigh less than 198 pounds.

The patch follows a 4-week cycle consisting of 28 days (this does not refer to dates marked on a calendar. Your start day wearing the patch is day 1 and the last day is day 28.) A new patch is placed on the skin and worn for 7 continuous days. The patch is replaced on the same day of the week for the next two consecutive weeks. For the fourth week, when a woman menstruates, no patch is used. If you are interested in Ortho Evra, talk with your health care provider about your medical history to be sure that it is right for you. You can switch from oral contraceptives to the patch when you get your period.

The contraceptive patch prevents a woman from becoming pregnant by slowly and continually supplying the bloodstream with norelgestromin (progestin) and ethinyl estradiol (estrogen). These hormones are embedded in the sticky layer of the thin beige (other colors, including clear, are currently being researched and developed) adhesive square patch (1¾ inches wide). When adhered to the skin, the patch has to remain in that spot for the 7-day duration. Activities including showering, bathing, swimming, exercising, and sweating should not loosen the patch.

The contraceptive patch is most effective when it is:

  • worn on one of the following four body parts:
    • the buttocks
    • the abdomen
    • the upper portion of the outer arm
    • the upper portion of the torso (either the front or the back, but not on the breasts)
  • placed on healthy skin that is not red, irritated, or cut.
  • placed on clean, dry skin. Using make-up, lotions, creams, powders, or other products on or around the area of the patch can loosen it from the skin, causing it to be ineffective.
  • applied on the same day of the week for three consecutive weeks.
  • applied at the end of week 4 after day 28 ends. This is the beginning of a new cycle.

Don't reapply the patch if it's no longer sticky, has been stuck to itself or another surface, if it has other material stuck to it, or if it has become loose or has fallen off once before.

Attempting to change the location of the patch after it has been placed on the skin is not advised as it may become loose. If your patch loosens from your skin for more than 24 hours, it is possible to become pregnant. Immediately begin a new 4-week cycle by affixing a new patch. Similarly, if you forget to change the patch on day one of week 1, it is possible to become pregnant. As soon as you remember, apply the first patch of that cycle. In both of these instances, this day will become your new "patch change day" and day 1. To prevent a pregnancy, use a non-hormonal back-up method of birth control — condom, diaphragm, or cervical cap — for one week.

Side effects of the contraceptive patch may include:

  • headaches
  • skin reaction where the patch is placed
  • nausea
  • upper respiratory infection
  • menstrual cramps
  • abdominal pain
  • breast symptoms

The contraceptive patch is not recommended for women with any of the following conditions:

  • already using oral contraceptives (they should not be used together)
  • having allergic reactions to any of the elements of Ortho Evra
  • are pregnant, smoke, have chest pain, unexplained vaginal bleeding, hepatitis, liver tumor, severe high blood pressure, diabetes, headaches with neurological symptoms, or need for prolonged bed rest following major surgery
  • have a history of blood clots, heart attack or disease of the heart valves, stroke, and/or certain cancers

Some medications can cause Ortho Evra to be less effective in preventing pregnancy or can cause breakthrough bleeding, including:

  • some antibiotics
  • Rifampin, a tuberculosis treatment
  • drugs for epilepsy
  • anticonvulsants
  • certain drugs used in the treatment of HIV/AIDS

Check with your health care provider if you are taking any prescription medications. In the event of an interaction, a non-hormonal back-up method of contraception needs to be used to prevent a possible pregnancy.

When women want to become pregnant, they simply stop applying the contraceptive patch. Some women's menstrual cycles regulate right away, increasing their probability of becoming pregnant, while others may take longer to regulate.

For Columbia University students, Ortho Evra is available through Medical Services; call x4-2284 for an appointment. Others can contact their own health care provider.

More detailed information about Ortho Evra is also available on the FDA website and the Ortho Evra manufacturer's web site.