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Contraceptive Patch (Evra)
The Evra contraceptive patch is a small, thin, beige coloured patch, nearly 5cm x 5cm in size. You stick it on your skin and it releases two hormones - oestrogen and progestogen. These are similar to the natural hormones that women produce in their ovaries and like those used in the combined oral contraceptive
How effective is the patch?
How effective any contraceptive is depends on how old you are, how often
you have sex and whether you follow the instructions. If 100 sexually
active women don't use any contraception, 80 to 90 will become pregnant
in a year. If used correctly and according to the instructions the patch
is over 99% effective. This means that less than I woman will get pregnant
in a year. If the patch is not used according to instructions, more women
will become pregnant
How does the patch work?
The patch releases a daily dose of hormones through the skin, into the
bloodstream. The main way it works is to stop the ovaries from releasing
an egg each month (ovulation).This is the same as the combined oral contraceptive
pill. It also: thickens the mucus from your cervix, which makes it difficult
for sperm to move through it and reach an egg, and, makes the lining of
your womb thinner so it is less likely to accept a fertilised egg
Where can I get the patch?
Family planning doctors, nurses and most GPs provide contraception. You
can go to any general practice if you prefer not to see your own doctor
Can anyone use the patch?
Not everyone can use the patch and a doctor or nurse will need to ask
you about your own and your family's medical history Do mention any illnesses
or operations you have had. Some of the conditions which may mean you
should not use the patch are: you are or think you might be pregnant,
you are breastfeeding, you smoke and are over 35, you have now or had
in the past: thrombosis (blood clots) in any vein or artery, a heart abnormality
or circulatory disease including raised blood pressure, very severe migraines
or migraines with aura, breast cancer, active disease of the liver or
gall bladder, diabetes, unexplained bleeding from your vagina (for example,
between periods or after sex). Research has shown that the effectiveness
of the patch may be reduced in women who weigh 90kg (14 stone) or over.
If you do, the patch may not be your first choice method if it's important
not to get pregnant
What are the advantages of the patch?
Some of the advantages of the patch are: you don't have to think about
it every day; you only have to remember to replace the patch once each
week, it doesn't interrupt sex, it is easy to use, unlike the pill the
hormones do not need to be absorbed by the stomach so the patch is not
affected by vomiting or diarrhoea, it usually makes your periods regular
lighter and less painful
What are the disadvantages of the patch?
It may be seen. For a small number of women it may cause skin irritation.
It does not protect you against sexually transmitted infections so you
may need to use condoms as well. You may get some temporary side-effects
when you first start using the patch, these should stop within a few months.
They include: headaches, nausea, breast tenderness, mood changes, weight
gain or loss, breakthrough bleeding (bleeding between periods) and spotting
is common in the first few cycles of patch use. If you are using the patch
correctly this is nothing to worry about. You will still be protected
against pregnancy
Are there any risks?
The contraceptive patch is a safe and effective method. Before any method
is made widely available to women, it has to go through extensive medical
trials. Research shows that the effects of the patch are similar to those
seen in women using combined oral contraceptives. There is a very low
risk of some serious side-effects with the patch. These are the same as
those associated with the combined pill. A very small number of women
may develop a blood clot which can block a vein (venous thrombosis) or
an artery (arterial thrombosis or heart attack or stroke). If you have
ever had a thrombosis, you should not use the patch. The risk of venous
thrombosis is greater if any of the following apply to you: you are very
overweight, are immobile for a long period of time or use a wheelchair
or a member of your immediate family had a venous thrombosis before they
were 45. Some women have genetic differences that affect how their blood
clots. This can increase their risk of venous thrombosis if they also
use the patch. The risk of arterial thrombosis is greater if any of the
following apply to you: you smoke, are diabetic, have high blood pressure,
are very overweight, have migraine with aura, or a member of your immediate
family had a heart attack or stroke before they were 45
Research into the risk of breast cancer cervical cancer and hormonal contraception is complex and contradictory. Current research suggests that all users of hormonal contraception appear to have a small increase in risk of being diagnosed with breast cancer compared to non-users of hormonal contraception. Further research is ongoing. All risks and benefits should be discussed with your doctor or nurse. See a doctor straightaway if you have any of the following: pain in the chest, including any sharp pain which is worse when you breathe in, breathlessness, you cough up blood, painful swelling in your leg(s), weakness, numbness, or bad "pins and needles" of an arm or leg, severe stomach pains, a bad fainting attack or you collapse, unusual headaches or migraines that are worse than usual, sudden problems with your speech or eyesight, jaundice (yellowing skin or yellowing eyes)
How do I use the patch?
A new patch is applied, once a week, every week for three weeks. The first
patch is applied on the first day of your period (day 1 of your menstrual
cycle).This is known as the start day. No additional contraception is
needed if you start on the first day of bleeding. After seven days the
patch is removed and a new one applied immediately This is known as the
change day. Change days will always be days 8 and 15 of your menstrual
cycle. The patch can be changed at any time of the day. Do not leave a
patch on for more than seven days. Used patches need to be disposed of
carefully by placing in the special disposal sachet provided and putting
them in the waste bin. Used patches must not be flushed down the toilet.
After three weeks you have a patch-free week, starting on day 22. During
this week off you get a withdrawal bleed (period). This usually starts
around the fourth patch-free day. Withdrawal bleeds are caused by you
not taking hormones in the patch-free week. A new cycle starts again after
seven patch-free days. A new patch is applied on the eighth day. It is
important not to extend the patch-free week, or you may lose contraceptive
cover. Start the new cycle whether you are still bleeding or not. It's
important only to use one patch at a time - using more may cause nausea
and vomiting
Where
do I put the patch?
The patch can be used on most areas of the body as long as the skin is
clean, dry and not hairy It is commonly worn on the upper arm, buttock
or lower abdomen. The patch should not be put on the breasts, on any skin
that is sore or irritated, or any place that can be rubbed by tight clothing.
It is recommended to change the position of each new patch to help to
lessen any possible skin irritation
Can anything make the patch less effective?
If you are given a medicine by a doctor dentist or hospital always
say you are using the patch. This is because some medicines may make the
patch less effective. Some complementary medicines which you can buy without
a prescription, such as St John's Wort may also affect how the patch works.
You may need to use an extra contraceptive method, such as condoms, while
you are taking the medicine and for two days afterwards. If you are worried
about the patch not working and you are not sure what to do, seek advice
straight away Until you do, use an extra contraceptive method, such as
a condom, when you have sex. If the patch falls off or if you forget to
put a new patch on at the end of the patch-free week, follow the advice
below as these can also make the patch less effective
What if the patch falls off?
The patch is very sticky and should stay on in the shower or bath, during
swimming, saunas or exercise. If it does slip or come off completely it
should be reapplied as soon as possible if still sticky or a new patch
needs to be used. If the patch has been off for less than 24 hours no
additional contraception is required. If it has been off longer than 24
hours, or you are unsure how long, then another method of contraception
is needed for the next seven days. If you have had unprotected sex in
the previous few days you may need to use emergency contraception
What if I forget to take the patch off at the end of week three?
Take the patch off as soon as you remember and start with a new patch
on your usual start day. This means that you have less than seven patch-free
days. You will be protected against pregnancy
What if I forget to put a new patch on at the end of the patch-free
week?
Put a new patch on as soon as you do remember. If this is more than two
days (48 hours) after your usual start day then you may not be protected
from pregnancy Use an extra method of contraception, such as condoms,
for the following seven days. If you have had unprotected sex in the previous
few days you may need to use emergency contraception
Am I protected from pregnancy during the seven day patch-free week?
Yes, you are protected during the seven day break if you have used the
previous three patches correctly and you start using the first patch of
the next cycle on time
I didn't get a period in my patch-free week, am I pregnant?
You don't always bleed in your patch-free week. If you have used all the
patches correctly and you have not taken any medicines which might affect
the patch, then it is unlikely you are pregnant. Put a new patch on at
the right time. If there is any doubt ask your doctor or nurse for advice,
or do a pregnancy test. Always do this if you miss more than one period.
If you do become pregnant, there is no evidence to show that having used
the contraceptive patch harms the baby
Can a withdrawal bleed be postponed?
Yes. If you want to postpone your withdrawal bleed then start using a
new patch on day 22. This will miss out the patch-free week and prevent
a withdrawal bleed. You will now have begun a new cycle and should continue
to use patches for the next three weeks before having a patch-free week.
It is not harmful to do this
How often do I need to see a doctor or nurse?
When you first start using the patch you will usually be given three months'
supply to see how it suits you. After that you will go back to the doctor
or nurse and supplies may be given for six months or up to a year: You
do not have to have a vaginal examination or cervical smear test when
you are first prescribed the patch
Can the patch be decorated?
This is not recommended. You should also avoid covering the patch with
body cream or lotions such as suntan lotion. This may cause the patch
to become loose
What if I decide I want to have a baby?
Stop using the patch at the end of a three week cycle, when you would
be due to have a patch-free week. Ideally you should wait for one natural
period before trying to get pregnant, so you will need to use another
method of contraception, such as condoms. Waiting means the pregnancy
can be dated more accurately and you can start pre-pregnancy care such
as taking folic acid and stopping smoking. You can ask your doctor or
nurse for advice. Don't worry if you do get pregnant sooner it will not
harm the baby
I've just had a baby. Can I use the patch?
You can start using the patch four weeks (28 days) after childbirth, but
will need to use an extra method of contraception, such as condoms, for
the first seven days. Do not use the patch if you are breastfeeding as
it can reduce your flow of milk
When can I start using the patch after a miscarriage or abortion?
You can start using the patch immediately after a miscarriage or abortion
that occurs in the first 20 weeks of pregnancy. No additional contraception
is needed. If the abortion or miscarriage occurs after 20 weeks, you can
start using the patch after three weeks (day 21) or on the first day of
your period, whichever is sooner You do not need to use additional contraception
if you start this way
Sexually transmitted infections
Most methods of contraception do not protect you from sexually transmitted
infections. Male and female condoms, when used correctly and consistently
can help protect against sexually transmitted infections. Diaphragms and
caps may also protect against some sexually transmitted infections. If
you can, avoid using condoms containing Nonoxynol 9 (spermicidally lubricated),
as this does not protect against HIV and may even increase the risk of
infection
Source: Family Planning Association
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