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 pill.
How
effective is the patch?
How does the patch work?
Where can I get the patch?
Can anyone use the patch?
What are the advantages
of the patch?
What are the disadvantages
of the patch?
Are there any risks?
How do I use the patch?
Where do I put the patch?
Can anything make the
patch less effective?
What if the patch falls off?
What if I forget to take the
patch off at the end of week three?
What if I forget to put a new
patch on at the end of the patch-free week?
Am I protected from pregnancy
during the seven-day patch-free week?
I didn't get a period in my
patch-free week, am I pregnant?
Can a withdrawal bleed be
postponed?
How often do I need to see a
doctor or nurse?
Can the patch be decorated?
What if I decide I want to have
a baby?
I've just had a baby. Can I
use the patch?
When can I start using
the patch after a miscarriage or abortion?
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 1 woman will get pregnant
in a year.
If the patch is not used according
to instructions, more women will become pregnant.
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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. This makes it difficult
for sperm to move through it and reach an egg
•
makes the lining
of your womb thinner so it is less likely to accept
a fertilised egg.
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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.
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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.
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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.
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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.
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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
•
you are immobile
for a long period of time
•
you use a wheelchair
•
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
•
you are diabetic
•
you have high blood
pressure
•
you are very overweight
•
you have migraine
with aura
•
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).
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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 (See What
if I forget to put a new patch on at the end of
the patch-free week?). 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.
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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.
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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 medicines such as some antibiotics,
those used to treat epilepsy, HIV and TB, and
the complementary medicine St John's Wort, may
make the patch less effective. Talk to your doctor
or nurse. You may need to use a different method
of contraception.
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Can the patch be decorated?
This is not recommended. You should also avoid
covering the patch with body cream or lotions
such as sunscreen. This may cause the patch to
become loose.
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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.
Don't worry if you do get pregnant sooner, it
will not harm the baby.
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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.
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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.
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