How to use the contraceptive patch

There are lots of different types of contraception available for women. The pill is perhaps one of the most common types, but the contraceptive patch is also a popular option.  

In this article we’re going to look at what the patch is, how it works and the possible advantages and side effects.  

What is the contraceptive patch?

The contraceptive patch (Evra) is a type of combined contraceptive. This means it contains a mixture of oestrogen and progestogen. It’s a good option for women who feel they might forget to take the pill daily. It also has the added advantage of not being affected by sickness and diarrhoea. 

The patch is 99% effective when used correctly. If the patch isn’t always used correctly 9 out of 100 women who use the patch will get pregnant.  

How does the contraceptive patch work?

The patch, sometimes called the birth control patch, works by releasing a daily dose of hormones into your bloodstream. These hormones stop your body releasing an egg. They also thicken the mucus in your cervix, making it difficult for sperm to move through and reach an egg. And they make the lining of the uterus thinner, so it’s harder for an egg to implant.  

How to use the patch

You can start the patch at any point during the period. It’s designed is designed to be changed each week for three weeks and then you have a four or seven-day break. 

During this break you’ll likely have a withdrawal bleed. This isn’t a period, but it might feel like one. It’s just your body reacting to the break in hormones. After your break you apply a new patch and start the cycle again. 

But there are a variety of different ways you can use the contraceptive patch, particularly if you want to avoid having the withdrawal bleed: 

• You can apply a patch once a week for nine weeks in a row and then have a break for four or seven days. This is called tricycling. You’ll usually have a withdrawal bleed in your break. You then apply a new patch on the fifth or eighth day and start the cycle again.

• You can apply a new patch once a week without a break for at least three weeks. If after this time you get bleeding that’s unacceptable to you for three-four days, you can take a four-day break and then reapply the patch. Use three more patches before you take another break. This is called flexible extended use.

• You can apply a new patch once a week without a break. This is called continuous use. You won’t have a withdrawal bleed, but you might get some bleeding. This should reduce as you use the patch over a long period of time. 

Protection during your patch-free days 

You will be protected from pregnancy in your patch-free break provided: 

• You’ve used the previous 3 patches correctly 
• You start your next patch cycle on time 
• You’re not taking any other medicines that will affect the way the patch works. These medicines include St John’s Wort and those used to treat epilepsy, HIV and TB. Check with your clinician about using the patch if you’re on any of these treatments.  

Where to put the contraceptive patch

• You can put the patch anywhere on your body provided it’s not too hairy and the skin is dry and clean. It’s good to avoid putting it somewhere that will get rubbed a lot by clothes, e.g., near a bra strap or the top of your trousers/skirt.  
• Don’t put the patch on skin that is irritated or sore and don’t put it on your breasts.

When should I start using the patch? 

As long as you’re sure you’re not pregnant you can start using your patch at any point in your cycle. You’ll be protected from pregnancy: 

• Immediately – if you start on the first day of your period  
• Immediately – if you start anytime between the first and fifth day of your period (provided you don’t have a very short or irregular menstrual cycle) 
• After seven days – if you start the patch at any other time in your cycle. You’ll need to use other contraception, such as condoms, if you have sex during the first seven days. 

Contraceptive patch side effects

Like when you start any medication, there is the chance you’ll experience side effects. Side effects might include:

• Skin irritation
• Headaches
• Nausea
• Sore breasts
• Mood changes
• Breakthrough bleeding and speeding

Using the patch incorrectly

You should try to use the contraceptive patch correctly as much as possible, but of course from time to time it’s easy to slip up. So, it’s good to be prepared and know what to do if you do forget to change your patch.  

If your patch has come off in the last 48 hours or you’ve left the patch on for up to 48 hours too long, you need to: 

• Apply a new patch as soon as possible 

• Keep the new patch on only until the day you usually change it  

You shouldn’t need to use any other contraception if you have sex. 

You don’t need to use emergency contraception provided: 

• You’re in the first week after a patch-free break and used the patch correctly before your break 
• You’re in any other week of your cycle and you’ve used the patch correctly in the previous seven days 

If the patch has come off for more than 48 hours or you’ve left the patch on for more than 48 hours too long, you need to: 

• Apply a new patch as soon as possible 
• Keep the new patch on only until the day you usually change it 
• Use extra contraception when having sex until the patch has been on for seven days in a row 
• Ignore your patch-free break, if it was due to start in the next seven days 

If you’re in the first week after a patch-free break and had unprotected sex in this week or the patch-free break you might need emergency contraception. You may also want to take a pregnancy test in three weeks’ time. 

If you’re in any other week of your pill cycle you don’t need emergency contraception, provided you use the patch correctly in the previous seven days.  

If you applied the patch more than 24 hours late after a seven-day break, or 96 hours later after a four-day break (i.e. more than eight days after you took the patch off), you need to: 

• Apply a new patch as soon as you remember - this is now the first day of your new patch cycle
• This means your 'changeover' day will be different to your usual day moving forward

You might not be protected against pregnancy and will need to use additional contraception, such as condoms, for seven days.

See a GP or nurse for advice if you've had unprotected sex in the patch-free interval, as you may need emergency contraception. 

Where to get the Evra patch

You can get the contraceptive patch from your GP, local sexual health clinic and some online pharmacies and online doctors, like our service, if clinically suitable. 

References 

https://www.nhs.uk/conditions/contraception/contraceptive-patch/