Overview
The contraceptive patch is a small sticky patch that releases hormones into your body through your skin to prevent pregnancy. In the UK, the patch's brand name is Evra.
At a glance: facts about the patch
- When used correctly, the patch is more than 99% effective at preventing pregnancy.
- Each patch lasts for 1 week. You change the patch every week for 3 weeks, then have a week off without a patch.
- You don't need to think about it every day, and it's still effective if you're sick (vomit) or have diarrhoea.
- You can wear it in the bath, in the swimming pool and while playing sports.
- If you have heavy or painful periods the patch can help.
- The patch can raise your blood pressure, and some women get temporary side effects, such as headaches.
- Rarely, some women develop a blood clot when using the patch.
- The patch may protect against ovarian cancer, womb cancer and bowel cancer.
- It may not be suitable for women who smoke and who are 35 or over, or who weigh 90kg (14 stone) or more.
- The patch does not protect against sexually transmitted infections (STIs), so you may need to use condoms as well.
How it works
The patch releases a daily dose of hormones through the skin into the bloodstream to prevent pregnancy.
It contains the same hormones as the combined pill – oestrogen and progestogen – and works in the same way by preventing the release of an egg each month (ovulation).
It also thickens cervical mucus, which makes it more difficult for sperm to move through the cervix, and thins the womb lining so a fertilised egg is less likely to be able to implant itself.
How to use the patch
Apply your first patch and wear it for 7 days. On day 8, change the patch to a new one. Change it like this every week for 3 weeks, and then have a patch-free week.
During your patch-free week you'll get a withdrawal bleed, like a period, although this may not always happen.
After 7 patch-free days, apply a new patch and start the 4-week cycle again. Start your new cycle even if you're still bleeding.
Where to put the patch
Stick the patch directly onto your skin. You can put it onto most areas of your body, as long as the skin is clean, dry and not very hairy. You shouldn't stick the patch onto:
- sore or irritated skin
- an area where it may get rubbed off by tight clothing
- your breasts
It's a good idea to change the position of each new patch to help reduce the chance of skin irritation.
When the patch starts to work
If you start using the patch on the first day of your period, and up to and including the fifth day of your period, you'll be protected from pregnancy straight away.
If you start using it on any other day, you need to use an additional form of contraception, such as condoms, for the first 7 days.
If you have a short menstrual cycle with your period coming every 23 days or less, starting the patch on the fifth day of your period or later means you may not be protected against pregnancy and will also need additional contraception for the first 7 days.
You can talk to a GP or nurse about when the patch will start to work, and whether you need to use additional contraception in the meantime.
What to do if a patch falls off
The contraceptive patch is very sticky and should stay on. It shouldn't come off after a shower, bath, hot tub, sauna or swim.
If the patch does fall off, what you need to do depends on how long it has been off.
If it's been off for less than 48 hours:
- put a new patch on (don't try to hold the old patch in place with a plaster or bandage)
- change it on your normal change day
- you're protected against pregnancy if you've used your patch correctly for the past 7 days (and the 7 days before your patch-free week, if you're in week 1)
If it's been off for 48 hours or more, or you're not sure how long:
- put on a new patch
- change it on your normal change day, if you're in week 1 or 2 of your patch cycle
- if you're in week 3, you need to start a new patch cycle (this is now day 1 of your new cycle) and miss your usual patch-free week
- whatever week you're in, use additional contraception, such as condoms, until you've had a patch on for 7 days in a row
- you may need emergency contraception if you had sex during the patch-free break, or in week 1, and the patch fell off during week 1. Or, you had sex during week 2 or 3 when a patch had not been on properly for the previous 7 days. In these situations, ask a GP or nurse for advice
What to do if you forget to take the patch off
If you forget to take the patch off, what you should do depends on how many extra hours it has been left on.
If you remove it before going over 48 hours (it's been on for 8 or 9 days in total):
- take off the old patch and put on a new one
- change it on your normal change day
- you're protected against pregnancy if you've used the patch correctly up until the time you forgot to take it off.
If a patch has been on for 48 hours or longer (it's been on for10 days or more):
- put on a new patch as soon as possible
- change it on your normal change day
- use additional contraception, such as condoms, until you've had the patch on for 7 days in a row
- see a GP or nurse for advice if you've had unprotected sex in the previous few days as you may need emergency contraception
If you forget to take the patch off after week 3, take it off as soon as possible. Start your patch-free break and start a new patch on your usual start day, even if you're bleeding. This means you won't have a full week of patch-free days.
You'll be protected against pregnancy and won't need to use any additional contraception. You may or may not bleed on the patch-free days.
What to do if you forget to put a patch on after the patch-free week
Put on a new patch as soon as you remember. This is the beginning of your new patch cycle. You'll now have a new day of the week as your start day and change day.
If you're more than 24 hours late sticking on the patch (the interval has been 8 days or more), you may not be protected against pregnancy and will need to use additional contraception, such as condoms, for 7 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.
Bleeding in the patch-free week
Some women don't always have a bleed in their patch-free week. This is nothing to worry about if you've used the patch properly and have not taken any medicine that could affect it.
See a GP or nurse for advice if you're worried, or do a pregnancy test to check if you're pregnant.
If you miss more than 2 bleeds, get medical advice.
Who can use the patch
The contraceptive patch isn't suitable for everyone, so if you're thinking of using it, a GP or nurse will need to ask about you and your family's medical history. Tell them about any illnesses or operations you've had, or medicines you're taking.
You may not be able to use the patch if:
- you're pregnant or think you may be pregnant
- you're breastfeeding a baby less than 6 weeks old
- you smoke and are 35 or over
- you're 35 or over and stopped smoking less than a year ago
- you're very overweight
- you're taking certain medicines, such as s St John's Wort, or medicines used to treat epilepsy, tuberculosis (TB) or HIV
You may also not be able to use the patch if you have or have had:
Advantages and disadvantages of the patch
Advantages:
- it's very easy to use and doesn't interrupt sex
- unlike the combined oral contraceptive pill, you don't have to think about it every day – you only have to remember to change it once a week
- the hormones from the patch aren't absorbed by the stomach, so it still works if you're sick (vomit) or have diarrhoea
- it can make your periods more regular, lighter and less painful
- it can help with premenstrual symptoms
- it may reduce the risk of ovarian, womb and bowel cancer
Disadvantages:
- it may be visible
- it can cause skin irritation, itching and soreness
- it doesn't protect you against STIs, so you may need to use condoms as well
- some women get mild temporary side effects when they first start using the patch, such as headaches, sickness (nausea), breast tenderness and mood changes – this usually settles down after a few months
- bleeding between periods (breakthrough bleeding) and spotting (very light, irregular bleeding) is common in the first few cycles of using the patch – this is nothing to worry about if you're using it properly and you'll still be protected against pregnancy
- some medicines can make the patch less effective – see a GP, nurse or pharmacist for advice
- you need to remember to change it every week, so if it would be easier to use a method that you don't have to think about you may want to consider the implant or intrauterine device (IUD)
Risks of using the patch
There is a very small risk of some serious side effects when you use a hormonal contraceptive, such as the contraceptive patch.
For most women, the benefits of the patch outweigh the possible risks, but you should discuss all risks and benefits with a GP or nurse before starting the patch.
Blood clots
A very small number of people using the patch may develop a blood clot in a vein or an artery. Don't use the patch if you've had a blood clot before.
Your risk is higher if:
- it's your first year of using the patch
- you smoke
- you're very overweight
- you're unable to move (immobile) or use a wheelchair
- you have migraines with aura (warning signs)
- a close family member has had a heart attack, stroke or blood clot before they were 45
Cancer
Research suggests that people who use the contraceptive patch have a small increased risk of being diagnosed with breast cancer compared with those who don't. But this reduces with time after stopping the patch.
Research also suggests there's a small increase in the risk of developing cervical cancer with long-term use of oestrogen and progestogen hormonal contraception.
Where you can get it
When you first get the contraceptive patch you will be given a 3-month supply, to see how you get on with it. If there are no problems, you can be prescribed the patch for a year at a time.
You an get contraception for free, even if you're under 16, from:
- contraception clinics
- sexual health or GUM (genitourinary medicine) clinics
- some GP surgeries
- some young people's services
Find your nearest sexual health clinic
If you're under 16 years old
Contraception services are free and confidential, including for people under the age of 16.
If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer), as long as they believe you fully understand the information you're given and the decisions you're making.
Doctors and nurses work under strict guidelines when dealing with people under 16. They'll encourage you to consider telling your parents, but they won't make you.
The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.
NHS 111 Wales has a contraception symptom checker that you can use if you are concerned about your method of contraception.